Can Reflex Anoxic Seizures Progress to Status Epilepticus in Young Children?

Elaine Wyllie, MD


September 12, 2000


Can reflex anoxic seizures in babies and young children progress to status epilepticus (SE) through a "kindling" effect, or should another diagnosis be considered if SE occurs? When should treatment be considered, and which antiepileptic is the best choice? Could you recommend a thorough review article on this phenomenon?

Janie Worth, MD

Response from Elaine Wyllie, MD

Cyanotic infant syncope (breath-holding spells) is apparently due to acute cerebral hypoxia. In most cases, the child recovers spontaneously after a brief period of unconsciousness and sometimes opisthotonic posturing. The syncopal event itself is not epileptic, and concurrent EEG typically shows cerebral slowing or suppression rather than a seizure pattern. However, the anoxic event can provoke a true epileptic seizure, even SE, evolving from the initial syncope.

Correction of any underlying anemia may reduce the attacks. Antiepileptic medications will not prevent the episodes. However, treatment with antiepileptic medication may reduce the tendency for the events to evolve to SE. No single agent has been proposed as superior to others for this indication. Carbamazepine could be a rational choice.


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