Diverse Presentation of Breath Holding Spells: Two Case Reports with Literature Review

Geetanjali Rathore,Paul Larsen,Manish Parakh,Cristina Fernandez

doi:10.1155/2013/603190

Abstract

Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education is the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells.

Highlights

Breath holding spells are paroxysmal nonepileptic events of infancy. These were first described in 1737 by Nicholas Culpepper and were thought to be voluntary breath holding. These episodes are often precipitated by emotional stimuli like anger, frustration, sudden fright, or minor trauma [1]
Piracetam, levetiracetam, and atropine are considered as treatment and have shown variable efficacy
Breath holding spells have an incidence of 4.6% to 4.7% [1, 2], with a male to female ratio of 3 : 1 [3]

Summary

Case Report

Diverse Presentation of Breath Holding Spells: Two Case Reports with Literature Review. Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. Reassurance and education is the mainstay of therapy. We present 2 cases, one of each, pallid and cyanotic breath holding spells

Introduction

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Discussion