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Case Reports in Neurological Medicine
Volume 2013 (2013), Article ID 603190, 3 pages
Case Report

Diverse Presentation of Breath Holding Spells: Two Case Reports with Literature Review

1Pediatric Neurology, Baylor College of Medicine, Houston, TX 77030, USA
2Pediatric Neurology, University of Nebraska Medical Center, Omaha, NE 68198, USA
3Pediatrics, Creighton University, Omaha, NE 68131, USA
4Pediatric Neurology, Umaid Women and Children’s Hospital, Jodhpur, Rajasthan 342001, India

Received 14 August 2013; Accepted 8 September 2013

Academic Editors: J. E. Cohen, R. Koide, and P. Sandroni

Copyright © 2013 Geetanjali Rathore et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. 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 breathholding 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 is 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.