The value of neurologic and cardiologic assessment in breath holding spells
Unsal Yilmaz1, Onder Doksoz2, Tanju Celik3
1Unsal Yilmaz, MD; Department of Pediatric Neurology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
Insights
Breath Holding Spells (BHS) in children often involve iron deficiency anemia. Neurologic and cardiologic assessments are generally unnecessary for diagnosed BHS cases, simplifying clinical evaluation.
Area of Science:
- Pediatrics
- Neurology
- Cardiology
Background:
- Breath Holding Spells (BHS) are common in children.
- The necessity of extensive neurologic and cardiologic workups for BHS is often questioned.
- Iron deficiency anemia is a potential comorbidity in children with BHS.
Purpose of the Study:
- To assess the diagnostic value of neurologic and cardiologic evaluations in children with BHS.
- To determine the prevalence of iron deficiency anemia in pediatric patients experiencing BHS.
Main Methods:
- Retrospective review of hospital charts for patients diagnosed with BHS between 2011 and 2013.
- Comparison with a control group of children diagnosed with febrile convulsions.
- Analysis of family history for BHS, febrile convulsions, and epilepsy.
Main Results:
- Out of 165 children with BHS, 47.9% had iron deficiency anemia.
- Electroencephalography (EEG) abnormalities were found in 18 patients, but only one was diagnosed with epilepsy.
- No cardiologic abnormalities were detected in the study group; however, a family history of epilepsy was noted in 12.1% of first-degree relatives.
Conclusions:
- Routine referral to pediatric neurology or cardiology for BHS is often not required.
- Echocardiography and EEG investigations may be unnecessary for excluding heart disease or epilepsy in clinically definite BHS.
- Consideration of electrocardiogram for prolonged QT syndrome is advised, despite the absence of cardiologic abnormalities in this series.
Abstract:
Objective : To evaluate the value of neurologic and cardiologic assessment and also the frequency of iron deficiency anemia in children with Breath Holding Spells (BHS). Methods : The hospital charts of patients diagnosed with BHS between 2011 and 2013 were reviewed retrospectively. Results : A total of 165 children (90 boys, 75 girls) with BHS comprised the study group. A matched group of 200 children with febrile convulsions served as controls. Among the first-degree relatives, 13.3% had BHS, 1.8% had febrile convulsions and 12.1% had epilepsy. The spells were cyanotic in 140 (84.8%) children and pallid or mixed in the remainder. BNS type was simple in 46.7% of patients and complicated in the remainder. Eighteen patients had abnormalities in electroencephalography, however only one patient was diagnosed with epilepsy. Sixty nine (47.9%) patients were found to have iron deficiency anemia. Conclusion : Referral of children with clinically definite BHS to pediatric neurology or pediatric cardiology clinics and performance of echocardiography and EEG investigations for exclusion of heart disease or epilepsy appear unnecessary. However, performance of an electrocardiogram to search for prolonged QT syndrome should be considered although no patient in our series had any cardiologic abnormalities.
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