A female neonate born at 38 weeks’ gestation presents to the emergency department on the eighth day after birth with a 2-day history of seizures. Two days ago, she began to have episodes of rightward eye deviation and shaking and stiffness of the right arm and leg. According to her parents, the episodes always occur while the neonate is awake, and she cries just prior to them. The spells typically last less than 15 seconds and are followed by heavy sleeping. Other than these spells, the neonate is acting normally and feeding appropriately, has remained afebrile, and her parents note no other complaints.

The infant was born via a normal, spontaneous vaginal delivery to a 27-year-old multiparous woman. The pregnancy was complicated by diabetes mellitus, requiring glyburide therapy. Maternal screening test results included O-negative blood type; rubella-immune; and negative screening for syphilis, hepatitis B surface antigen, and group B streptococcal...

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