Breath-holding spells

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 spells, without sequelae, is anticipated, Reassurance is the mainstay of therapy, Occasionally, pharmacologic intervention may be of benefit.