Background: Breath holding spells (BHS) with reflex anoxic seizures (RAS) are a major source of stress in parents. There is need for more effective therapies. Methods: Descriptive analytical study in children with BHS and RAS Results: 24 children were enrolled: 13 boys, mean age at onset 8.9 months (0.5-18 months, median: 9), mean age at presentation 16.2 months (range 3-36). Six of 24 children (25%) had developmental delay: 3 had motor delay, 2 had speech delay and one had global developmental delay. Seventeen children presented with BHS (70.8%), 7 children (29.2%) presented with paroxysmal events misdiagnosed as epilepsy before visiting us. Nineteen children (79.2%) had reflex anoxic seizures along with BHS. All 24 children (100%) had microcytic, hypochromic anaemia. Neurological examination was normal in 20 (83.3%), hypotonia in two, spasticity in one. Three children (12.5%) had febrile seizures. At presentation, seven children (29.2%) were on Iron supplements, four (16.7%) were on Iron and Piracetam and one child (4.2%) was on Piracetam. Eight children (33.3%) were on anti-seizure medication. The mean and median daily dose of Risperidone was 0.32 mg and 0.25 mg respectively (dose/kg/day: 0.032 and 0.030). Following Risperidone treatment, there was significant reduction in severity of BHS (Table 1). In the subgroup analysis, in those children who were already on Iron and Piracetam prior to Risperidone, there was greater reduction in the severity of BHS, than those without prior Iron therapy (table 2). Conclusion: Risperidone significantly reduces severity of BHS, and may have synergistic effect with Iron and Piracetam.

Sandhya A P
Rainbow Children's Hospital, Secunderabad
India

Ramesh Konanki
Rainbow Children's Hospital, Secunderabad
India

Vivek Jain
Neo Clinic Children’s Hospital
India

Lokesh Lingappa
Rainbow Children's Hospital
India