resonance imaging (MRI) study if the patient’s condition allows The following situations should be considered emergent: (i) a patient who has signs or symptoms of elevated ICP, (ii) a patient who has a persistent focal neurologic deficit (Todd paresis vs stroke), and in selected patients with a focal seizure or, (iii) a patient who has seizures in the setting of head trauma, (iv) a patient who has persistent seizure activity or status epilepticus, or (v) a patient who appears toxic Until C-spine injury is ruled out, it is important to maintain C-spine immobilization when head trauma is a concern Patients with transient generalized seizures in whom a cause of the seizure activity is identified probably not require any further head imaging studies Patients with transient generalized seizures in whom no cause is identified and who appear clinically well can have their head imaging performed on a nonemergent basis in coordination with a pediatric neurologist In the past, because of easier availability and lack of a need for sedation for most patients, CT scans were most often the study of choice in the ED for a patient who presented with a seizure However, given the heightened awareness of the risks of ionizing radiation associated with CT scans, patients who not require emergent imaging may have an MRI study instead An MRI study also has several other advantages; MRI is better at identifying underlying white matter abnormalities, disorders of brain architecture, lesions of the neurocutaneous syndromes, lesions in the posterior fossa and the brainstem, and small lesions EEG is an important diagnostic tool in the evaluation of seizure types, response to treatment, and prognosis A limited EEG screen in the acute setting can rule out subclinical or nonconvulsive SE and help with differentiating seizures from some cases of psychogenic nonepileptic seizures or PNES (formerly known as pseudoseizures) When there is uncertainty regarding ongoing seizure activity, an urgent electroencephalogram (EEG) should be obtained In the emergency department, this can be a limited study, with application of only a few electrodes to determine if the background is consistent with a normal awake individual (i.e., psychogenic nonepileptic seizure) or the diffusely slow and depressed background of SE Over recent years, various products and protocols have emerged for quick lead placement (e.g., helmets, etc.) among actively seizing patients EMERGENCY TREATMENT OF AN ACTIVE SEIZURE