First Seizures, Fewer Tests: Rethinking Pediatric Investigations

This is one of several articles being discussed by Dr. Moore & Dr. Dhillon LIVE during the College of Family Physicians of Canada (CFPC) Clinical Live Stream Webinar! Read more at cfpc.ca... For children over 6 months with a simple febrile seizure or a first unprovoked generalized seizure, urgent blood work or neuroimaging is typically unnecessary. These seizures are often benign—febrile seizures are usually viral, and many unprovoked seizures are idiopathic and nonrecurrent. Routine emergency investigations rarely change management and may cause harm.

Exceptions include:

• Infants under 6 months

• Complex febrile seizures

• Status epilepticus

• Focal deficits, trauma, or signs of serious infection

  
  

Management should focus on:

• Careful history and physical exam

• Reassurance and education for families

• Seizure first aid and red-flag symptoms

• Clear follow-up plans

  
  

Most cases can be managed with outpatient EEG and, if indicated, nonurgent MRI—reducing unnecessary testing in emergency settings.

References

https://www.cfp.ca/content/71/9/563