Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-26T12:52:22.829Z Has data issue: false hasContentIssue false
  • English
  • Français

Efficacy of treatment with belladonna in children with severe pallid breath-holding spells

Published online by Cambridge University Press:  11 May 2018

M. Cecilia Gonzalez Corcia ,
Adrien Bottosso ,
Isabelle Loeckx ,
Françoise Mascart ,
Guy Dembour  and
Geneviève François
M. Cecilia Gonzalez Corcia*
Affiliation:
Pediatric Department and Pediatric Cardiology Departments, St. Luc Hospital, Brussels, Belgium
Adrien Bottosso
Affiliation:
Pediatric Department and Pediatric Cardiology Departments, St. Luc Hospital, Brussels, Belgium
Isabelle Loeckx
Affiliation:
Pediatric Department, Centre Hospitalier Chrétien, Liege, Belgium
Françoise Mascart
Affiliation:
Pediatric Department, Centre Hospitalier Chrétien, Liege, Belgium
Guy Dembour
Affiliation:
Pediatric Department and Pediatric Cardiology Departments, St. Luc Hospital, Brussels, Belgium
Geneviève François
Affiliation:
Pediatric Department and Pediatric Cardiology Departments, St. Luc Hospital, Brussels, Belgium
*
Author for correspondence: M. C. Gonzalez Corcia, PhD, Pediatric Cardiology Department, Cliniques Universitaires St Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium. Tel: +32 (0)2 764 13 80; Fax: +32 (0)2 764 89 11; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Pallid breath-holding spells are common and dramatic forms of recurrent syncope in infancy. They are very stressful despite their harmless nature and sometimes require treatment.

Objective

The objective of this study was to evaluate the efficacy of belladonna in severe breath-holding spells.

Methods

This is a multicentric, retrospective series involving 84 children with severe pallid breath-holding spells. Inclusion criteria were >1 pallid breath-holding spell with loss of consciousness, paediatric cardiology evaluation, and follow-up >6 months. In total, 45 patients received belladonna and 39 patients did not receive treatment, according to physician preference.

Results

Mean age was 11 months, ranging from 4 to 18 months, with 54% of males. Mean spell duration was 30 seconds (interquartile range 15, 60), and the frequency was four episodes per month (interquartile range 0.5, 6.5). Comparison of baseline characteristics between groups showed similar demographics, with the single difference in the severity of the spells, being more severe in the treated group. When comparing the treated and non-treated groups at 3 months, only two (5%) patients had a complete remission in the first group, whereas 20 (44%) had remission in the belladonna group (p<0.01). When considering the characteristics of the spells before and after the initiation of treatment with belladonna, 75% of the patients presented a positive response, with 44% of the patients presenting with complete resolution of the spells (p<0.01). No major adverse reaction was reported, with only 5% minor adverse events.

Conclusions

Belladonna is highly effective to alleviate severe breath-holding spells in young children, without any major adverse effects.

Keywords

Breath-holding spellsbelladonnaatropinesyncopetreatment
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 7 , July 2018 , pp. 922 - 927
Check for updates
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. DiMario, FJ Jr. Prospective study of children with cyanotic and pallid breath-holding spells. Pediatrics. 2001; 107: 265–269.Google Scholar
2. DiMario, FJ Jr, Burleson, JA. Autonomic nervous system function in severe breath holding spells. Pediatr Neurol. 1993; 9: 268–274.CrossRefGoogle ScholarPubMed
3. Gauk, EW, Kidd, L, Prichard, JS. Mechanism of seizures associated with breath-holding spells. N Engl J Med 1963; 268: 1436–1441.Google Scholar
4. Southall, P, Stebbens, V, Shinebourne, E. Sudden and unexpected death between 1 and 5 years. Arch Dis Child 1987; 62: 700–705.CrossRefGoogle ScholarPubMed
5. Colina, KF, Abelson, HT. Resolution breath holding spells with treatment of concomitant anemia. J Pediatr 1995; 126: 395–397.Google Scholar
6. Daoud, AS, Batieha, A, al-Sheyyab, M, Abuekteish, F, Hijazi, S. Effectiveness of iron therapy on breath-holding spells. J Pediatr 1997; 130: 547–550.Google Scholar
7. Abbaskhanian, A, Sajjadi, S, Rezai, MS. Effects of piracetam on pediatric breath holding spells: a randomized double blind controlled trial. Iran J Child Neurol 2012; 6: 9–15.Google ScholarPubMed
8. Sawires, H, Botrous, O. Double-blind, placebo-controlled trial on the effect of piracetam on breath-holding spells. Eur J Pediatr 2012; 171: 1063–1067.CrossRefGoogle ScholarPubMed
9. Walsh, M, Knilans, T, Anderson, J, Czosek, R. Successful treatment of pallid breath-holding spells with fluoxetine. Pediatrics 2012; 130: 685–689.Google Scholar
10. Kelly, AM, Porter, CJ, McGoon, MD, Espinosa, RE, Osborn, MJ, Hayes, DL. Breath-holding spells associated with significant bradycardia: successful treatment with permanent pacemaker implantation. Pediatrics. 2001; 108: 698–702.Google Scholar
11. Wilson, D, Moore, P, Finucane, AK, Skinner, JR. Cardiac pacing in the management of severe pallid breath-holding attacks. J Paediatr Child Health 2005; 41: 228–230.Google Scholar
12. Weiner, N. Atropine, scopolamine and related antimuscarinic drugs. In: Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 6th edn. Macmillan Publishing Co., New York, 1980: 120–137.Google Scholar
13. Mc Guigan, H. The effect of small doses of atropine on heart rate. J Am Med Assoc 1921; 76: 1338–1340.Google Scholar
14. Kahn, A, Rebuffat, E, Sottiaux, M, Muller, MF, Bochner, A, Grosswasser, J. Prevention of airway obstructions during sleep in infants with breath-holding spells by means of oral belladonne: a prospective double-blinded crossover evaluation. Sleep 1991; 14: 432–438.Google Scholar
15. Vajpayee, N, Graham, SS, Bem, S. Basic examination of blood and bone marrow. In: McPherson RA, Pincus MR, (eds). Henry’s Clinical Diagnosis and Management by Laboratory Methods, Chapter 30, 22nd edn. Saunders, an imprint of Elsevier Inc., Philadelphia, PA, 2011: 509–535.Google Scholar
16. Caksen, H, Odabas, D, Akbayram, S, et al. Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children. Hum Exp Toxicol 2003; 22: 665–668.CrossRefGoogle ScholarPubMed
17. Murata, R, Matsuoka, O, Hattori, H, et al. Efficacy of Kan-baku- taiso-to (TJ-72) on breath holding spells in children. Am J Chin Med 1988; 16: 155–158.Google Scholar
18. Donma, MM. Clinical efficacy of piracetam in treatment of breath holding spells. Pediatr Neurol. 1998; 18: 41–45.CrossRefGoogle ScholarPubMed
19. Williams, J, Cain, N. Case report of successful treatment of pallid breath-holding spells with glycopyrrolate. Pediatrics 2015; 135: e1308–e1311.Google Scholar
20. Garg, M, Goraya, JS. Treatment of cyanotic breath-holding spells with oral theophylline in a 10-year-old boy. J Child Neurol 2015; 30: 919–921.Google Scholar
21. Carano, N, Bo, I, Zanetti, E, Tchana, B, Barbato, G, Agnetti, A. Glycopyrrolate and theophylline for the treatment of severe pallid breath-holding spells. Pediatrics. 2013; 131: e1280–e1283.Google Scholar
22. McWilliam, RC, Stephenson, JB. Atropine treatment of reflex anoxic seizures. Arch Dis Child 1984; 59: 473–475.Google Scholar
23. Bolat, N, Eliacik, K, Sargin, E, Kanik, A, Baydan, F, Sarioglu, B. Efficacy of a brief psychoeducational intervention for mothers of children with breath-holding spells. Neuropediatrics. 2016; 47: 226–232.Google Scholar