Key result
Routine echocardiography and EEG show no diagnostic benefit in children with breath-holding spells.
Why the study?
Does routine neurologic and cardiologic assessment yield clinically significant findings in children with breath holding spells?
Case-Control (n=365)
Does routine neurologic and cardiologic assessment yield clinically significant findings in children with breath holding spells?
Routine echocardiography and EEG are unnecessary in children with typical breath holding spells, though ECG may be considered to rule out prolonged QT syndrome.
Supports limiting routine echocardiography and EEG in breath holding spells; hypothesis-generating and requires prospective confirmation before practice change.
Objective : To evaluate the value of neurologic and cardiologic assessment and also the frequency of iron deficiency anemia in children with Breath Holding Spells (BHS). Methods : The hospital charts of patients diagnosed with BHS between 2011 and 2013 were reviewed retrospectively. Results : A total of 165 children (90 boys, 75 girls) with BHS comprised the study group. A matched group of 200 children with febrile convulsions served as controls. Among the first-degree relatives, 13.3% had BHS, 1.8% had febrile convulsions and 12.1% had epilepsy. The spells were cyanotic in 140 (84.8%) children and pallid or mixed in the remainder. BNS type was simple in 46.7% of patients and complicated in the remainder. Eighteen patients had abnormalities in electroencephalography, however only one patient was diagnosed with epilepsy. Sixty nine (47.9%) patients were found to have iron deficiency anemia. Conclusion : Referral of children with clinically definite BHS to pediatric neurology or pediatric cardiology clinics and performance of echocardiography and EEG investigations for exclusion of heart disease or epilepsy appear unnecessary. However, performance of an electrocardiogram to search for prolonged QT syndrome should be considered although no patient in our series had any cardiologic abnormalities.
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Yılmaz et al. (2013) conducted a case-control in Breath Holding Spells (n=365). Breath holding spells vs. Febrile convulsions was evaluated on Neurologic and cardiologic abnormalities and iron deficiency anemia. Among children with breath holding spells, cardiologic abnormalities were absent and only 1 of 165 patients was diagnosed with epilepsy, suggesting routine echocardiography and EEG are unnecessary.
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