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History and Physical

In the evaluation of a child who presents after a first-time seizure the primary goal is to determine whether the event was provoked, as this has implications for estimating recurrence risk. The following elements should be elicited from the history:

  • Is there any history suggestive of a possible electrolyte disturbance?

    Examples: vomiting, diarrhea, missed feeds or altered concentrations of feeds, known underlying condition with associated electrolyte abnormalities (Type I diabetes, congenital adrenal hyperplasia (CAH), kidney disease, etc.)

  • Is there any history suggestive of ingestion?

    Examples: medication overdose, accidental ingestion, new or changed prescriptions, periods of time when a child might have been unattended and around accessible medications

  • Is there any history to suggest head trauma?

    Examples: fall, non-accidental trauma (NAT), etc.

  • Is there any underlying history of epilepsy, provoked seizures, or febrile seizures?

The following physical exam findings may also be suggestive of an underlying source of provocation for seizure:

  • Stigmata of a neurodevelopmental disorder: dysmorphic features, neurocutaneous markers

  • Obvious signs of trauma (bruising, fractures, bleeding, etc.)

Note: This guideline is not intended for children who have ongoing seizure activity at the time of presentation or who fail to return to their neurological baseline.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.