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Abstract : Two-year-old monozygotic-twin girls, born to non-consanguineously married couple, presented with development delay and generalised tonic seizures noticed since 6 months of age. The seizures worsened during fever and had partial response to anti-seizure medications. They also developed arrhythmic erratic multifocal myoclonic jerks involving all the four limbs, head and trunk since past 2 months. The best attained milestones were sitting with support, babbling, unidextrous grasp with no stranger anxiety. Examination revealed truncal hypotonia along with distinct facial appearance, microcephaly, happy demeanour, protruding tongue and tremulousness (Fig. 1a,b). Electroencephalography (EEG) revealed high-voltage, arrhythmic, asynchronous delta background resembling hypsarrhythmia-like pattern (Fig. 1c). Neuroimaging was normal. (Answer on page 963)