Olive update

Here are some of the details from today.  She passed her neurological exam, perfectly normal.  After hearing her history, family history, etc. he narrowed it down to seizures, heart issues, or pallid breath holding spells (also called reflex anoxic seizures–info below).  He is leaning toward the latter.  She did an EKG today and passed that, they drew blood to test for anemia (this can cause the BHS).  She has an EEG scheduled Oct. 21 (5 days before my due date!–great…)  His thoughts are that the EKG & EEG will come back negative.  COULD it be something way worse (i.e., brain tumor)?  yes, but very unlikely and he felt like the risk of an MRI was greater than the need for it–BJ & I agree.  Because her falls are always “provoked” as he called it, there is less reason to worry.  So…in the meantime, if she does it again, do what we’ve been doing by letting her lay there and her come out of it on her own.  If it stays in the same pattern, do nothing.  If the pattern changes, bring her to the ER.

My brain is fried at this point so I’m sure I’ve left something out–ask away if I have!  thank you everyone for your prayers, it means so much to us.  BJ & Aubin

Here is all of the info for those of you who want to know more)

Pallid Breath Holding Spell

About 20 percent of affected children have the pallid form of BHS in which the child turns pale. It also is called type 2, white breath-holding, reflex anoxic seizure, or pallid infantile syncope. The pallid form of BHS typically follows a frightening or painful experience.

Causes

Although the exact physiological mechanism of breath holding spells is not understood, they are an involuntary reflex caused by the interplay between the respiratory control center of the central nervous system, the autonomic nervous system, and the cardiopulmonary system.

PALLID BHS Pallid breath holding spells are unpredictable. They usually occur in response to being startled, frightened, in pain, immunized, or injured, particularly after hitting the head.
In a pallid BHS the brain sends a signal via the vagus nerve that severely slows the heart rate, leading to a temporary cessation of breathing and loss of consciousness.

Risk factors

There appears to be a genetic component to at least some breath holding spells. About 25 percent of affected children—particularly those who experience pallid BHS—have a family history of BHS or fainting.
In some cases breath holding spells may be associated with anemia (a reduced number of red blood cells) caused by an iron deficiency, although this is controversial. Treatment may decrease the number of spells in some anemic children; however, treatment with iron increases the frequency of spells in children who are not anemic.

PALLID BHS In a pallid breath holding spell a child do the following:

• gasp and the lower jaw may quiver, but there is little or no crying
• experience a slowing heart rate or the heart may even stop briefly
• turn pale
• sweat
• stop breathing
• lose muscle strength and go limp
• faint or lose consciousness
• experience muscle twitching or body stiffness while unconscious
• have a seizure

Following these responses, the child’s heart speeds up, breathing resumes on its own, and consciousness returns. The child usually recovers completely within one minute but may feel sleepy.
Seizures are much more likely with the pallid form than with the cyanotic form of BHS. Seizures during breath holding spells are more likely if breath holding lasts longer than usual. A child may vomit or urinate during a seizure.

Breath holding spells can be distinguished from epileptic seizures using the following criteria:

• BHS are provoked by an event or situation.
• BHS seizures are brief.
• Recovery from BHS is rapid.
• The change in skin color and loss of consciousness with BHS occur before any seizure-type jerking.
• With epilepsy, convulsions and muscle weakness precede the loss of skin color.
• An electroencephalogram (EEG) that records electrical activity in the brain is normal in all forms of BHS, whereas it may be abnormal with epilepsy.

If a child is anemic, iron (at 6 mg per kg [2.2 lb]) of body weight per day for at least three months) may reduce the frequency of breath-holding spells. If pallid breath holding spells are frequent and severe, a preventative anti-cholinergic medicine such as atropine sulfate may be prescribed, in consultation with a neurologist or cardiologist. The dosage is usually 0.1 mg of oral atropine three times daily. Anti-convulsive medications have no effect on breath holding spells.

Prognosis

There are no long-term effects of breath holding spells. Both types of BHS cease without treatment as the child’s brain and body develops and matures. The cyanotic form usually peaks at about two years of age and is rare past the age of five. Both types of BHS disappear by the age of four or five in about 50 percent of affected children and in 90 percent of children by the age of six.
Up to 17 percent of children with pallid BHS will experience syncope (fainting spells) as adults, usually in response to fear, injury, or emotional stress. Children with cyanotic episodes are not at a greater risk for syncope as adults.

Parental concerns

Breath holding spells can be extremely frightening for parents, siblings, and caregivers. Families need to be reassured that BHS is not a harmful or dangerous event and that no treatment is needed. It is important that caregivers understand the cause of breath holding spells and the proper response.
During a breath holding spell parents should:

• Protect children from injury and prevent their arms, legs, and head from hitting something hard or sharp.
• Lay children down on their back or side, preferably on a padded surface such as a carpeted floor; this increases blood flow to the brain and helps prevent muscle jerking.
• Check for food in the mouth if the child ate just before a spell. Parents should not try to remove the food; rather the child’s head should be turned to one side so that the food can come out on its own.
• Touch and talk to the child.
• Allow children to wake from the spell on their own.
• Time the spell with a watch.