Atypical presentation of breath holding spells: two case reports with literature review


  • G. V. K. Kishore Varma Department of Pediatrics, Al-Lamki polyclinics, Muscat, Oman
  • P. Govardhan Department of Pediatrics, Cloud nine hospital, Chennai, India
  • Vijaya Lakshmi K. Department of Metarnal and Child Health, Ferandez Hospital, Hyderabad, India



Breath holding spells, Non-epileptic condition, Seizure


Breath holding spells are a common form of a benign sudden non-epileptic condition commonly seen in healthy children 6 to 48 months of age. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breath holding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of   breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education are the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells.


Author Biography

G. V. K. Kishore Varma, Department of Pediatrics, Al-Lamki polyclinics, Muscat, Oman

Department of Pediatrics 

Allamki Polyclinic , Muscat


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Case Reports