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[Hypochromic anemia in children with affective breath-holding spells]
S Zubcević1, E Hasanbegović, M Gavranović
1Pedijatrijska klinika, Klinicki centar Univerziteta u Sarajevu.
Insights
Breath holding attacks, common in young children, can mimic epilepsy. Iron therapy effectively resolves these episodes in children with hypochromic anemia.
Area of Science:
- Pediatrics
- Neurology
Context:
- Breath holding attacks (BHAs) are common in children aged 6 months to 6 years.
- These episodes are often misdiagnosed as epileptic seizures due to cyanosis, loss of consciousness, and occasional seizure-like activity.
- BHAs can be triggered by emotional distress or minor injuries.
Purpose:
- To investigate the clinical presentation of breath holding attacks in children.
- To determine the prevalence of hypochromic anemia in children experiencing BHAs.
- To evaluate the efficacy of iron therapy in managing BHAs.
Summary:
- A study of 17 children with BHAs revealed hypochromic anemia in 76% of cases.
- All participants had normal electroencephalogram (EEG) recordings, ruling out epilepsy.
- Iron therapy showed an 88.9% positive response rate in patients followed up.
Impact:
- Highlights the frequent association between hypochromic anemia and BHAs in pediatric patients.
- Suggests iron supplementation as a potential treatment to resolve BHAs.
- Emphasizes the importance of differentiating BHAs from epileptic seizures through thorough clinical history and investigations.
Abstract:
Breath holding attacks are most common in children aged 6 months to 6 years, in 76% of cases between 6 and 18 months of age. Very often they are misinterpreted as tonic epileptic seizures. They are provoked by frustration, anger or sudden injury. Child starts to cry, then holds the breath at the end of expirium. After a few seconds it becomes cyanotic, and losses consciousness. It is usually floppy, but sometimes stiffness, and clonic seizures can be present, and child can be diagnosed as having epilepsy. The form in which child is pale is less frequent, and crying is usually brief or even absent in this type. Breath holding attacks usually do not last more then one to three minutes. Good heteroanamnesis is essential for diagnosis, revealing provoking factors for each attack. Interictal EEG registration is usually normal. Attacks often spontaneously cease after 5 or 6 years of age, and do not require any medical treatment. In more severe cases behavioral therapy has shown good results. It has been noticed that those children in adolescence have syncope more frequent then rest of population. Seventeen children (12 male and 5 female) were investigated at Pediatric Hospital in Sarajevo as breath holding attacks in period from June 1997 to June 2000. Age of patients was between 5 months and 5.5 years (median was 11 months). Hypochromic anemia was present in 12 patients (76%), with average hemoglobin value of 8.2 g/dl (5.9-11.0 g/dl). All children had normal EEG recording. Iron therapy gave positive response in 8 out of 9 patients that were followed (88.9%). Three patients had not come for follow up. It is concluded that hypochromic anemia is often a part of clinical presentation of breath holding attacks in children, and iron therapy can stop them.