Editing Febrile seizure (section)

==Diagnosis==
The diagnosis is made by [[diagnosis of exclusion|eliminating]] more serious causes of [[seizure]] and fever: in particular, [[meningitis]] and [[encephalitis]].<ref name=":9">{{cite journal|last=Subcommittee on Febrile Seizures|date=2011-02-01|title=Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure|journal=Pediatrics|language=en|volume=127|issue=2|pages=389–394|doi=10.1542/peds.2010-3318|pmid=21285335|issn=0031-4005|doi-access=free}}</ref> However, in children who are immunized against [[Streptococcus pneumoniae|pneumococcal]] and ''[[Haemophilus influenzae]]'', the risk of bacterial meningitis is low.<ref name=BMJ2015 /> If a child has recovered and is acting normally, bacterial meningitis is very unlikely, making further procedures such as a [[lumbar puncture]] unnecessary.<ref name="Leu2018" />

Diagnosis involves gathering a detailed history including the value of highest temperature recorded, timing of seizure and fever, seizure characteristics, time to return to baseline, vaccination history, illness exposures, family history, etc.; and performing a physical exam that looks for signs of infection including meningitis and neurological status.<ref name="Leu2018" /> Blood tests, [[Neuroimaging|imaging of the brain]] and an [[electroencephalogram]] are generally not needed.<ref name=AFP2012/><ref name=":9" /> However, for complex febrile seizures, [[Electroencephalography|EEG]] and imaging with an [[Magnetic resonance imaging of the brain|MRI of the brain]] may be helpful.<ref name=":2" /><ref>{{cite journal|last1=Shah|first1=Pankaj B.|last2=James|first2=Saji|last3=Elayaraja|first3=Sivaprakasam|date=9 April 2020|title=EEG for children with complex febrile seizures|journal=The Cochrane Database of Systematic Reviews|volume=2020|issue=4 |pages=CD009196|doi=10.1002/14651858.CD009196.pub5|issn=1469-493X|pmc=7142325|pmid=32270497}}</ref>

Lumbar puncture is recommended if there are obvious signs and symptoms of meningitis or if there is high clinical suspicion.<ref name=":9" /> However, lumbar puncture is an option that may be considered in children younger than 12 months of age since signs and symptoms of meningitis may be atypical, if the child does not return to baseline, or if the child lacks immunization against ''Haemophilus influenzae'' and pneumococcal or vaccination status is unknown.<ref name=AAP2017 /><ref name="Leu2018" /><ref name=":9" />

Differential diagnosis includes other causes of seizures such as [[List of infections of the central nervous system|CNS infections]] (i.e. meningitis, encephalitis), [[Metabolic disorder|metabolic disturbances]] (i.e. [[electrolyte imbalance]]s), [[Head injury|CNS trauma]], drug use and/or withdrawal, genetic conditions (i.e. [[Generalized epilepsy with febrile seizures plus|GEFS+]]), [[Febrile infection-related epilepsy syndrome|FIRES]], [[shivering]], febrile [[delirium]], febrile [[myoclonus]], [[Breath-holding spell|breath holding spells]], and convulsive syncope.<ref name="Leu2018" /> However, febrile seizures are still the most likely cause of convulsions in children under the age of 5 years old.<ref name=":9" />