Breath-holding spells, a type of syncope, are not uncommon in otherwise-healthy infants and young children. Onset is usually between the ages of 6 and 28 months and they usually disappear by 5-6 years. Spells may be cyanotic or pallid, the former associated with reflex-induced forceful and prolonged expiration, and the latter with vagally-mediated bradycardia or temporary asystole. Generally no medical treatment is recommended, but severe spells may be stressful for parents and a pharmacological agent may be desired (but only after exclusion/treatment of iron deficiency anaemia which may be associated with breath-holding). Several studies dating back to the late 1990’s have used piracetam for severe cases, all with good results and no adverse effects. The drug (2-oxo-1-pyrrolidine – Nootropil®) is a cyclic derivative of GABA that has also been used for various cognitive disorders in children, and for post-anoxic action myoclonus in adults. In the latest study 40 children were randomised and assigned to placebo or treatment with 50mg/kg/day for 4 months. Other studies have used dosages ranging from 40 to 100 mg/kg/day, with response rates all around 80-90+%. In the latest study (which treated patients for 4 months), median age was 34.5 months in the study group and 31 months for placebo controls. Male:female ratio was 2:1, and cyanotic spells occurred slightly more frequently than pallid (11 vs 9 in both groups). Children had ~5 spells per month prior to treatment, reducing to 1 per month in the piracetam group (range 0-3) and remaining at the same level in the placebo group. Piracetam appears to be safe and effective for treatment of breath-holding spells in children, and based on available evidence should be considered in the management of severe and more-frequent spells.
Eur J Pediatr doi 10.1007/s00431-012-1680-1 Int
J Psychiatry Med 2008; 38: 195-201
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