Valproic Acid in Treating Cyanotic Breath Holding Spells
Status:
Completed
Trial end date:
2018-12-30
Target enrollment:
Participant gender:
Summary
Breath holding spells (BHS) are common non-epileptic paroxysmal behavioral involuntary
episodes occurring in up to 5.9% of healthy children. The attacks occur in early childhood
(0.5-3 years) but are self-limited by school age (4-5 years old) (90%). Classically, BHS were
classified as cyanotic (blue), pallid (pale) and mixed based on the color change of the child
during the spell. In general, cyanotic spells have been classically described in a toddler
with excessive temper tantrums [stubborn, easily frustration or annoyed. The mechanisms of
BHS are controversial. The most suggested cause of BHS is instability of the autonomic
nervous system, inhibition of respiratory effort and cyanosis in cyanotic BHS and bradycardia
or a brief asystole and cerebral hypoperfusion in pallid BHS. Iron deficiency anemia (IDA)
has been widely regarded as a risk factor for BHS in nearly 50% of children due to reduced
brain oxygenation [4]. It is generally agreed that the long-term prognosis is considered good
[1]. There is no definite therapy for BHS. In children with low frequency spells, parental
reassurance are just enough; however, high frequency spells may result in anxiety to the
parents or fear from sudden death of the child or development of mental subnormality.
Treatment of iron has been reported to result in reduction of the frequency of spells or its
stoppage. Some reported improvement of BHS with piracetam [a nootropic drug known to increase
brain oxygenation]. We did not find systematized published reports evaluating the
effectiveness of antiepileptic drugs (AEDs) in reduction of spells frequency of cyanotic BHS
or their stoppage.