Breath-holding spell

The diagnosis of a breath-holding spell is made clinically. A good history including the sequence of events, lack of incontinence and no postictal phase, help to make an accurate diagnosis. Some families are advised to make a video recording of the events to aid diagnosis. An electrocardiogram (ECG) may rule out cardiac arrhythmia as a cause. There is some evidence that children with anemia (especially iron deficiency) may be more prone to breath-holding spells. Classification There are four types of breath-holding spells. ; Simple breath-holding spell : This is the most common type and the cause is the holding of breath. The usual precipitating event is frustration or injury. There is no major alteration of circulation or oxygenation and the recovery is spontaneous. ; Pallid breath-holding spells : The most common stimulus is a painful event. The child turns pale (as opposed to blue) and loses consciousness with little if any crying. The EEG is also normal, and there is no postictal phase, nor incontinence. The child is usually alert within minutes. There may be a relationship with adulthood syncope. ; Complicated breath-holding spells : These may simply be a more severe form of the two most common types. They generally begin as either a cyanotic or pallid spell that is then associated with seizure-like activity. An EEG taken while the child is not having a spell is still generally normal. ==Treatment==

The most important approach is to reassure the family, because witnessing a breath-holding spell is a frightening experience for observers. There is no definitive treatment available or needed for breath-holding spells, as the child will eventually outgrow them. Some trials have demonstrated the efficacy of iron therapy, especially because although BHS can readily occur without anemia, BHS has been found to be aggravated by the presence of anemia. Other studies have supported the use of piracetam; a 1998 study indicating that over two months piracetam reduced BHS incidence by sixty percent, twice as much as a placebo. All of these studies agree with the established medical view that a pharmacological agent is not necessary, although it may be desirable for the comfort of the parent and child. Two articles on breath-holding spells strongly suggest that parents consider having their child be tested by electrocardiogram for the rare, but real possibility that the BHS episodes are actually a symptom of prolonged QT-syndrome, a serious but treatable form of cardiac arrhythmia. ==References==