Citation

Hamed SA, Elhadad AF, Farghaly HS. Expert Rev Clin Pharmacol 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Informa Healthcare)

DOI

10.1080/17512433.2020.1828059

PMID

32969724

Abstract

BACKGROUND: Cyanotic breath holding spells (CBHS) are self-limited conditions among younger children. Frequent spells causes parents' fear and anxiety. Seizures, brain damage and sudden death have been rarely reported with BHS. Some reported reduction of spells' frequency with iron or piracetam. We evaluated the effectiveness of valproic acid (VPA) to treat CBHS and predictors of improvement.

METHODS: Participants were 90 children with CBHS (≥ 4/week) (age: 1.6±0.4yrs). They were treated with VPA (5mg/kg/d). Follow-ups occurred after 3-≥6 months. Autonomic nervous system functions were evaluated.

RESULTS: The majority (74.4%; n=67) had daily spells and 19% had ≥2 spells/d. Crying or anger provoked the spells. Postural hypotension was found in 46.7%. They had normal electroencephalography and QT, QTc interval or QTd or QTcd and heart rate. Compared to controls, postural fall in systolic (>20mmHg) and diastolic (>10mmHg) blood pressures and mean arterial pressure (>10mmHg) were observed in 46.7%, 74.4% and 72.2% (P=0.001) and miosis observed with 0.125% pilocarpine in 28.9% (P=0.001). Spells frequency reduction (P=0.001) occurred within 3 months with VPA. Multivariate analysis showed that reduction of anger and crying are independent predictor for spells' frequency [OR=4.52(95%CI=2.35-6.04), P=0.01].

CONCLUSION: VPA therapy reduces CBHS' frequency. Mood improvement is a suggestive effective mechanism.

CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier is NCT04482764.

Language: en

Keywords

Breath holding spells; cyanosis; iron deficiency anemia; piracetam; valproic acid