What prompts you to procure EEG and/or imaging in patients presenting with multiple simple febrile seizures?

History always plays a key role. Is the child developing normally, and how old is the child? Also, were all of the seizures truly simple, or were there other features that make me suspicious that this is actually a "lower seizure threshold" in a patient with underlying epilepsy? Fortunately, a sleep-deprived electroencephalogram is relatively non-invasive, and I would start there before imaging. Many children do have multiple simple febrile seizures and outgrow them before the age of 6 years old, but others don't. I tend to be on the cautious side and order an EEG for anyone with over three febrile seizures and monitor them.

It depends a bit on the age of the patient and the presence of other risk factors, but I may well choose to do a sleep-deprived EEG.