Seizure: First, Non-Febrile

Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by methodical review of available evidence and consensus among committee members.

Clinical Pathway:

• Seizure: First Non-Febrile Algorithm
• Seizure: First Non-Febrile Synopsis (provides care standards employed for this clinical pathway)

Additional tools associated with the Seizure: First Non-Febrile Clinical Pathway:

• First Non-Febrile Seizure Discharge Instructions 
• First Non-Febrile Seizure Discharge Instructions - Spanish
• First, Non-Febrile Seizure Provider Education Video 
  • Conversations about new seizures can be challenging
  • This 5-minute video demonstrates effective communication with families

Exclusion criteria:

•  < 90 days old
• Unimmunized or under-immunized infant < 6 months of age
• Concurrent fever, refer to the Febrile Seizure Clinical Pathway
• Presenting in status epilepticus (seizure lasting longer than 5 minutes), refer to the Status Epilepticus Initial Management Clinical Pathway
• Concerns for epileptic (formerly infantile) spasms (consult Neurology as soon as possible)
• Significant CNS event or surgical intervention within the past two weeks; refer to the Shunts (Neurosurgical): Infection and Malfunction Clinical Pathway

Committee members involved in the development:

•  Julie (Gianakon) Kostreva, MD | Pediatric Neurology Fellow | Committee Co-Chair
•  Jean-Baptiste (J.B.) Le Pichon, MD, PhD, FAAP | Neurology | Committee Co-Chair 
• Ara Hall, MD | Neurology | Committee Co-Chair 
•  James Hubbard, MD | Urgent Care | Committee Member 
•  Jonathan Ermer, MD | Pediatric Hospital Medicine Fellow | Committee Member 
• Christine Scoby, DO | Hospital Medicine | Committee Member 
• Amy D’Angelo, MD, FAAP | Emergency Medicine | Committee Member 
• Audrey Kennedy, PharmD, BCPS, CPPS | Clinical Pharmacy Specialist, Neurology | Committee Member 
• Jill Vickers, MSN, RN-BC, CPN | Clinical Practice and Quality | Committee Member 
• Susana Chavez-Bueno, MD | Infectious Diseases | Contributor 

Patient/Family Committee Member:  

• Allen Hall | Committee Member 

EBP Committee Members:  

• Kathleen Berg, MD, FAAP | Hospitalist, Evidence Based Practice
• Kelli Ott, OTD, OTR/L | Evidence Based Practice 

Publication dates:

• Finalized date: 02/2024
• Next expected revision date: 02/2027

Concerns with content:

If you have any questions regarding this content or identify a broken link, please email evidencebasedpractice@cmh.edu. 

These pathways 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 a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.