A 10-year-old boy present...

A 10-year-old boy presented to the Pediatrics OPD with a three-year history of weakness in all four limbs. The history of present illness revealed bilateral symmetrical weakness in both lower limbs for the past four years, characterized by an inability to stand up from a sitting position. The onset was gradual, and the weakness had worsened over time. Additionally, both upper limbs had symmetrical involvement and progressive weakness over the last three years. In the past year, the patient experienced an inability to move his torso from side to side while lying down. He reports no history of trauma or fever. Bowel and bladder function were reported as normal. In the past history, the patient had a pattern of frequent falls while walking since the age of three, with an increasing frequency over time. The child exhibited a slow walking pattern with widely separated feet. On examination, the patient displayed a "pithed frog" appearance with selective hypertrophy and atrophy of the brachioradialis, gastrocnemius, and triceps/biceps, respectively. The power of the hip girdle was 1/5, the flexor hallucis longus (FHL) was 4/5, the power of the shoulder girdle was 1/5, and the lumbricals was 4/5.