Should laboratory tests and lumbar puncture be performed routinely for children with a first non-febrile seizure?
It is an option for emergency physicians to perform serum tests (e.g., electrolytes, complete blood count, toxicology screen) on children with a first non-febrile seizure. This recommendation is based on a series of class I and class II publications. Two classes I, prospective cohort studies of children with new seizures found that the rate of significant electrolyte disorders diagnosed in these children was 0-1%; however the 95% confidence intervals were in the 10-20% range. Larger class II studies identified hypoglycemia, hypocalcemia, and cocaine intoxication at about he same rate (i.e., 0-1%). Lumbar puncture (LP) is of limited value in children with first-time non-febrile seizures. In one study of LP performed in 57 children with non-febrile seizures, no subjects (95% CI: 0-6.3%) had meningitis although the CSF of 12% reflected post-seizure CSF pleocytosis. The ACEP Clinical Policy suggests as a level B recommendation that one determine a serum glucose, pregnancy test, and sodium
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