Pediatric Hospital Medicine

11

Chapter 2 • Seizure

TABLE 2.3 DIAGNOSTIC STUDIES PROCEDURE

TYPE OF TESTING PURPOSE OF TEST

CONSIDERATIONS

EEG

• 24 h • Sleep deprived • Intermittent photic stimulation

• Evaluate for epileptiform

• Normal EEG is not evidence for absence of seizures. • Skull defects

or background abnormalities.

can alter the patterns on EEG.

Neuroimaging Head CT

• Head CT may be performed in the ER setting; it may be helpful in cases of acute intracra nial processes. • Brain MRI may be helpful for some seizure types and in neonatal seizures. • Assess for acute and fixable abnormalities.

• Radiation

exposure and low yield

Brain MRI

• Depending on seizure type, low yield • Sedation may be indicated.

Laboratory testing

Glucose Electrolytes

• Often low yield

Metabolic testing (blood/urine amino acids, blood/urine organic acids)

• Metabolic

testing for those that present with extreme symptoms (multiorgan dysfunction, developmental concerns)

Genetic testing • Consider in children with epilepsy onset

before 3 y of age (in consultation with neurology).

Immune studies

• Consider in acute-onset seizures with

encephalopathy and/or other neurologic signs.

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