Medical image. Reflex anoxic seizures in a toddler

Area of Science:

• Pediatric Cardiology
• Neurology

Background:

• Breath-holding spells, a common cause of childhood syncope, can be triggered by emotional stress or pain.
• Reflex anoxic seizures (RAS) are a type of syncope characterized by asystole and bradycardia, leading to seizures.

Observation:

• A toddler experienced frequent pallid breath-holding or reflex anoxic seizure episodes.
• Ambulatory electrocardiogram (ECG) monitoring revealed an 18-second period of asystole during an event.

Findings:

• The toddler's frequent syncopal episodes were successfully managed with pacemaker implantation.
• Pacemaker implantation corrected the underlying cardiac arrhythmia causing the reflex anoxic seizures.

Implications:

• Pacemaker implantation is a viable treatment option for severe, refractory reflex anoxic seizures in children.
• This case highlights the importance of cardiac evaluation in children presenting with recurrent syncope or seizure-like episodes.