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Management of reflex anoxic seizures in children

Anand Iyer1, Richard Appleton

  • 1The Roald Dahl EEG Unit, Paediatric Neurosciences Foundation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.

Archives of Disease in Childhood
|July 2, 2013
PubMed

Insights

Reflex anoxic seizures (RAS) are a common cause of non-epileptic events in children, triggered by distress leading to brief cardiac asystole and loss of consciousness. Diagnosis relies on witness history, avoiding unnecessary investigations, with reassurance as primary management.

Area of Science:

  • Pediatric Neurology
  • Cardiology
  • Autonomic Nervous System Disorders

Background:

  • Reflex anoxic seizures (RAS) are frequently misdiagnosed as epilepsy in infants and young children.
  • These events involve loss of consciousness and motor symptoms following a distressing stimulus.
  • The pathophysiology involves vagal-mediated cardiac asystole causing transient cerebral hypoperfusion.

Purpose of the Study:

  • To highlight the importance of recognizing Reflex Anoxic Seizures (RAS) in pediatric differential diagnosis.
  • To emphasize the diagnostic pathway for RAS, differentiating it from epileptic seizures.
  • To outline current management strategies for RAS.

Main Methods:

  • Clinical diagnosis based on detailed witness history.
  • Exclusion of cardiac arrhythmias.
  • Avoidance of electroencephalography (EEG) and neuroimaging unless indicated for other reasons.

Main Results:

  • A thorough witness account is sufficient for diagnosing RAS.
  • Unnecessary investigations like EEG and neuroimaging can be avoided in most cases.
  • Reassurance and education are the primary management strategies.

Conclusions:

  • RAS requires timely and accurate diagnosis to differentiate from epileptic seizures.
  • Management focuses on parental reassurance and education, with selective use of medications like atropine or fluoxetine.
  • Cardiac pacing is a definitive treatment for severe, recurrent cases, managed in conjunction with cardiology.

Keywords:
General PaediatricsNeurology

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