Breath-holding spells comorbidity with epileptic seizures in children: VEEG and clinical outcomes

This study aims to explore the electroencephalogram (EEG) and clinical characteristics of breath-holding spells (BHS) comorbidity with epileptic seizures (ES) in children, providing reference for the rational diagnosis and prognosis assessment of such children. We conducted a prospective summary of the clinical data from patients of BHS comorbidity with ES, who were admitted to Hunan Children's Hospital from April 2017 to November 2023, by analyzing their EEGs and clinical characteristics. There were 7 patients of BHS comorbidity with ES. BHS and ES appeared successively or simultaneously in the course of the disease. There were 8 "slow" patterns and 5 "slow-flat-slow" patterns in all 13 BHS of 7 cases during ictal EEG. The types of ES included tonic-clonic seizures, epileptic spasms, myoclonic, focal seizures, and so on. In the BHS, 5 cases were controlled, and 2 cases were uncontrolled after psychological and behavioral therapy. In the ES, 5 cases were seizures-free, 1 case with myoclonic and epileptic spasms decreased after treatment using valproate and vigabatrin, and 1 case with multiple seizure types was uncontrolled after being treated with multiple antiseizure medications. The onset age of breath-holding attacks in the BHS-only group was earlier than that in the BHS + epilepsy groups. The abnormal rates of head magnetic resonance imaging (MRI) and EEG in the BHS-only group were lower than those in the BHS + epilepsy groups. The BHS-only group had normal interictal EEG, while 5 out of 7 patients in the BHS + epilepsy group had epileptic waves in interictal EEG. The incidence of the BHS + epilepsy group combined with other diseases was higher than that of the BHS-only group. The rate of developmental delay in the BHS + epilepsy group was higher than that in the BHS-only group. Both differences had statistical significance (P < .05). BHS combined with ES may exist in children, especially for patients with head MRI abnormalities, EEG abnormalities, and developmental delay. Diagnosis needs to be based on clinical manifestations and VEEG. If new seizure forms appear in BHS patients, a timely EEG examination should be completed to correctly identify the occurrence of ES. If necessary, antiseizure medication should be given.