Silent seizures in children

[PH500]

My patient is a 6year old Trisomy 1 child with chronic tonic-clonic seizures (day nurse, home health). Some of his seizures are severe, but most are silent and you don't even know he is having them until the post -ictal phase. He is usually sleeping when these happen. There is usually no or very little change in sats and heart rate. Does any one have any advice?

[wooh, BSN, RN]

Ketogenic diet?

[smurfynursey]

Trisomy 1?

Are there any specific timing to the seizures? I lknow some kids that seize at the same time of day because that is when their meds start to wear off, maybe a med change/eval is in order? Other than that I would suggest monitoring him closely and keeping him in a position that's safe if he seizes and you don't see/realize it.

[Double-Helix, BSN, RN]

If he is having uncontrolled seizures, and the neurologists are not aware of this, then his doctors need to be called and told about the frequency and characteristics of the seizures. He may need his medication adjusted, new medications added, or the current levels of his medications checked. Ketogenic diets can also be helpful in controlling seizures in children when medications have failed.

If his neurologists are aware of the seizures and consider it acceptable for him to be seizing, then simply document the time and characteristics of the seizure and support him medically as needed.

[KelRN215, BSN, RN]

I have never heard of Trisomy 1 but, in my experience, kids with underlying genetic disorders tend to have refractory epilepsy. Some kids just have seizures every day and 30% of all epilepsy cases are refractory to medication. The most important thing you can do is to keep him safe, if these are seizures you don't even realize he's having, they're not likely hurting him.