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.
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In cyanotic breath-holding spells, expiratory apnoea with hypoxia is the primary mechanism.
“In cyanotic breath-holding spells, expiratory apnoea with hypoxia is the primary mechanism. 10”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [10]
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2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951 · see citing works
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Anoxic-epileptic seizures: home video recordings of epileptic seizures induced by syncopes
Stephenson, J., Breningstall, G., Steer, C., Kirkpatrick, M., Horrocks, I., Nechay, A., & Zuberi, S. (2004) · Epileptic Disorders · doi:10.1684/j.1950-6945.2004.tb00044.x · Cited by 53 · see citing works
Self-citation
- Authors
- Breningstall, G. N.
- Affiliations
- Park Nicollet Health Services (US)
- Corresponding author
- Breningstall, Galen N.
- Venue
- Pediatric Neurology
- Publisher
- Elsevier BV
- Published
- 1996-02
- Volume
- 14
- Issue
- 2
- Pages
- 91-97
- ISSN
- 0887-8994 (ISSN-L)
- OpenAlex
- W2006972718
- Cited by
- 107
- References
- 32
- Citations by year
- 2025: 4 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 8 · 2017: 6 · 2016: 6 · 2015: 5 · 2014: 3 · 2013: 6 · 2012: 3
- FWCI
- 3.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pediatric Neurology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- breath-holding spells, syncope, hyperventilation, Valsalva maneuver, long QT syndrome, EEG, ocular compression, spontaneous resolution, pharmacotherapy, early childhood
- MeSH terms
- Apnea, Hypoxia, Brain, Child, Preschool, Cyanosis, Epilepsy, Tonic-Clonic, Female, Humans, Hyperventilation, Infant, Newborn, Male, Syncope
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