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.
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.