A 6-year-old girl presents to the pediatric refugee clinic for her initial refugee health assessment shortly after arrival from Syria.

Her past history is notable for a seizure disorder of unknown etiology and global developmental disability.

After an uncomplicated prenatal and postnatal course, the patient’s seizures and developmental delays reportedly first manifested at 7 months of age. At that time, the family attributed the seizure to a fall from a stroller. After this event, she had a total of 4 more lifetime seizures, which were characterized by eye rolling, clonic posturing, and left arm jerking.

Her only medications are clobazam and valproic acid. Her family history is negative for known seizures or genetic disorders, although her parents are consanguineous (first cousins). Her review of systems is otherwise negative, and her family denies previous infectious diseases nor exposure to individuals with tuberculosis.

At presentation to our clinic, her estimated developmental age...

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