See Febrile<unk> If patient returns to baseline no labs/imaging necessarily indicated
Head to toe exam - abusive head trauma may precipitate<unk> and requires emergent imaging
Glucose
Consider chemistry, Mg
Consider EKG if concerned for cardiac arrhythmia
LP only necessary if concern for meningitis (peds)
Neuroimaging
Preferred test is outpatient MRI
Consider emergent imaging (CT head) for focal deficit, no return to baseline
40% have 2nd<unk> Head to toe exam - abusive head trauma may precipitate<unk> and requires emergent imaging
Glucose
Consider chemistry, Mg
Consider EKG if concerned for cardiac arrhythmia
Preferred test is outpatient MRI
Consider emergent imaging (CT head) for focal deficit, no return to baseline
Often subtle, focal, poor prognosis
Less often have generalized tonic-clonic<unk> 
Findings include lip smacking, eye deviation, staring, ALTE
Work-up
CBC, chemistry, UA, LP for CSF (including HSV), utox (withdrawal)
Consider neuroimaging if concern for abuse, intracranial hemorrhage, mass
Consider lactate, ammonia if concern for inborn errors of metabolism
Treatment
Start IV antimicrobials (including acyclovir)
Consider pyridoxine and folic acid if unresponsive to benzos
Pyridoxal phosphate 10mg/kg/dose q2h x 2 doses
If persistent, folinic acid 5mg q6h x 2 doses
EEG monitoring during this period is helpful
Less often have generalized tonic-clonic<unk> 
Findings include lip smacking, eye deviation, staring, ALTE
Findings include lip smacking, eye deviation, staring, ALTE
CBC, chemistry, UA, LP for CSF (including HSV), utox (withdrawal)
Consider neuroimaging if concern for abuse, intracranial hemorrhage, mass
Consider lactate, ammonia if concern for inborn errors of metabolism
Start IV antimicrobials (including acyclovir)
Consider pyridoxine and folic acid if unresponsive to benzos
Pyridoxal phosphate 10mg/kg/dose q2h x 2 doses
If persistent, folinic acid 5mg q6h x 2 doses
EEG monitoring during this period is helpful
Pyridoxal phosphate 10mg/kg/dose q2h x 2 doses
If persistent, folinic acid 5mg q6h x 2 doses
EEG monitoring during this period is helpful
Epilepsy = 2 or more<unk>  with out acute provocation (fever, trauma)
Often due to patient "outgrowing" their dosage
Check levels:
See anticonvulsant levels and reloading
Phenytoin, carbamazepine, valproic acid
If low consider medication non-adherence, "outgrowing" dose, vomiting, med interaction
Patients with epilepsy may have lower<unk> threshold with febrile illness
Usually can limit ED work up to fever evaluation
See anticonvulsant levels and reloading
Phenytoin, carbamazepine, valproic acid
If low consider medication non-adherence, "outgrowing" dose, vomiting, med interaction
If low consider medication non-adherence, "outgrowing" dose, vomiting, med interaction
Usually can limit ED work up to fever evaluation
Consider underlying epilepsy, shunt malfunction, CNS infection
If patient has fever,<unk> more likely secondary to infection than malfunction
Consult pediatric neurosurgeon to tap the shunt
Imaging
Obtain shunt series and head CT or MRI to evaluate for increased ventricular size
If patient has fever,<unk> more likely secondary to infection than malfunction
Consult pediatric neurosurgeon to tap the shunt
Consult pediatric neurosurgeon to tap the shunt
Obtain shunt series and head CT or MRI to evaluate for increased ventricular size
"Impact<unk> " <unk>  that occurs within minutes of head trauma)
Not associated with severe head injuries<unk>  that occur after this time more likely to represent intracranial injury
Abusive head trauma should always be considered in differential
Not associated with severe head injuries<unk> or recurrent<unk> lasting >5min with out regaining consciousness
If prolonged postictal state or longer than usual consider nonconvulsive status
Obtain emergency EEG; if not available, trial of anticonvulsants appropriate
Management
Glucose, chemistry, CBC, LFTs, ?CSF, ?neuroimaging
Intubate if evidence of apnea and persistent hypoxia
If paralytic used, EEG monitoring should be arranged
If prolonged postictal state or longer than usual consider nonconvulsive status
Obtain emergency EEG; if not available, trial of anticonvulsants appropriate
Obtain emergency EEG; if not available, trial of anticonvulsants appropriate
Glucose, chemistry, CBC, LFTs, ?CSF, ?neuroimaging
Intubate if evidence of apnea and persistent hypoxia
If paralytic used, EEG monitoring should be arranged
Seizure 
Epileptic seizure
Febrile seizure
First-time seizure
Status epilepticus
Seizure with known seizure disorder
Syncope
Syncope 