Spotlight on Breath-holding spells

Breath-holding spells, described more than 400 years ago, are paroxysmal clinical events that occur between the ages of 6 months and 4 to 6 years in which vigorous crying is interrupted by end-expiratory apnea, followed by cyanosis or pallor, loss of consciousness, and occasionally by a clonic seizure or myoclonic movements. Though virtually always triggered by a stimulus (pain, fear, or anger), the misconception still exists that the child “does it on purpose.” The spells are terrifying to parents or caregivers but are often dismissed by clinicians in a cavalier manner due to their benign long-term outcome and the misconception that they occur in “spoiled children.”

In this article, Dr. Felicia Gliksman of Hackensack University Medical Center, Hackensack Meridian Health School of Medicine discusses studies regarding presumed autonomic dysregulation, rare occurrences of asystole, and seizures. Dr. Gliksman also expands on recent studies proposing possible treatment options in children with breath-holding spells.

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Spotlight on Electroconvulsive therapy (ECT)

Although seizures typically indicate a state of brain dysfunction, there are circumstances in which the biological effects of a seizure may exert therapeutic benefits. In this article, Dr. Justin Coffey of the Menninger Clinic and Baylor College of Medicine discusses the standard technique for inducing controlled therapeutic seizures in humans: electroconvulsive therapy (ECT), a safe and remarkably effective treatment that involves the application of an electrical stimulus to the scalp of a patient under general anesthesia and muscle relaxation. ECT remains a cornerstone of treatment for severe mood disorders and certain other neuropsychiatric conditions, including those in patients with neurologic disorders. In addition, the neurobiological effects of ECT may have beneficial effects on a number of neurologic disorders, including Parkinson disease, epilepsy, and delirium. As with any procedure in medicine, the safety and efficacy of ECT depend critically on appropriate technique and proper patient selection and preparation.

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Spotlight on Atypical absence seizures

Atypical absences are epileptic seizures that occur in children with severe learning and neurologic disabilities of epileptic encephalopathies, mainly, Lennox-Gastaut syndrome. They are distinct from typical absences in that onset and termination is slow, impairment of consciousness is mild, and they are often associated with significant tone disturbances. The ictal EEG shows diffuse spike waves that are slower than the typical absence, usually between 1.5 and 2.5 Hz. Patients with atypical absences also suffer from concurrent tonic, atonic, and other types of epileptic seizures according to the primary epileptic syndrome. Management is usually difficult, and prognosis is that of the underlying disorder.

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Spotlight on First unprovoked seizure: workup and management

First seizure (single or multiple events within 24 hours) represents a frequent presentation of new-onset seizures, accounting for up to a third of such presentations. However, the majority of these patients will not go on to have recurrent seizures (ie, epilepsy). Although treatment reduces recurrence risk, it does not alter long-term prognosis; therefore, reserving treatment until occurrence of the second seizure is appropriate in most cases, especially in children and adolescents. In this clinical summary, Dr. Shlomo Shinnar and Dr. Susan Duberstein of Albert Einstein College of Medicine address the workup and approach to management for a patient presenting with a first seizure.

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