The first febrile seizure warrants the most concern, because the benign nature of the illness has not yet been established. More concern regarding intracranial infection is justified with the first febrile seizure before the propensity for recurring simple febrile convulsions has been established. The initial evaluation concentrates on serious causes, such as meningitis, encephalitis, and bacterial sepsis. Lumbar puncture is warranted whenever intracranial infection appears likely. If a cause is not found and the child is ill, admission, workup, and therapy are warranted. Underlying diseases should be diagnosed. Toxic encephalopathy with fever as a symptom should be identified and treated. An EEG can be done electively and, when indicated by family history or atypical presentation, may be helpful in determining whether AED treatment is warranted.
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