A 14-year-old previously healthy African American boy presents to the emergency department after 2 episodes of generalized tonic-clonic activity lasting 30 seconds to 1 minute each, followed by a period of drowsiness. Both episodes occurred on the day of presentation. Before presentation he experienced headaches, fatigue, cough, and nasal congestion with intermittent low-grade fevers during the past 3 weeks. He was started on amoxicillin for sinusitis 5 days before presentation, with symptomatic improvement. He has not had mental status changes, vomiting, rash, or trauma. However, he uses marijuana daily. He denies other illicit drug use. His current medications include amoxicillin, pseudoephedrine, and acetaminophen. He has no personal or family history of seizures.

On presentation, he is afebrile, with blood pressure of 110/62 mm Hg, a pulse of 62 beats/min, weight of 50.6 kg (112 lb) (40th percentile), and height of 174 cm (68.5 in) (75th percentile). He is sleepy and...

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