REFLEX ANOXIC SEIZURES

What are Reflex Anoxic Seizures ?

Reflex Anoxic Seizures(RAS)  or white breath holding spells are episodes which occur usually in young children which are triggered by fear , minor injury or fall. They are not epilepsy 

What age group do they occur?

 Most children (80 to 90 percent) with these spells have their first episode between 6 and 18 months of age . However, onset may occur from the neonatal period to five years of age .

What happens to the child during reflex anoxic seizures ?

There is usually a trigger , like emotion ( fear anger) , pain or minor head trauma.There may be crying before the episode. Then the child may become unresponsive and sometimes this may be followed by stiffness and jerking of all four limbs. The child may be unresponsive for 30 -60 minutes afterwards .

What causes reflex anoxic seizures?

The exact cause is not known.Iron deficiency anemia is more prevalent in children with RAS and may contribute to changes in the autonomic nervous system which may cause slowing of the heart , hence reduced blood supply to the brain and the episodes.

How is the diagnosis made?

The diagnosis is made by close questioning of the parents caregiver about the episode. Video recordings may be useful. There is no test to diagnose reflex anoxic seizures .A history of any provocation (eg, head injury, crying) should be asked and  is typical for RAS but not epileptic seizures. Prominent color change (pallor or whiteness ) also suggests RAS rather than epileptic seizures. Your doctor will also take a detailed history of development and examine the child to make sure there are no other problems

CBC and ferritin blood tests should be done in all children.

Depending on the history or examination , other tests like EEG, ECG  etc may be requested.

How are they managed ?

They are scary for parents to watch , hence parents should be reassured about the episodes. If there is iron deficiency , iron supplementation should be done. If they are very frequent then please discuss with your doctor about other medications

What about the future?

Most children stop having them by 4 years and virtually all by 8 years of age. Neurologic development is usually normal 

DR RASHMI ADIGA

CONSULTANT PAEDIATRIC NEUROLOGIST 

MBBS, D.C.H, M.R.C.P.C.H (U.K), C.C.T(U. K), F.R.C.P.C.H