PAROXYSMAL EVENTS RELATED TO INCREASED VAGAL REACTIVITY IN HEALTHY-CHILDREN

“Breath-holding spells” and “reflex anoxic seizures” in children are sometimes misdiagnosed as epilepsy. Paroxysmal events may however be vagally-mediated. Initiation of the vagal reflex follows usually a sudden and unexpected fright or pain. The purpose of this study was to evaluate the strength of the vagal reflexes in children with various forms of paroxysmal events. Subjects and methods: 57 infants, aged 5 months to 5 years, with a history of at least two episodes on non-epileptic paroxysmal events were retained for this study. Great care was provided in the parental history. Based on anamnestic data, each subject was assigned to a group. Group I: Blue breath-holding spells (BBHS =18); Group II: Reflex anoxic seizures (RAS=17); Group III: Sobbing spasms (SS=14); Group IV : Mixed spasms (MS=8). An ocular compression test (OCT) was performed according to previously described technique (Ramet Ped Res 1988). Following parameters were measured : control RR interval; longest RR interval; vagal escape; % RR (= longest RR interval / control RR interval) × 100. Results : The highest values for the longest RR obtained in the RAS group, differed significantly from those obtained in the BBHS group. - The mean and SD values for % RR were respectively for groups I, II, III and IV 354 + 207 %, 601 + 164%, 524 + 256% and 611 + 260%. % RR was significantly higher in the RAS group than in the BBHS group. Quite unexpectedly, we found that the % RR in the SS and in the mixed groups were significantly higher than in the BBHS. We can assume that the clear-cut dissociation between “vagally-mediated” RAS and “vagally independent” BBHS seems incorrect. However, we demonstrated that vagal reactivity plays a certain role in SS. Our results sustain the importance of performing an O.C.T. not only in RAS but also in BBHS and SS as well as in the MS group. The classical description between “blue” and “white breath holding spells” depending on the absence or presence of an increased vagal reactivity is, according to our present data, no longer fully applicable.