spine can be thoroughly examined Examination of the chest, lungs, and abdomen is performed in the usual fashion The extremities are examined for the evidence of trauma, especially as the result of falling during a seizure The neurologic examination may be limited by either ongoing seizure activity or a postictal state and may consist solely of the pupillary examination, an assessment of any asymmetric movements (focality), and best response to stimuli Any abnormal posturing (decerebrate or decorticate) should be noted and dealt with immediately, with emergent imaging and possibly neurosurgical intervention During the postictal state, presence of a Todd paresis should be recorded If there is a question of a possible ingestion, the examination is also directed at uncovering a potential toxicologic syndrome (toxidrome) that may suggest a specific class of drugs or toxins that are responsible for the seizure (see Chapter 102 Toxicologic Emergencies ) Important variables include temperature, heart rate, blood pressure, pupil size, sweating, flushing, and cyanosis As the patient recovers from the seizure episode, periodic reassessment is needed to assess for any underlying neurologic abnormalities DIAGNOSTIC APPROACH Once it has been determined that a seizure may have taken place, the initial diagnostic evaluation (Fig 72.1 ) starts with the history and physical examination Laboratory, radiologic, and other neurodiagnostic testing (e.g., EEG) are other tools that can be a part of the seizure evaluation Patients with obvious trauma who are seizing should be treated per advanced trauma life support (ATLS) guidelines (see Chapter A General Approach to the Ill or Injured Child ), with close attention to possible intracranial injury (see Chapter 113 Neurotrauma ) Often, patients with a known seizure disorder will present to the ED actively seizing Patients known or suspected to be taking anticonvulsants should have drug levels evaluated A subtherapeutic anticonvulsant level is among the most common reasons for patients to present with seizures At times, a concurrent mild infectious process (URI, diarrhea) may have an effect on both seizure threshold and/or anticonvulsant absorption/metabolism Many different laboratory tests may reveal a cause for a seizure and, as a result, suggest a potential treatment A rapid glucose reagent strip test should be performed with the initial blood sample Hypoglycemia is a common problem that can often precipitate seizure activity If hypoglycemia is documented or a rapid assessment is not available, treatment with 0.25 to g/kg of dextrose is