Elsevier

Pediatric Neurology

Volume 14, Issue 2, February 1996, Pages 91-97
Pediatric Neurology

Review article
Breath-holding spells

https://doi.org/10.1016/0887-8994(96)00006-9Get rights and content

Abstract

Two particularly common, and frequently frightening, forms of syncope and anoxic seizure in early childhood are pallid and cyanotic breath-holding spells. Pallid breath-holding spells result from exuberant vagally-mediated cardiac inhibition. Cyanotic breath-holding spells are of more complex pathogenesis, involving an interplay among hyperventilation, Valsalva maneuver, expiratory apnea, and intrinsic pulmonary mechanisms. The history is the mainstay of diagnosis; video-tape documentation may be possible. Performance of an electrocardiogram to evaluate for prolonged QT syndrome should be strongly considered. In patients with pallid breath-holding spells, a characteristic sequence of changes may be documented on an electroencephalogram with ocular compression, if this study is performed. Spontaneous resolution of breath-holding spells, without sequelae, is anticipated. Reassurance is the mainstay of therapy. Occasionally, pharmacologic intervention may be of benefit.

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    Communications should be addressed to: Dr. Breningstall; Pediatric Subspecialties; Park Nicollet Medical Center; 910 East 26th Street, Suite 325; Minneapolis, MN 55404.

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