Electroencephalographic Study in Children with Breath-Holding Spells in a Tertiary Care Hospital in South India

INTRODUCTION: Breath holding spells, otherwise called as “Infantile syncope”, are well recognized, common clinical entity characteristically seen in infants and younger children aged 6 months to 5 years. Syncope – derived from the Greek word “Synkoptein”, meaning “to cut” or “to break” - is defined as a sudden loss of consciousness and postural tone, because of transient cerebral hypoperfusion, followed by spontaneous recovery. Transient interruption of cerebral blood flow is followed by loss of consciousness within 8 to 10 seconds. Less than 30 ml blood per 100 grams of brain tissue per minute results in syncope. The critical threshold of cerebral hypoperfusion at which syncope ensues is 50% below baseline mean cerebral flow velocity. OBJECTIVE: The aim of the study was to determine the EEG abnormalities in the intervals of Breath-Holding Spells in children from 6 months to 5yrs. METHODS: An observational prospective study was done at Institute of Child Health and Hospital for Children between May 2016 and October 2016, on children diagnosed as having Breath Holding Spells by clinical history and laboratory evaluation, including complete blood count (CBC), ECG, Echocardiography and Electroencephalography (EEG). RESULTS: A total of 100 children (63 boys, 37 girls) with breath holding spells comprised the study group compared with similar age and sex group of 100 children with simple febrile convulsions served as controls. We found that mean age of onset was 12.7 months. Cyanotic spells (62%) were predominated over pallid spells (26%). There were positive family history (26%) and consanguinity (13%) in the study patients. Mean haemoglobin values was significantly lower in children with BHS (9.978±0.925 g/dl) than with controls (10.276±0.947). Electroencephalographic study in children with BHS showed no significant abnormality except for one child which had slow wave. CONCLUSION: Electroencephalographic study in combination with detailed history and clinical observation is of value in differentiating breath holding spells from convulsive disorders. Routine referral of children with clinical diagnosis of breath holding spells to paediatric neurology clinics is unnecessary and routine EEG is not appropriate investigation in the initial evaluation of breath holding spells.