References
Reflex anoxic seizure: an important diagnosis to remember
Abstract
Children may present with a sudden collapsing episode, and the paramedic team is often requested to attend such emergencies. It is important that these episodes are correctly categorised as being either epileptic or non-epileptic events. A reflex anoxic seizure (RAS) is one such presentation. RAS is a paroxysmal, spontaneously-reversing, brief episode of asystole triggered by pain, fear or anxiety.
RAS occur due to a brief stoppage of the heart caused by overactivity of the vagus nerve. This is usually triggered by an unpleasant stimulus, following which the child may appear pale and lifeless. The diagnosis is usually made by a paediatrician but it is important that the paramedic team are aware of this condition. A child with a diagnosis of RAS may be managed by reassurance from paramedic practitioners if the child is judged to be well after an episode.
Reflex anoxic seizure (RAS) is a paroxysmal, spontaneously resolving, short-lived episode of pronounced bradycardia or transient asystole. It causes relative cerebral ischaemia, thereby inducing an anoxic ‘seizure’ or ‘attack’. A RAS is also referred to as pallid syncope or a white breath-holding attack (Blackmore, 1998; Bower, 1984; Meyer, 2009; Martin et al, 2010).
These events are usually triggered by painful or frightening stimuli causing excessive vagal stimulation and often can be misdiagnosed as epileptic seizures (Appleton, 1993; Hindley et al, 2006; Tidy, 2012). It is estimated that RAS affects up to 0.8% of preschool children (Tidy, 2012). A paramedic team may be requested to attend to a child after an episode of RAS. It is important for the team to remain aware of this relatively common but under-recognised condition. In this article we present a case of a five year old girl who was diagnosed with RAS followed by a discussion of the condition itself. Some practical points are provided which will be helpful in managing children with RAS in the pre-hospital setting.
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