Review Question - QID 215027

A 5-month-old boy presents with his mother to the pediatrician’s office because the mother is concerned about some abnormal movements that her son has been making for the past month. She states that he will often jerk his arms out to the sides of his body, especially when he is crying or just waking up. The episodes typically last a few seconds. This is the mother’s first child, so she is not sure if these behaviors are normal but is concerned that they are increasing in frequency, initially occurring only a few times a day but increasing to 50 times per day over the past month. Otherwise, he does not seem to move around very much and does not jerk other parts of his body. He is feeding well and is a very happy baby. He was born at 38 weeks via a non-complicated vaginal delivery. On exam, his temperature is 98.5°F (36.9°C), blood pressure is 93/61 mmHg, pulse is 110/min, and respirations are 32/min. He is able to track an object with his eyes. He is unable to sit up. The pediatrician decides to order an electroencephalogram (EEG), which shows high-amplitude irregular spikes and waves in a background of chaotic, disorganized activity. The serum pyridoxal phosphate level is 15µg/L (normal: 5-50 µg/L). Which of the following is the most appropriate treatment for this patient?