Electroencephalographic Findings in Breath Holding Spells

Low, Niels L.; Gibbs, Erna L.; Gibbs, Frederic A.

doi:10.1542/peds.15.5.595

Cited by 28 publications

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“…2 EEG is usually not needed for the diagnosis, but it could be useful when the semiology is unclear. 3,4 In a study by Low et al, 3 on 129 children with BHA aged 7 months-11 years, a normal interictal background EEG activity during wake and sleep was usually found. In their study, they registered only one patient during a BHA episode: a 13-monthold girl who during the attack at EEG showed slow activity 'such as occurs in anoxia and with stupor from various causes'.…”

Section: Discussionmentioning

confidence: 96%

“…In their study, they registered only one patient during a BHA episode: a 13-monthold girl who during the attack at EEG showed slow activity 'such as occurs in anoxia and with stupor from various causes'. 3 No polygraphy or video was performed at that time. In addition to this, descriptions of ictal EEG are very rare.…”

Section: Discussionmentioning

confidence: 99%

“…BHA is commonly reported above the age of 6 months, but it should be considered also below this age, as this case and few other published cases demonstrate 2 . EEG is usually not needed for the diagnosis, but it could be useful when the semiology is unclear 3,4 …”

Section: Discussionmentioning

confidence: 99%

“…Some patients have severe and frequent BHA up to five times per day, so their management can be complicated, especially when occurring under 6 months of age. Electroencephalogram (EEG) is used in specific cases to exclude tonic epileptic seizures 3 …”

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confidence: 99%

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Ictal video‐electroencephalogram of breath‐holding attack

Dilena,

Biffi,

Mauri

et al. 2023

J Paediatrics Child Health

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Breath-holding attacks (BHAs) are non-epileptic paroxysmal events that affect 0.1% to 4.6% of infants from 6 months to 5 years of age. 1 Their frequency peaks at about 2 years of age and reduces by 5 years. The detailed description of the event is the key point for the diagnosis: the child typically emits a short loud cry, followed by breath holding, cyanosis, rigidity or limpness and transient loss of consciousness for a few seconds. Then, an inspiration marks the resolution of the spell. 1 The BHA are considered rare before 6 months of age, although they have been reported in the neonatal age. 2 BHA might be a frightening experience for parents, but its course is known to be benign. 1 Some patients have severe and frequent BHA up to five times per day, so their management can be complicated, especially when occurring under 6 months of age. Electroencephalogram (EEG) is used in specific cases to exclude tonic epileptic seizures. 3 Case HistorySince the age of 1 month and half an infant presented, usually during crying, episodes of apnea with cyanosis, and hypertonia, sometimes followed by hypotonia, pallor, loss of consciousness and finally sleep. For this reason, at 2 months of life, he was admitted to the hospital where physical, neurologic and cardiologic examination, brain ultrasound, standard EEG, blood cell count, serum ferritin level and electrocardiogram (ECG) showed no abnormalities. The infant was discharged with a diagnosis of BHA and a cardiorespiratory monitor was suggested.His medical history was remarkable for obstructive apnea due to gastroesophageal reflux disease and mild congenital laryngomalacia. His mother's history was unremarkable, except for exposure to a stressful event during pregnancy since, at 20 weeks of gestational age, fetal ultrasound showed shortness of long bones, suggesting a possible congenital disease. This event increased the anxious state of the mother already greatly upset by COVID-19 pandemic issues. However, the suspicion of congenital disease was ruled out.After discharge from the hospital, these episodes increased in intensity and frequency up to five times per day becoming so alarming that the patient was admitted to the Paediatric Intensive Care Unit (ICU) and Ambu bag ventilation was used during the episodes. The mother was frightened, fearing for the infant's life, so her capacity to console him was reduced. A long-term video EEG (vEEG) (Video S1) was performed, recording a typical event and demonstrating the non-epileptic nature of the paroxysmal event.After vEEG, resuscitation procedures with Ambu bag were stopped during the episodes and reassurance and psychological support was offered to the parents. In the following days, episodes decreased to 2 per day. Iron supplementation and piracetam 40 mg/kg divided in two daily doses was prescribed and in the following weeks the situation further improved. At 8 months of age he presented a normal development, BHA are still present although with minor manifestations, that the family has learned to manage.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Ictal video‐electroencephalogram of breath‐holding attack

Dilena,

Biffi,

Mauri

et al. 2023

J Paediatrics Child Health

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“…[1][2][3][4][5][6][7]9,10 An equal sex distribution or male predominance has been reported. [2][3][4][5][6][7][8][9][10][11] Spontaneous remission in most children usually occurs before school age, but syncopal attacks occur more frequently in adolescents and adults who had BHS as children. [1][2][3][4]7 Signs of autonomic dysregulation have been noted in children with BHS, 9,12 and iron deficiency and anaemia have frequently been observed.…”

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confidence: 99%

Overuse of EEG and ECG in children with breath‐holding spells and its implication for the management of the spells

Hellström Schmidt,

Smedenmark,

Jeremiasen

et al. 2023

Acta Paediatrica

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AimBreath‐holding spells (BHS) are common in children, but evidence‐based clinical guidelines are lacking. We investigated a large population‐based cohort of BHS patients, to propose a refined description of typical BHS and guidelines for its management.MethodsIn a cross‐sectional retrospective study, patients diagnosed with BHS in Southern Sweden 2004–2018 were recruited. Disease characteristics and diagnostic data were collected from patient medical records.ResultsIn total, 519 patients, mean age at diagnosis 19.8 ± 13.8 months with equal gender distribution, were included. In 48.3%, BHS had already been diagnosed after one spell. During spells, 78.0% of patients were unresponsive. For 71.5%, atonic, tonic, tonic–clonic or myoclonic seizures were reported, and 78.0% of patients had a spell lasting less than 1 min. Electroencephalography was conducted in 30.4% and Electrocardiography in 45.1%. Six children (3.8%) had a pathological electroencephalogram, four of which had concomitant epilepsy and only 0.9% of children had electrocardiogram findings suggesting pathology, none showing long QT syndrome.ConclusionChildren with BHS were frequently subjected to unnecessary diagnostic interventions. We characterise a typical presentation of BHS and propose a management‐algorithm, which is expected to reduce unnecessary usage of electroencephalography and electrocardiography.

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Breath-Holding Spells in Childhood

DiMario

1992

Arch Pediatr Adolesc Med

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Electroencephalographic Findings in Breath Holding Spells

Cited by 28 publications

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Ictal video‐electroencephalogram of breath‐holding attack

Ictal video‐electroencephalogram of breath‐holding attack

Overuse of EEG and ECG in children with breath‐holding spells and its implication for the management of the spells

Breath-Holding Spells in Childhood

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