March 29, 2011 by dailybolusoflr
First time non-febrile seizure
· A healthy child older than 12 months can be safely discharged without emergent imaging when there is no concern for an underlying structural, traumatic, or infectious etiology that may require intervention.
· Patients who are at higher risk for a focal finding include those:
o With recurrent or persistent seizures
o Who are from areas endemic for cysticercosis (ie, Mexico)
o Who are immunocompromised
o Have hypercoaguable states such as sickle cell disease
o Have sustained trauma
o Have VP shunts or other conditions which put them at higher risk for having elevated intracerebral pressure (ICP)
· Neuroimaging is preferred in children under 12 months in the setting of first time seizure.
· In the ED, CT or MRI can be obtained to evaluate for any of these findings.
· As an outpatient, non-emergent MRI is the indicated test.
Other tests which may be indicated, as determined based on history and physical examination, include:
· serum glucose
· serum electrolytes
· urine toxicology
· lumbar puncture (rarely indicated)
In general, children with isolated first time seizures without any identifiable etiology are not started on anti-epileptic agents. Expeditious follow up with a specialist for outpatient MRI and EEG is indicated.
Linda Regan, MD FACEP
Associate Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions