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Overuse of EEG and ECG in children with breath-holding spells and its implication for the management of the spells

Hellström Schmidt, Sanna LU orcid ; Smedenmark, Julia ; Jeremiasen, Ida LU ; Sigurdsson, Björn LU ; Eklund, Erik A LU and Pronk, Cornelis Jan LU (2023) In Acta Pædiatrica
Abstract

AIM: Breath-holding spells (BHS) are common in children, but evidence-based clinical guidelines are lacking. We investigated a large population-based cohort of BHS patients, to propose a refined description of typical BHS and guidelines for its management.

METHODS: In a cross-sectional retrospective study, patients diagnosed with BHS in Southern Sweden 2004-2018 were recruited. Disease characteristics and diagnostic data were collected from patient medical records.

RESULTS: In total, 519 patients, mean age at diagnosis 19.8 ± 13.8 months with equal gender distribution, were included. In 48.3%, BHS had already been diagnosed after one spell. During spells, 78.0% of patients were unresponsive. For 71.5%, atonic, tonic,... (More)

AIM: Breath-holding spells (BHS) are common in children, but evidence-based clinical guidelines are lacking. We investigated a large population-based cohort of BHS patients, to propose a refined description of typical BHS and guidelines for its management.

METHODS: In a cross-sectional retrospective study, patients diagnosed with BHS in Southern Sweden 2004-2018 were recruited. Disease characteristics and diagnostic data were collected from patient medical records.

RESULTS: In total, 519 patients, mean age at diagnosis 19.8 ± 13.8 months with equal gender distribution, were included. In 48.3%, BHS had already been diagnosed after one spell. During spells, 78.0% of patients were unresponsive. For 71.5%, atonic, tonic, tonic-clonic or myoclonic seizures were reported, and 78.0% of patients had a spell lasting less than 1 min. Electroencephalography was conducted in 30.4% and Electroencephalography in 45.1%. Six children (3.8%) had a pathological electroencephalogram, four of which had concomitant epilepsy and only 0.9% of children had electrocardiogram findings suggesting pathology, none showing long QT syndrome.

CONCLUSION: Children with BHS were frequently subjected to unnecessary diagnostic interventions. We characterise a typical presentation of BHS and propose a management-algorithm, which is expected to reduce unnecessary usage of electroencephalography and electroencephalography.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Acta Pædiatrica
publisher
Wiley-Blackwell
external identifiers
  • scopus:85175490666
  • pmid:37905418
ISSN
1651-2227
DOI
10.1111/apa.17020
language
English
LU publication?
yes
id
8c9f7b27-9ae5-4c06-bfe4-513adce4994d
date added to LUP
2023-11-07 09:40:41
date last changed
2024-04-19 20:12:38
@article{8c9f7b27-9ae5-4c06-bfe4-513adce4994d,
  abstract     = {{<p>AIM: Breath-holding spells (BHS) are common in children, but evidence-based clinical guidelines are lacking. We investigated a large population-based cohort of BHS patients, to propose a refined description of typical BHS and guidelines for its management.</p><p>METHODS: In a cross-sectional retrospective study, patients diagnosed with BHS in Southern Sweden 2004-2018 were recruited. Disease characteristics and diagnostic data were collected from patient medical records.</p><p>RESULTS: In total, 519 patients, mean age at diagnosis 19.8 ± 13.8 months with equal gender distribution, were included. In 48.3%, BHS had already been diagnosed after one spell. During spells, 78.0% of patients were unresponsive. For 71.5%, atonic, tonic, tonic-clonic or myoclonic seizures were reported, and 78.0% of patients had a spell lasting less than 1 min. Electroencephalography was conducted in 30.4% and Electroencephalography in 45.1%. Six children (3.8%) had a pathological electroencephalogram, four of which had concomitant epilepsy and only 0.9% of children had electrocardiogram findings suggesting pathology, none showing long QT syndrome.</p><p>CONCLUSION: Children with BHS were frequently subjected to unnecessary diagnostic interventions. We characterise a typical presentation of BHS and propose a management-algorithm, which is expected to reduce unnecessary usage of electroencephalography and electroencephalography.</p>}},
  author       = {{Hellström Schmidt, Sanna and Smedenmark, Julia and Jeremiasen, Ida and Sigurdsson, Björn and Eklund, Erik A and Pronk, Cornelis Jan}},
  issn         = {{1651-2227}},
  language     = {{eng}},
  month        = {{10}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Pædiatrica}},
  title        = {{Overuse of EEG and ECG in children with breath-holding spells and its implication for the management of the spells}},
  url          = {{http://dx.doi.org/10.1111/apa.17020}},
  doi          = {{10.1111/apa.17020}},
  year         = {{2023}},
}