Dec
09
2009

THE FIRST SEIZURE AND THE DIAGNOSIS OF EPILEPSY: REFLEX ANOXIC SEIZURES AND BREATH-HOLDING ATTACKS

These are a type of syncope, but deserve a particular mention as the attacks are frequently misdiagnosed as epileptic seizures. Reflex anoxic seizures (also called pallid syncopal attacks) usually affect young children between 12 months and 4 years of age, but can affect older children and even adults. The attacks are always provoked by either a sudden fright, or unexpected pain. This unpleasant experience then stimulates a nerve (the vagus nerve) which causes the heart to slow down or even stop for a few seconds. As a result of this the child becomes pale, then limp, and may even have a brief clonic convulsion. Almost immediately the child will recover, may cry, and then appear sleepy. Within a few minutes the child is usually back to normal. These attacks do not damage the brain or heart, do not need treatment, and usually stop by the age of 5-10 years.

Breath-holding attacks-These attacks occur only in young children, aged usually between one and three years. The typical story is of a child who is frustrated, told off, or spanked. The child becomes angry or upset and will hold their breath. After a few seconds the child becomes blue (cyanosed) because of a lack of oxygen in the blood and loses consciousness, and becomes limp. Because of the reduced oxygen supply to the brain (as the child is not breathing) the child may have some clonic (jerking) movements and wet themselves. The child always starts breathing again and is back to normal within a few minutes. These breath-holding attacks usually stop by the age of 4-5 years.

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