Treatment of Cyanotic Breath-Holding Spells With Oral Theophylline in a 10-Year-Old Boy

Garg, Montey; Goraya, Jatinder S.

doi:10.1177/0883073814540519

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…28,29 In the literature, there are only 2 case reports suggesting that theophylline can be effective in BHS. 16,30 Carano et al 16 described the successful use of theophylline (80 mg twice daily) in combination with glycopyrrolate, an anticholinergic drug, in a 13-month-old girl with severe pallid BHS who otherwise would have required ventricular pacemaker implantation. This combined approach was chosen with the aim of declining cardiac inhibition with glycopyrrolate, while producing a positive chronotropic effect and stimulating the medullar respiratory center with theophylline.…”

Section: Discussionmentioning

confidence: 99%

“…They found that the combined therapy was effective in suppressing syncope and reflex anoxic seizures associated with BHS. In the second case study, Garg and Goraya 30 showed that oral etofylline (77 mg, a theophylline derivative) and theophylline (23 mg) treatment (twice daily) produced dramatic amelioration of severe BHS in a 10year-old boy, and suggested that general central nervous system stimulant and respirogenic effects of theophylline can lead to control of symptoms. We found in the present study that 10 mg/kg/d theophylline dose was effective for inhibiting simple BHS.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness Oral Theophylline, Piracetam, and Iron Treatments in Children With Simple Breath-Holding Spells

Dai

Demiryürek

2019

J Child Neurol

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Breath-holding spells (BHS) are common nonepileptic paroxysmal events in children. This is a retrospective study to compare the effectiveness of oral theophylline, piracetam, and iron treatments in children with simple BHS. A total of 146 children (75 girls and 71 boys) with simple BHS were included to this retrospective study. Children were divided into 4 groups: nontreated (no anemia and no treatment), oral theophylline (10 mg/kg/d as a single daily dose), piracetam (40 mg/kg/d in 2 divided doses), and elementary iron (3 mg/kg/d as a single daily dose) treatments. Iron therapy had been given only in children with iron deficiency anemia. Neurologic, cardiologic, and biochemical evaluations were performed for all children. The majority of the patients had cyanotic spells (83.6%). The frequency of attacks/month was markedly decreased with iron (58.8%) and theophylline (82.9%) treatments, but not with piracetam therapy (8.8%) and nontreated group (4.7%). Satisfaction of the parents/caregivers was found to be high in the theophylline group ( P < .001). Our results showed that theophylline was the most effective therapy to decrease the frequency of simple BHS in children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness Oral Theophylline, Piracetam, and Iron Treatments in Children With Simple Breath-Holding Spells

Dai

Demiryürek

2019

J Child Neurol

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“…Successful treatment of severe and frequent breath-holding spells with theophylline has also been described [57, 70]. Further studies are needed to confirm or refute the usefulness of theophylline in the treatment of severe and frequent breath-holding spells.…”

Section: Treatmentmentioning

confidence: 99%

Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence

Leung

Wong

et al. 2019

CPR

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Background: Breath-holding spells are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made.Objective: To familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of children with breath-holding spells.Methods: A PubMed search was completed in Clinical Queries using the key term “breath-holding spells”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.Results: Breath-holding spells affect 0.1 to 4.6% of otherwise healthy young children. The onset is usually between 6 and 18 months of age. The etiopathogenesis is likely multifactorial and includes autonomic nervous system dysregulation, vagally-mediated cardiac inhibition, delayed myelination of the brain stem, and iron deficiency anemia. Breath-holding spells may be cyanotic or pallid. The former are usually precipitated by anger or frustration while the latter are more often precipitated by pain or fear. In the cyanotic type, the child usually emits a short, loud cry, which leads to a sudden involuntary holding of the breath in forced expiration. The child becomes cyanosed, rigid or limp, followed by a transient loss of consciousness, and a long-awaited inspiration and resolution of the spell. In the pallid type, crying may be minimal or “silent”. The apneic period in the pallid type is briefer than that in the cyanotic type prior to the loss of consciousness and posture. The episode in the pallid type then proceeds in the same manner as a cyanotic spell except that the child in the pallid type develops pallor rather than cyanosis. In both types, the entire episode lasts approximately 10 to 60 seconds. The spells usually disappear spontaneously by 5 years of age.Conclusion: Although breath-holding spells are benign, they can be quite distressing to the parents. Confident reassurance and frank explanation are the cornerstones of treatment. Underlying cause, if present, should be treated. Interventions beyond iron supplementation may be considered for children with severe and frequent breath-holding spells which have a strong impact on the lifestyle of both the child and family.

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“…Several agents were tested in case of severe BHS (7). Besides administering medical therapies such as iron therapy (11), piracetam (17), levetiracetam (18), theophylline (19), fluoxetine (20), glycopyrrolate (21), atropine ( 22) so far, even some invasive methods such as a cardiac pacemaker (23) were also used in some children. We couldn't find any data in the literature about the rate of treated BHS patients, however, 194 (11,3%) out of 1707 patients were already initiated therapy in our series.…”

Section: Discussionmentioning

confidence: 99%

Katılma Nöbetlerinde Demir ve Pirasetam ile Anoksik Epileptik Nöbetlerde Levetirasetamın Etkinliği

Özgün

Akdeniz

Çelik

et al. 2023

Artuklu International Journal of Health Sciences

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Introduction: In this study, the patients diagnosed with breath holding spell (BHS) or anoxic epileptic seizures and initiated at least one out of iron or piracetam or levetiracetam therapies were evaluated. Material and Methods: We retrospectively evaluated 194 BHS patients. Iron therapy was initiated in case of iron deficiency anemia or case of ferritin values under 12 ng/dl even if there was no anemia. The patients having no iron deficiency anemia, low ferritin and anoxic epileptic seizures were administered piracetam and the patients diagnosed with anoxic epileptic seizures were administered levetiracetam. Results: One hundred and eight patients (55.7%) were male. The mean age was 21.39±12.78 months. Iron therapy was initiated in 87 patients, piracetam to 96, and levetiracetam in 11 patients. Seizure numbers were manifestly decreased in all groups by the end of the first month after treatment concerning pretreatment levels (p<0.05). Conclusions: We determined that the spells were reduced or completely stopped in all groups. Levetiracetam seems to be considerably effective in patients developing anoxic epileptic seizures after BHS.

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Treatment of Cyanotic Breath-Holding Spells With Oral Theophylline in a 10-Year-Old Boy

Cited by 6 publications

References 14 publications

Effectiveness Oral Theophylline, Piracetam, and Iron Treatments in Children With Simple Breath-Holding Spells

Effectiveness Oral Theophylline, Piracetam, and Iron Treatments in Children With Simple Breath-Holding Spells

Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence

Katılma Nöbetlerinde Demir ve Pirasetam ile Anoksik Epileptik Nöbetlerde Levetirasetamın Etkinliği

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