An 11 years old boy who was born to a G3P2 32 years old mother following an uneventful pregnancy. He had his first seizure at 4 months of age, and they were progressing in term of severity and frequency and reaching a peak at the age of three years. He was developing normally until three years of age when he started to lose his milestones. His parents are first-degree cousins, and there is a history of seizures on the paternal side. His growth parameters at 11 years of age were weight 45.5 kg (75th-90th percentile), height 144.7 cm (50th-75th percentile) and head circumference 52.7 cm (25th-50th percentile). His physical examination was significant for hyporeflexia, and he did not have dysmorphic features. His brain MRI was normal and EEG showed dysrhythmia with evidence of encephalopathy. 