Breath holding spells - a tale of 50 years.

Historical background and past knowledge: The earliest reference to BHS, then referred to as infantile form of temper tantrums or infantile syncope, were made by Rillet and Barthezin in 1843, and by Meigsin in 1848. Subsequently in the 20th century, various authors published their clinical viewpoints on its pathophysiology and prognostic significance. Based on the color change demonstrated by the child during the spell, BHS were classified as cyanotic, pallid and mixed. Till the 1960’s, despite several hypotheses, the pathophysiology and etiology remained largely nebulous and uncertainities existed regarding the outcome. Multiple factors like disturbed parent-child relationship, hereditary autonomic instability, self asphyxiation, decreased cerebral blood flow secondary to increased intrathoracic pressure due to spontaneous valsalva manoeuvre and altered cerebral mechanism secondary to various stimuli were implicated for cyanotic BHS [1]. For the pallid form, circulatory failure secondary to asystole leading to cerebral anoxia was considered the most probable hypothesis [2].