Other questions that should be asked include if there was any other significant medical history (including abnormal developmental history), any significant surgical history (including the placement of a ventricular shunt), family history of seizures, other medication use, and travel history to an endemic region (neurocysticercosis is one of the leading worldwide causes of seizures) Planning for an Active Seizure The pediatric emergency physician should address the possibility of further seizure during the ED stay, especially in patients with a known seizure disorder admitted to the ED for a breakthrough seizure The history should focus on home medications that need to be administered and/or a possible medication load during the current visit An active seizure plan should be addressed Medication allergies or past adverse events, status epilepticus episodes in the past, or past medication failures, can guide the clinician toward a better tailored plan in some epilepsy patients Some patients may already have an active seizure/status epilepticus plan laid out by their primary neurologist Physical Examination With the history, a directed physical examination is performed to look for a possible cause of the seizure The examination should not be deferred until a postictal phase has resolved While limited in neurologic scope, a timely physical exam may identify a short-lived Todd paresis and other time-sensitive findings such as those related to trauma and/or ingestion Vital signs, including temperature, should be obtained An elevated temperature points to a potential infectious cause The entire body needs to be examined for the evidence of trauma, either as a preceding cause or as a result of falling during the seizure episode The skin should be examined for rashes or congenital skin lesions Dysmorphic features may be associated with other congenital CNS anomalies Stigmata of underlying hepatic, renal, or endocrinologic disorders should also be noted The head should be carefully examined for swelling, deformity, or other signs of trauma The presence of a ventricular shunt should be noted The pupils are studied for shape, size, reactivity, and equality The fundi are examined for the presence of retinal hemorrhages or papilledema The tympanic membranes are examined for the presence of hemotympanum or for a source of potential infection The mouth should be examined for the evidence of tongue biting The neck is assessed for meningeal irritation If there is a history or other physical signs of trauma, neck immobilization should be maintained until the C-