RHC for Health Professionals
Red Flag Symptoms:
- Prolonged events
- Chest pain/dyspnoea/palpitations/structural heart disease
- Syncope during exercise/lying down/during sleep
- Sensorineural hearing loss
- Family history - sudden unexplained death
Reflex Anoxic Seizures in Children: Advice for Referrers
Warning
Reflex anoxic seizures (RAS) are a common non-epileptic paroxysmal event in infants and preschool-aged children, but can occur at any age.
They are classically provoked by a sudden distressing stimulus, which causes loss of consciousness followed by stiffening and brief clonic movements affecting some or all limbs. The underlying pathophysiology is a vagal-induced brief cardiac asystole with resultant transient cerebral hypoperfusion. Parents and carers who witness the event are understandably anxious, and the mainstays of management are ensuring the appropriate timely diagnosis of RAS and excluding cardiac arrhythmia. A detailed history from a witness is all that is needed to diagnose this condition. Education and reassurance are the mainstay in the management, and an ECG is the only required investigation.
- Diagnosis unclear
- Red flag features
- ECG has not been previously performed and been reported as normal
Please include the following points from history in the referral letter
- Frequency of events
- Age at onset
Description of Event(s):
- Prior to Event – triggers, activity prior to onset, crying or breath-holding
- During Event(s) – responsiveness, skin colour, change in breathing, movement, duration
- After Event(s) – what was the child like after the event and for how long
General History:
- Any developmental concerns
- Past medical and family history including seizures and cardiac disease
Please include the following points from the clinical examination in the referral letter
- Document neurological and cardiac examination
- Consider features of iron deficiency (including pallor, Pica)
Advise parents to video events where possible
- Iyer A, Appleton R. Management of reflex anoxic seizures in children. Arch Dis Child 2013; 98: 714-717.