A comparative study of the efficacy of using piracetam with iron therapy versus iron therapy alone in children with breath-holding spells

Abstract

Background Breath-holding spells (BHS) are apparently frightening events occurring in otherwise healthy children. Generally, no medical treatment is recommended and parental reassurance is believed to be enough; however, in some cases BHS can be very stressful for the parents and a pharmacological agent may be desired in some of these children. Objective The aim of this work was to determine the efficacy of using piracetam with iron therapy versus iron therapy alone in children with BHS associated with iron-deficiency anemia. Study design The study design was an interventional randomized controlled one. Patients and methods This study was conducted at the Neuro-Pediatric Outpatient Clinic at Alexandria University Children’s Hospital, Egypt. A total number of 70 children between 6 months and 5 years of age with a diagnosis of BHS and iron-deficiency anemia reporting to the clinic were randomly divided into two groups: group I included 35 children who were given only iron therapy at a dose of 6 mg/kg/day, and group II included 35 children who were given iron therapy at the same dose and piracetam at a dose of 40 mg/kg/day. Follow-up of the cases monthly for 3 months was scheduled to evaluate the frequency of the attacks and the improvement in iron deficiency by evaluating iron profile after 3 months (iron, ferritin, and total iron binding capacity). Results Seventy patients were enrolled in this study (42 boys and 28 girls) and completed the study. The ratio of boys to girls was 3 : 2. The patients’ ages ranged between 6 months and 5 years at the time of presentation with 50% above 2 years of age. The frequency of spells varied widely, ranging from 1 to 3 per day to 3 per month, and the mean frequency was six episodes of BHS in 1 month (about 2/week) for both groups. On comparing the improvement in the frequency of attacks between the two studied groups after treatment, there was a significant difference (P=0.001) between the two groups; the median number of attacks was two attacks per month for group I and one attack per month for group II. Conclusion Treatment with piracetam in addition to iron therapy is better than iron therapy alone in reducing the frequency of breath-holding attacks in children with BHS associated with iron-deficiency anemia.