A 16-year-old named Adam convinces his father Doug to let him drive their ATV. Adam's eye twitches and he physically cannot control the brakes. Doug is thrown from the bike. He watches in horror as Adam crashes the bike and his body is engulfed in flames.
House reads a friend's article in an Indian medical journal. Foreman reports that Adam's heart is suffering from tachycardia and his potassium is low, even though the burn unit is pumping him full of liquids. This could be caused by amphetamines or bacteria or even cardiomyopathy. Yet the skin burned off Adam's chest means they can't get an EKG. The team needs to figure out why his heart has shut down so that the burn unit can treat his skin. House thinks they can use a Belgian device from the turn of the century called a Galvanometer. First, they have to find one.
Cuddy is startled to find out that her office scheduled a lecture by a neurologist named Dr. Weber. Unfortunately, Cuddy's assistant quit because she "couldn't deal." Cuddy sees that she didn't sign the memo, and House admits to forging it. Yet House is more interested in the coma patient who's showing signs of a migraine headache. House had given the man migraine prevention medicine and then nitroglycerine, which induced the headache. Cuddy is appalled at House's lack of ethics.
Cameron explains to Doug and his wife Emily that they don't know if Adam's heart problems are connected to the burns. They tell her that Adam doesn't use drugs. Foreman and Chase hook Adam up to the Galvanometer. The boy's hands and feet are immersed in pots of water. The heart waves at first seem normal, and then suddenly, Adam convulses as if he was being electrocuted. They turn off the machine, but he continues to spasm.
The team runs through why Adam may have suffered a seizure. It could be caused by adrenoleukodystrophy, a virus of the brain, or multiple sclerosis. Yet his burns prevent them from performing an MRI, CT scan or lumbar puncture to find out. There's no other way to look at a brain. House suggests a sonogram, because he performed one on the coma patient earlier. He didn't use an MRA because he was doing "something illegal." They may not get a definitive diagnosis with a sonogram, but M.S. patients' more reactive neurons may turn up something.
Cuddy awkwardly introduces Dr. Weber to the lecture hall. He is from a center in India and he is there to talk about headaches. House sits in the back, wearing a baseball cap and sunglasses. Wilson notes House's presence and realizes that House went to medical school with Weber. Weber won an internship that House didn't get. He also is the one who got House thrown out for cheating. "He's a bad scientist," House says. House has been stalking Weber for twenty years and plans to humiliate him.
Chase props Adam's eyes open and shows him flash cards. Foreman monitors on a sonogram whether Adam has any brain activity. Foreman interrupts House's lecture to tell him about the bleeding they found in Adam's brain. Yet House refuses to leave Weber's lecture. He tells Foreman to fix the bleed.
House challenges Weber's breakthrough theory on a drug that actually prevents a migraine. He says aloud that Weber published this in an obscure journal in India so that he could get a pharmaceutical company to fund his studies. Weber suddenly recognizes House. He thinks this is just an old school rivalry. House says that he tested Weber's medicine on a coma patient. It doesn't work.
Chase inserts a platinum wire coil into Adam's femoral artery as Foreman follows him with the sonogram. Afterwards, they place Adam in a hyperbaric chamber as they discuss what could be disrupting brain function. They think they can rule out M.S. Suddenly, Adam wakes up in the chamber. His breathing is rapid, but Foreman sees that what Adam is experiencing is an orgasm. They call for an anesthesiologist.
In his darkened office, House shoots himself up with Weber's migraine medicine. He then injects himself with nitroglycerin, which has a side effect of migraine headaches. Cameron rushes in to tell him about Adam's orgasm, but House begins to suffer from intense migraine pain.
Foreman treats House for the headache and tells him not to move around. House doesn't listen and goes into his outer office to hear the team's theories on Adam. He lies on the floor as they come up with an idea that sensory information is getting misinterpreted by the medial forebrain. Good feels bad and bad feels good. They list a slew of infections that could affect the forebrain, but Cameron wonders if it's merely a regular infection festering in the burned skin. Unfortunately, they don't have time to wait for the burns to heal to find out if this is the cause.
Even in his altered state, House comes up with an alternate idea. Several thousand maggots are placed on Adam's chest to eat the dead flesh and clean the wounds. This will also kill the bacteria that thrive in injured tissue.
House tells Wilson that he must prove that he still has a migraine even after taking Weber's medicine. Wilson accuses House of using pain as a distraction because he pushed away Stacy, the love of his life.
Later, the team finds House asleep in his office. Foreman is concerned because he should have recovered from his migraine by now. They report that the maggots have treated the burns but that Adam's brain waves are still all over the map. The infection wasn't causing the brain dysfunction. House says they should perform a cervical tap lumbar puncture even though it could paralyze the boy.
Foreman gets the parents to sign a consent form to perform the cervical tap. He then inserts a 25 gauge needle between the C2 and C3 areas on Adam's neck. The needle isn't penetrating, and Foreman begins to force it. Chase panics when Adam's blood pressure spikes. He warns Foreman to stop, but Foreman is successful and collects CSF.
Foreman reports to House that Adam doesn't have M.S. or an infection. House goes to the burn unit and forces the anesthesiologist to wake Adam up. He does, and Adam cries out from the immense amount of pain. House asks him if he experienced any tingling or numbness before the accident. Adam manages to say that he urinated in his pants before he blacked out. House quickly injects Adam's IV to make him pass out.
House calls for the team to assemble. He takes a shower in the doctor's lounge. He's wasted and starts to hallucinate. Cameron finds him and is furious that he took drugs while Adam is fighting for his life.
She tells Foreman and Chase about House. Suddenly, House enters, feeling fine. He has come to the conclusion that Adam is depressed. The urination and blacking out mean that Adam had seized even before they had tested his heart. A tox screen didn't catch anti-depressants because there are so many drugs in his system from the burn treatment. His brain might be suffering from Serotonin Storm, but if it's something else, then the treatment might kill him. House wants to wake Adam up again, but the anesthesiologist ratted him out to the parents.
House confronts the parents in the waiting area and asks if their son is depressed. He tells them that Adam suffered a seizure, which caused him to crash the bike. House wants to know if he is taking anti-depressants. The parents say no. Their son tells them everything.
The team has ruled out just about everything that could cause the seizure disorder. House goes back to the burn unit, ready to wake him up. Doug retrieves Foreman, who tries to stop House. House sees a perfect circular burn on Adam's wrist even though the boy's forearms are not burned. There is also a nicotine stain on his fingers.
House goes out and asks the parents if their son smokes. Doug quickly says that he would kill Adam if he did. House lets them know that Adam does smoke and was trying to quit. The cheap no-smoke meds are also anti-depressants. Adam can be treated and will recover.
Cuddy accuses House of dropping acid. He informs her that LSD acts on serotonin receptors in the brain to stop a migraine and anti-depressants short-circuit the LSD. Yet House doesn't cop to doing any of this. Weber storms in and thanks House for ruining his clinical trials by sending the pharmaceutical company an email about his facts. "We're even," House says.
Later than night, House is paid an expected visit by a young woman. She introduces herself. "I'm looking for a distraction," he says, letting her in.