Iron supplementation should be given in breath-holding spells regardless of anemia

Gürkan Gürbüz,Turgay Çokyaman,Peren Perk

doi:10.3906/sag-1805-92

Abstract

Background/aim The purpose of this retrospective study was to determine the effectiveness of oral iron therapy in breath-holding spells and evaluation of electrocardiographical changes.Materials and methods Three hundred twelve children aged 1–48 months and diagnosed with breath-holding spells between January 2017 and April 2018 were included. Patients’ laboratory findings were compared with 100 patients who had one simple febrile seizure.Results Cyanotic breath-holding spells were diagnosed in 85.3% (n = 266) of patients, pallid spells in 5.1% (n = 16), and mixed-type spells in 9.6% (n = 30). Sleep electroencephalograms were applied for all patients, 98.2% (n = 306) of which were normal, while slow background rhythm was determined in 1.2% (n = 4). Epileptic activity was observed in only 2 patients (0.6%). The mean hemoglobin (Hb) value in the breath-holding spell group was 10.1 mg/dL. Patients’ mean corpuscular volume (MCV) was 73 fL. Patients’ Hb and MCV values were statistically significantly lower than those of the control group (P < 0.001). The difference between spell burden was not statistically significant (P = 0.691). Spell burden decreased equally in both groups.Conclusion Oral iron therapy can be administered in breath-holding seizures irrespective of whether or not the patient is anemic.

Highlights

Breath-holding spells are a nonepileptic paroxysmal phenomenon frequently seen in childhood
Cyanotic breath-holding spells were diagnosed in 85.3% (n = 266) of patients, pallid spells in 5.1% (n = 16), and mixed-type spells in 9.6% (n = 30)
Sleep electroencephalograms were applied for all patients, 98.2% (n = 306) of which were normal, while slow background rhythm was determined in 1.2% (n = 4)

Summary

Introduction

Breath-holding spells are a nonepileptic paroxysmal phenomenon frequently seen in childhood. They were first reported as ‘voluntary breath holding’ in 1737 by Nicholas Culpepper and were described as “A disease ... There are three types: cyanotic, pallid, and mixed type. Pallor resulting from bradycardia and asystole developing secondary to increased vagal tone is seen in pallid seizures. While no change in heart beat occurs in cyanotic breath-holding seizures, a blue color is observed around the mouth and in the face associated with prolonged expiration and a decrease in oxygen saturation. Seizures are frequently seen between 6 months and 4 years. Spells occur in association with an emotional or physical stimulus and do not occur during sleep.

Methods

Results

Conclusion