Breath Holding Spells (BHS) usually occur between the ages of 6 months and 5 years in children; but may start as early as first month of life. The frequency of the episodes is variable; they may occur a few times a day or every 3-4 months.
The spells are clinically observed in two forms as cyanotic form and pallid form.
Pallid breath-holding spells
The child screams briefly, usually following minor injuries and painful stimuli (falling, hitting the head) followed by hypotonia, loss of consciousness, and pale skin occur. Sudden bradycardia caused by a vagal response causes the event.
Cyanotic breath-holding spells
The children are healthy between episodes. Treatment is usually unnecessary. Reassurance to the family is beneficial. Iron therapy should be given, if anemia is present. Antiepileptics are not used for treatment of breath-holding spells. In case of recurrent pallid spells, ECG should be done to rule out a long QT syndrome.
They are triggered by pain, anger or fear. Prolongation of expiration during crying may result in apnea leading to cerebral anoxia and change in colour. During severe episodes, generalized hypertonia may be observed. Loss of tone and rarely myoclonic jerks may accompany.
Role of Piracetam in breath holding spells
Piracetam is a derivative of gamma-aminobutyric acid (GABA). In Breath Holding Spell (BHS), cerebral anoxia produced by asystole (pallid spell) or prolonged apnea (cyanotic spell) causes loss of consciousness during a spell and the GABA mimetic effect of Piracetam helps prevent the event.
Piracetam use reduces the number of attacks in BHS significantly. It is an effective drug with minimal side-effects and a good safety profile for treatment of severe and frequent spells.(i.e 3 or more spells per month associated with alteration of body tone or loss of consciousness)
Dose of Piracetam
50- 100 mg/kg/day in two divided doses
Available as Suspension 500mg per 5 ml and 400 mg Capsules (Nootropil, Pritam)**
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