1. A 20-month-old boy is brought to your office with concerns about recurrent abnormal eye movements. On review of his history, it appears he is having episodes of sustained conjugate upward deviation of the eyes, associated with flexion of the neck, lasting from 15 minutes to an hour. During these episodes, he appears aware, follows commands, and his parents believe this began after a recent ear infection. During the episodes, he seems wobbly, and they can occur multiple times a day, usually resolving after sleeping. Based on this information, what is the most likely diagnosis?
You are suspicious that the episodes are paroxysmal tonic up gaze (PTU). What options below seem reasonable for the evaluation and management of a child with PTU, as well as considerations for long-term prognosis?
