Neonatology: pyridoxine-dependent seizures: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Neonatology: pyridoxine-dependent seizures

Sample item

A neonate has recurrent seizures that fail to respond to phenobarbitone, midazolam and phenytoin, with normal glucose, calcium, and cranial imaging. What is the next best step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Trial of IV pyridoxine with EEG monitoring

Refractory neonatal seizures with a normal work-up should prompt a trial of pyridoxine since pyridoxine-dependent epilepsy responds dramatically to it. The trial is given under EEG and cardiorespiratory monitoring.

Option by option

  • A. Start corticosteroids

    Steroids are not first line for this scenario.

  • B. Discharge with observation

    Discharge is unsafe with ongoing seizures.

  • C. Add more phenytoin

    More phenytoin is unlikely to work if multiple drugs have failed.

  • D. Trial of IV pyridoxine with EEG monitoring (correct)

    Correct. A pyridoxine trial is indicated in refractory neonatal seizures.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is D, Trial of IV pyridoxine with EEG monitoring. Refractory neonatal seizures with a normal work-up should prompt a trial of pyridoxine since pyridoxine-dependent epilepsy responds dramatically to it.

Why is "Start corticosteroids" not the answer?

Steroids are not first line for this scenario.

Why is "Discharge with observation" not the answer?

Discharge is unsafe with ongoing seizures.

Why is "Add more phenytoin" not the answer?

More phenytoin is unlikely to work if multiple drugs have failed.

What concept does this question test?

It tests Neonatology: pyridoxine-dependent seizures in Pediatrics. The trial is given under EEG and cardiorespiratory monitoring.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neonatology: pyridoxine-dependent seizures?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.