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Affective and respiratory attacks


Affective and respiratory attacks (synonym: breath holding attacks) are an incidental emergence of an apnoea in children, sometimes followed by a loss of consciousness and spasms.

Reasons of affective and respiratory attacks:

ARP are observed approximately at 5% of the population with equal distribution between men and women. Most often happen at children aged from 6 up to 18 months and usually are not observed after 5-year age. Emergence of such attacks to 6-month age is unusual. The positive family anamnesis can be revealed in 25% of cases. They can be confused with epilepsy. ARP usually happen in response to pain or disappointment, are more probable during the periods of nervous tension and fatigue. Existence of attacks aged from 6 months up to 5 years does not demand treatment from children and with age disappears without effects, but demands the address to the neuropathologist for the differential diagnosis in view of existence of similar symptoms of other more serious diseases.

Symptoms of affective and respiratory attacks:

Very often ARP divide only into 2 types - "blue" and "pale".

There are four ARP types.
1. The most usual, is called simple ARP. It is shown in the form of breath holding at the end of an exhalation. Usually is a consequence of frustration or an injury. There are no serious changes of blood circulation or oxygenation and recovery of breath happens spontaneously.
2. Blue type. As a rule, is caused by anger or frustration though happen also from pain. The child cries and does the forced exhalation, sometimes there is cyanosis (blue color), an atonia and a loss of consciousness. Most of children recover consciousness, some fall asleep for an hour or two. Post-иктальная the phase is absent. EEG is normal.
3. Pale type. The child turns pale (in contrast to blue type) and faints; does not cry or cries a little. Post-иктальная the phase is absent too. EEG is normal.
4. The complicated type. Can be just more severe form of the previous two types. The attack of this type begins as "blue" or "pale", and then flows in similarity of an epileptic seizure. The electroencephalogram received at the child out of an attack is generally normal.

Treatment of affective and respiratory attacks:

The most important aspect is informing family members as the attack, in most cases, represents the frightening and shocking show, and attempts to help can lead to injuries and to be ineffective without due knowledge of the adult.

There is no final decision on need of treatment as in the majority couples attacks are harmless for life, and the child, eventually, outgrows them.

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