Abducens or sixth cranial nerve innervates lateral rectus muscle and pathology of this nerve results in abduction deficiency of ipsilateral eye. A 6-year-old girl presented with squinting and diplopia. Two weeks ago she suffered from mild cough and cold, likely viral fever. Cerebrospinal fluid analysis and magnetic resonance imaging of brain excluded any underlying disorder of central nervous system. Squint and diplopia subsided on its own within 3 weeks. Apart from serious etiologies benign isolated sixth nerve palsy can occur in children following viral prodrome and usually subsides within weeks without any treatment.

Electroencephalogram has long been an integral part of evaluation of a child with first episode of afebrile seizure. Several studies have backed up its routine use in pediatric neurology till date and management guidelines also have adopted it. But as evidences are accumulating, it has been shown that some researchers are opining against its routine use due to reasons like need for sedation in uncooperative smaller children, inter-observer variability, abnormal tracings found in normal children, normal tracings observed in epileptic children etc. In this article authors have tried to discuss evidences showing different aspects of the debates in support and against the use of electroencephalogram in first afebrile seizure episode in children.

Sodium valproate is an effective antiepileptic drug used as monotherapy or adjuvant/alternative with other antiepileptic drugs. Haematological toxicity of this drug, though rare, is now an established fact and comprises mainly of neutropenia, thrombocytopenia and aplastic anemia. Very few cases of Pure Red Cell Aplasia (PRCA) following valproate therapy were reported in last 35 years but none presented as acute emergency. We report a case of a 7-year-old child suffering from absence seizure who developed features of acute heart failure due to anemia after 2 months of sodium valproate monotherapy. No underlying haematological or cardiological cause was found. Bone marrow study showed evidence of PRCA. After discontinuation of the drug patient improved gradually and never relapsed again. This case highlights the importance of haematological evaluation both clinically and by laboratory investigation during follow up visits after starting sodium valproate therapy.

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