A 4-year-old girl from rural North Carolina presents to an outpatient clinic after 2 successive emergency department (ED) evaluations for sudden-onset difficulty walking. Symptoms began the morning of her initial ED presentation when her parents noticed stumbling and gait incoordination. Her symptoms progressed rapidly to overt lower extremity weakness, culminating in an inability to stand. She was walking normally the night previously. The patient has a history of epilepsy. Her first seizure occurred at 2 years old. She had been treated in the past with carbamazepine. She has been without seizure for 1 year and weaned from antiepileptic medications 6 months ago after normal findings on video electroencephalography and brain magnetic resonance imaging. There is no recent illness reported. With her current presentation, there is no report of fever, headache, neck pain, vision complaint or tearing, mentation change, sensory alteration, dysphagia, drooling, cough, wheezing, rhinorrhea, dyspnea, diarrhea, emesis, or rash....

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