Management of children with nonfebrile seizures in the emergency department

Background: Children with seizures are often referred to the emergency department where they are typically evaluated by a physician with limited knowledge of pediatric epileptology and undergo a costly and extensive work-up that contributes little to the final decision. Aim: The aim of this study was to examine the medical management of children with nonfebrile seizures in the emergency department and to define the potential role of the neurology clinic in this context. Materials and methods: The files of 85 children who made 104 visits to the emergency department of a pediatric tertiary hospital for nonfebrile seizures were retrospectively reviewed. Results: Average age was 7.5 years. Blood tests were performed in almost all visits; a minority also involved the use of brain scans and electroencephalography. A neurologist was consulted in about half the visits. Only electroencephalography and neurologic consultation contributed significantly to the final decision. Hospitalization was recommended in 71% of cases, but it was usually short term and not accompanied by significant changes in the management. Conclusion: In children with nonfebrile seizures, a problem-oriented approach including only the necessary work-up (e.g. electroencephalography) with neurologist consultation can potentially decrease the inpatient load and lower health care costs, while sparing patients unnecessary tests.