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repetitive and complex movements with impaired consciousness and postictal drowsiness An important distinction is whether the seizure is associated with fever Simple febrile seizures are those that are single, brief (lasting less than 15 minutes), and generalized Approximately 20% of febrile seizures are complex, meaning they are focal, prolonged (last for more than 15 minutes), or have multiple episodes within 24 hours Triage and Initial Assessment For an actively seizing child, initiate immediate resuscitative measures and consider administration of antiepileptic agents, as discussed below After seizures have stopped, the first steps in the evaluation are a thorough history and a physical examination, the results of which are helpful in determining the direction of the search for a specific cause (see Table 72.1 and Fig 72.1 ) Important historical items to elicit include fever, trauma, underlying illnesses, current medications, and possible toxic ingestions A complete neurologic assessment to evaluate for signs of increased intracranial pressure (ICP), focal deficits, or signs of meningeal irritation is also essential Diagnostic Testing In children older than 12 months with a typical simple febrile seizure and no signs of meningitis, generally no further evaluation of the seizure is required However, lumbar puncture (LP) is indicated if meningitis is suspected on the basis of physical findings An LP should be considered in children younger than 12 months, in whom signs of meningitis may be subtle, such as irritability and poor feeding; when the febrile seizure is complex; or if there has been pretreatment with antibiotics In addition, LP should be considered for children with prolonged fever before the seizure, and for febrile children who not return to neurologic baseline quickly Other laboratory tests discussed in the next paragraph have been found to have little yield in the child with a typical febrile seizure and are unnecessary Appropriate diagnostic tests to determine the source of the fever are determined by other features such as the intensity of fever, immunization status, and the child’s age For the child who presents with a first-time, nonfebrile seizure, laboratory or radiologic evaluation to search for a specific treatable cause of the seizure may be indicated There is little utility in extensive, routine workups; rather, ancillary test selection should be guided by the results of the history and physical examination In young infants, children with prolonged seizures, and those with a suggestive

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