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.