en Pediatric Pediatric Original Research Original Research <p> <strong> Abstract </strong></p><p> <strong> Backround: </strong>The first episode of an afebrile seizure is a common cause of admission </p><p>  of children to emergency departments. Alot of tests are routinely performed for these patients. The cost of such an evaluation is high and benefits are doubtful. We conducted </p><p>  this study in order to evaluate the results of the tests and find out what tests are necessary for children with first unprovoked seizure. </p><p> <strong> Methods: </strong>In a 7-year retrospective study files of 150 children aged between 1 month </p><p>  and 14 years admitted with first afebrile seizure to the pediatric ward of Rasool Akram </p><p>  hospital were reviewed. Reports of the brain neuroimaging studies (Ct-scan & MRI) and </p><p>  laboratory tests were extracted. </p><p> <strong> Results: </strong>150 patients with a mean age of 53 ± 48 months qualified for inclusion in the </p><p>  study. 143 (95%) of 150 children with first afebrile seizure were imaged. Ninety percent </p><p>  (128/143) had normal neuroimaging. Emergent computed tomography as the initial </p><p>  study was performed in 90% (128/143) and MRI in 10% (15/143 ). Sixty patients had </p><p>  both MRI and CT-scans. Clinically significant neuroimaging abnormalities were reported </p><p>  in only 9.7% (14/143). There was a significant relation (P<0.001) between focal </p><p>  seizures and abnormal neuroimaging. Children under 24 months of age were also more </p><p>  prone to have abnormal imaging (p<0.002). Laboratory tests including complete blood </p><p>  count (CBC) and chemistry panel (Na, K, Ca, BUN, Cr) were performed for all. Only </p><p>  two patients had low serum calcium level, later diagnosed as vitamin D resistant rickets. </p><p> <strong> Conclusions: </strong>The most important aspect of management of a child after a first </p><p>  afebrile seizure is careful history taking and physical examination. Laboratory tests </p><p>  should be requested in very limited situations. Emergent brain CT-scans are recommended for children with focal seizures, abnormal findings on physical examination, presence of any predisposing factors and those under 24 months of age. </p><p>  </p> unprovoked seizure, focal seizure, neuroimaging. 17 21 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1-56&slc_lang=en&sid=1 Fariba Khodapanahandeh Faribakoda@yahoo.com. 20031947532846001550 20031947532846001550 Yes Pediatric Department of Rasool-e- Akram Hospital, Sattar Khan AvenueNiyaesh Street, Tehran, Iran, Mona Nematian 20031947532846001551 20031947532846001551 No Rasool-e-Akram Hospital, Iran University of Medical Sciences. Homayoon Hadizadeh 20031947532846001552 20031947532846001552 No Radiology Department of Rasool-e-Akram Hospital, Iran University of Medical Sciences.