How to cite this article:Abbaskhanian A, Ehteshami S, Sajjadi S, Rezai MS. Effects of Piracetam on Pediatric Breath Holding Spells: A Randomized Double Blind Controlled Trial. Iran J Child Neurol Autumn 2012; 6(4): 9-15. Abstarct:Objective Breath holding spells (BHS) are common paroxysmal non-epileptic eventsin the pediatric population which are very stressfull despite their harmlessnature. There has been no specific treatment found for the spells yet. The aimof this study was to evaluate the efficacy of piracetam (2-oxo-l-pyrrolidine)on these children.Materials & MethodsIn this randomized double blind clinical trial study, 150 children with severe BHS referred to our pediatric outpatient service were enrolled from August2011 to July 2012. The patients were randomized into two equal groups.One received 40mg/kg/day piracetam and the other group received placebo,twice daily. Patients were followed monthly for three months. The numberof attacks/month before and after treatment were documented.ResultsOf the enrolled patients, 86 were boys. The mean age of the patients was17 months (range, 6 to 24 months). In the piracetam group, 1 month after treatment an 81% response to treatment was found. In the placebo group,none of the patients had complete remission and 7% of the cases had partialremission. Overall, control of breath-holding spells was observed in 91%of the patients in the group taking piracetam as compared with 16% in the group taking placebo at the end of the study. There wasd nosignificant difference detected between the groups regarding the prevalenceof drug side effects.ConclusionA significant difference was detected between piracetam and placebo in prevention and controlling BHS. Piracetam (40mg/kg/day) had a good effecton our patients. ReferencesDi Mario FJ Jr. Prospective study of children with cyanotic and pallid breath-holding spells. Pediatrics. 2001 Feb;107(2):265-9.Kotagal P, Costa M, Wyllie E, Wolgamuth B. Paroxysmal non epileptic events in children and adolescents. Pediatrics. 2002 Oct:110(4):e46.Kolkiran A, Tutar E, Atalay S, Deda G, Cin S. Autonomic nervous system functions in children with breath-holding spells and effects of iron deficiency. Acta Pediatric. 2005 Sep;94(9):1227-31.Hüdaoglu O, Dirik E, Yiş U, et al. Parental attitude of mothers, iron deficiency anemia, and breath-holding spells. Pediatr Neurol. 2006:Jul;35(1):18-20.Ahmad Bhat M, Ali W, Mohidin K, Sultana M. Prospective study of severe breath holding spells and role of iron. J Pediatr Neurol. 2007;5(1):27-32.Lombroso CT, Lerman P. Breath holding spells (cyanotic and pallid infantile syncope). Pediatrics. 1967 Apr;39(4):563-81.Gouliaev AH, Senning A. Piracetam and other structurally related nootropics. Brain Res Rev. 1994 May;19(20:180-222.Azam M, Bhatti N, Shahab N. Piracetam in severe breath holding spells. Int J Pschyiatry Med. 2008;38(2):195-201.Garg RK. Piracetam for the treatment of breath holding spells. Indian Pediatrics.1998 Oct;35(10):1034-5.Donma MM. Clinical efficacy of piracetam in treatment of breath holding spells. Pediatr Neurol. 1998 Jan;18(1):41-5.Murata R, Matsuoka O, Hattori H, Kawawaki H, Nakajima S, Nakamura M et al. Efficacy of Kan-baku-taiso-to (TJ-72) on breath-holding spells in children. Am J Chin Med. 1988;16(3-4):155-8.Kelly AM, Porter CJ, Mc Goon MD, Espinosa RE, Osborn MJ, Hayes DL. Breath-holding spells associated with significant bradycardia: successful treatment with permanent pacemaker implantation. Pediatrics. 2001 Sep;108(3):698-702.McWilliam RC, Stephenson JB. Atropine treatment of reflex anoxic seizures. Arch Dis Child. 1984 May;59(5):473-5.Ashrafi MR, Mohammadi M, Shervin Badve R. Efficacy of piracetam in treatment of breath-holding spells Iran J Pediatr. 2002;12(4):33-6.Daoud AS, Batieha A, al-Sheyyab M, Abuekteish F, Hijazi S. Effectiveness of iron therapy on breath-holding spells. J Pediatr. 1997 Apr;130(4):547-50.Ziaullah Nawaz S, Shah S, Talaat A. Iron deficiency anemia as a cause of breath holding spells. J Postgrad Med Instit. 2005;19(2):171-4.Di lanni M, Wilsher CR, Blank MS, Conners CK, Chase CH, Funkenstein HH et al. The effects of piracetam in children with dyslexia. J Clin Psychopharmacol. 1985 Oct;5(5):272-8.Wilsher CR, Bennett D, Chase CH, Conners CK, Dilanni M, Feagans L et al. Piracetam and dyslexia: effects on reading tests. J Clin Psychopharmacol. 1987 Aug;7(4):230-7.DiMario FJ Jr, Sarfarazi M. Family pedigree analysis of children with severe breath-holding spells. J Pediatr. 1997 Apr;130(4):647-51.Winnicka K, Tomasiak M, Bielawska A. Piracetam-an old drug with novel properties. Acta Pol Pharm. 2005 Sep-Oct:62(5):405-9.Winblad, B. Piracetam: a review of pharmacological properties and clinical uses. CNS drug rev. 2005 Summer:11(2):169-82
