WordNet

relieve (someone) from work by taking a turn; "She spelled her husband at the wheel"
take turns working; "the workers spell every four hours"
a verbal formula believed to have magical force; "he whispered a spell as he moved his hands"; "inscribed around its base is a charm in Balinese" (同)magic spell, magical spell, charm
indicate or signify; "Im afraid this spells trouble!" (同)import
orally recite the letters of or give the spelling of; "How do you spell this word?" "We had to spell out our names for the police officer" (同)spell_out
write or name the letters that comprise the conventionally accepted form of (a word or part of a word); "He spelled the word wrong in this letter" (同)write
place under a spell
a short respite (同)breather, breathing place, breathing space, breathing spell, breathing time
a slight movement of the air; "there wasnt a breath of air in the room"
the air that is inhaled and exhaled in respiration; "his sour breath offended her"
the process of taking in and expelling air during breathing; "he took a deep breath and dived into the pool"; "he was fighting to his last breath"
passing or able to pass air in and out of the lungs normally; sometimes used in combination; "the boy was disappointed to find only skeletons instead of living breathing dinosaurs"; "the heavy-breathing person on the telephone" (同)eupneic, eupnoeic
the bodily process of inhalation and exhalation; the process of taking in oxygen from inhaled air and releasing carbon dioxide by exhalation (同)external_respiration, respiration, ventilation
forming words with letters according to the principles underlying accepted usage

PrepTutorEJDIC

〈語〉‘を'『つづる』,‘の'つづりを言う(書く) ・〈…の文字が〉〈語〉‘の'『つづりである』・(受動態にできない) ・(結果として)…‘を'招く,意味する・語をつづる,語のつづりを言う(書く)
『呪文』(じゅもん)まじない;魔法にかかった状態,呪縛(しゅばく) / 《単数形で》魅力,魔力
しばらくの間,一時 / (ある天気の)『ひと続き』 / (病気などの)『ひとしきり』,発作 / ひと仕事,(仕事の)交替 / (…を)〈人〉‘と'交替する《+『名』+『at』+『名』(do『ing』)》
〈U〉『息』,『呼吸』;UC〉1回の吸気(め気) / 〈C〉(風の)そよぎ;(…の)かすかなかおり《+『of』+『名』》 / 〈C〉(…の)ささやき(whisper)《+『of』+『名』》
〈U〉呼吸;一息 / 〈C〉一呼吸の間,瞬時 / 〈C〉休息,休止
〈U〉しっかり握ること,保持 / 〈C〉《しばしば複数形で》所有地,持ち株 / 〈U〉ホールディング(バスケットボール・フットボールなどで腕や手で相手をじゃますね反則行為)
〈U〉『語のつづり方』 / 〈C〉語のつづり

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/10 20:25:11」(JST)

wiki en

Breath-holding spells are the occurrence of episodic apnea in children, possibly associated with loss of consciousness, and changes in postural tone.

Breath-holding spells occur in approximately 5% of the population with equal distribution between males and females. They are most common in children between 6 and 18 months and usually not present after 5 years of age. They are unusual before 6 months of age. A positive family history can be elicited in 25% of cases. They may be confused with a seizure disorder. They are sometimes observed in response to frustration during disciplinary conflict.

Classification

There are four types of breath-holding spells.

The most common is termed simple breath-holding spell, in which the manifestation is the holding of breath in and expiration. The usual precipitating event is a frustration or injury leading to the temporary cessation of breathing in and expiration. There is no major alteration of circulation or oxygenation and the recovery is spontaneous.
The second type are the Cyanotic breath-holding spells. They are usually precipitated by anger or frustration although they may occur after a painful experience. The child cries and has forced expiration sometimes leading to cyanosis (blue in color), loss of muscle tone, and loss of consciousness. The child usually recovers within a minute or two, but some fall asleep for an hour or so. Physiologically, there is often hypocapnea (low levels of carbon dioxide) and usually hypoxia (low levels of oxygen). The events are thought to occur due to a variety of factors, including the fact that the child is not breathing, there is increased intrathoracic pressure secondary to the Valsalva maneuver, and decreased cardiac output. This eventually leads to a significant decrease of circulation to the brain and ultimately, loss of consciousness. There is no postictal phase (as is seen with seizures), no incontinence, and the child is fine in between spells. EEGs are normal in these children. There is no relationship to the subsequent development of seizures or cerebral injury as a consequence of breath holding spells.
In the third type, known as Pallid breath-holding spells, the most common stimulus is a painful event. The child turns pale (as opposed to blue) and loses consciousness with little if any crying. The EEG is also normal, and again there is no post ictal phase, nor incontinence. The child is usually alert within a minute or so. There may be some relationship with adulthood syncope in children with this type of spell.
A fourth type, known as Complicated breath-holding spells, may simply be a more severe form of the two most common types. This type generally begins as either a cyanotic or pallid spell that then is associated with seizure like activity. An EEG taken while the child is not having a spell is still generally normal.

The diagnosis of a breath-holding spell is made clinically. A good history including the sequence of events, lack of incontinence and no post ictal phase, help to make an accurate diagnosis. Some families are advised to make a video recording of the events to aid diagnosis. An electrocardiogram (ECG) may rule out cardiac arrhythmia as a cause. There is some evidence that children with anemia (especially iron deficiency) may be more prone to breath-holding spells.

Treatment

The most important approach is to reassure the family, because witnessing a breath-holding spell is a frightening experience for observers. There is no definitive treatment available or needed for breath-holding spells, as the child will eventually outgrow them.

Some trials have demonstrated the efficacy of iron therapy, especially because although BHS can readily occur without anemia, BHS has been found to be exaggerated by the presence of anemia.^[1]^[2] Other studies have supported the use of piracetam;^[3]^[4] a 1998 study indicating that over two months piracetam reduced BHS incidence by sixty percent, twice as much as a placebo. All of these studies agree with the established medical view^[5]^[6] that a pharmacological agent is not necessary, although it may be desirable for the comfort of the parent and child.

Two articles on breath-holding spells^[6]^[7] strongly suggest that parents consider having their child be tested by electrocardiogram for the rare, but real possibility that the BHS episodes are actually a symptom of prolonged QT-syndrome, a serious but treatable form of cardiac arrythmia.

References

^ Poets CF, Samuels MP, Wardrop CA, Picton-Jones E, Southall DP (April 1992). "Reduced haemoglobin levels in infants presenting with apparent life-threatening events--a retrospective investigation". Acta Paediatr. 81 (4): 319–21. doi:10.1111/j.1651-2227.1992.tb12234.x. PMID 1606392.
^ Colina KF, Abelson HT (March 1995). "Resolution of breath-holding spells with treatment of concomitant anemia". J. Pediatr. 126 (3): 395–7. doi:10.1016/S0022-3476(95)70456-6. PMID 7869200.
^ Donma MM (January 1998). "Clinical efficacy of piracetam in treatment of breath-holding spells". Pediatr. Neurol. 18 (1): 41–5. doi:10.1016/S0887-8994(97)00153-7. PMID 9492090.
^ Azam M, Bhatti N, Shahab N (2008). "Piracetam in severe breath holding spells". Int J Psychiatry Med 38 (2): 195–201. doi:10.2190/PM.38.2.f. PMID 18724570.
^ DiMario FJ (January 1992). "Breath-holding spells in childhood". Am. J. Dis. Child. 146 (1): 125–31. doi:10.1001/archpedi.1992.02160130127035. PMID 1736640.
^ ^a ^b Breningstall GN (February 1996). "Breath-holding spells". Pediatr. Neurol. 14 (2): 91–7. doi:10.1016/0887-8994(96)00006-9. PMID 8703234.
^ Allan WC, Gospe SM (March 2005). "Seizures, syncope, or breath-holding presenting to the pediatric neurologist--when is the etiology a life-threatening arrhythmia?". Semin Pediatr Neurol 12 (1): 2–9. doi:10.1016/j.spen.2004.11.004. PMID 15929459.

UpToDate Contents

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1. 乳児期に生じる非てんかん性発作性障害 nonepileptic paroxysmal disorders in infancy
2. 小児や青年の失神の原因 causes of syncope in children and adolescents
3. 小児のチアノーゼへの治療アプローチ approach to cyanosis in children
4. 乳児や小児の痙攣発作の臨床検査診断 clinical and laboratory diagnosis of seizures in infants and children
5. 小児における先天性中枢性低換気症候群および睡眠関連低換気症のその他の原因 congenital central hypoventilation syndrome and other causes of sleep related hypoventilation in children

English Journal

[Changes in P-wave, T-wave, and ST segment amplitude in 12 lead electrocardiogram in children with breath holding spell].

Zhang W1, Wang C2, Zou R2, Liu L3, Wu L2, Luo X2, Li F2, Liao D2, Cai H2.
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences.Zhong Nan Da Xue Xue Bao Yi Xue Ban.2016 Jun 28;41(6):600-5. doi: 10.11817/j.issn.1672-7347.2016.06.008.
in

English, Chinese目的：探讨屏气发作儿童12导联心电图的P波、T波及ST段振幅变化。方法：收集2009年10月至2015年9月在中南大学湘雅二医院儿童心脏专科门诊就诊、明确诊断为屏气发作的儿童29例(研究组)，年龄3个月~6(1.82±1.27)岁�

PMID 27374444

Evaluation of QT Dispersion in Children with Breath Holding Spells.

Movahedian AH1, Heidarzadeh Arani M2, Motaharizad D3, Mousavi GA4, Mosayebi Z5.
Iranian journal of child neurology.Iran J Child Neurol.2016 Winter;10(1):25-30.
OBJECTIVE: Breath holding spells (BHS) are common involuntary reflexes in infancy and early childhood. Differential diagnosis should embrace Long QT Syndrome (LQTS) and paroxysmal abnormalities of rhythm. The aim of this study was to compare QT dispersion (QTd) in children with breath holding spells
PMID 27057184