title: Breath-holding spells.
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; videotape 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 spell, without sequelae, is anticipated. Reassurance is the mainstay of therapy. Occasionally, pharmacologic intervention may be of benefit.
authors.affiliation: Department of Pediatrics (Neurology), Park Nicollet Medical Center; Minneapolis, MN 55404, USA.
authors.forename: G N
authors.initials: GN
authors.lastname: Breningstall
mesh_terms: D001049:Apnea / Q000503:physiopathology*; D002675:Child, Preschool; D003490:Cyanosis / Q000175:diagnosis / Q000503:physiopathology*; D004830:Epilepsy, Tonic-Clonic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000175:diagnosis / Q000503:physiopathology; D002534:Hypoxia, Brain / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D007231:Infant, Newborn; D008297:Male; D013575:Syncope / Q000175:diagnosis / Q000503:physiopathology*