{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T08:48:06Z","timestamp":1781081286677,"version":"3.54.1"},"reference-count":25,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,4,1]]},"abstract":"<jats:p>Severe pallid breath-holding spells (BHSs) are based on parasympathetic hyperactivity, leading to cardiac asystole, pallor, brain ischemia, loss of consciousness, and reflex anoxic seizures. In recent years, an increasing number of patients with severe pallid BHSs have been successfully treated with pacemaker implantation. We present the case of a 13-month-old girl suffering from repeated severe pallid BHSs, causing asystole, loss of consciousness, and generalized anoxic seizures. She underwent treatment with oral glycopyrrolate, an anticholinergic drug, and an oral retard preparation of theophylline. The aim of the treatment was to decrease cardiac inhibition with glycopyrrolate and to bring about a positive chronotropic effect with theophylline. In our case, the combined therapy was effective in suppressing syncope and reflex anoxic seizures associated with BHSs This avoided the need for ventricular pacemaker implantation.<\/jats:p>","DOI":"10.1542\/peds.2012-0182","type":"journal-article","created":{"date-parts":[[2013,3,19]],"date-time":"2013-03-19T01:50:45Z","timestamp":1363657845000},"page":"e1280-e1283","source":"Crossref","is-referenced-by-count":18,"title":["Glycopyrrolate and Theophylline for the Treatment of Severe Pallid Breath-holding Spells"],"prefix":"10.1542","volume":"131","author":[{"given":"Nicola","family":"Carano","sequence":"first","affiliation":[{"name":"Pediatric Cardiology, Department of Pediatrics, University of Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Bo","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Department of Pediatrics, University of Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Zanetti","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Department of Pediatrics, University of Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Tchana","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Department of Pediatrics, University of Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Barbato","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Department of Pediatrics, University of Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo","family":"Agnetti","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Department of Pediatrics, University of Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,4,1]]},"reference":[{"issue":"1","key":"2021120903061904200_B1","first-page":"125","article-title":"Breath-holding spells in childhood.","volume":"146","author":"DiMario","year":"1992","journal-title":"Am J Dis Child"},{"issue":"3","key":"2021120903061904200_B2","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/S0022-3476(05)83446-8","article-title":"Behavior profile of children with severe breath-holding spells.","volume":"122","author":"DiMario","year":"1993","journal-title":"J Pediatr"},{"issue":"2","key":"2021120903061904200_B3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1684\/epd.2008.0189","article-title":"Ocular compression pressure during EEG for the study of increased vagal reactivity.","volume":"10","author":"Haneef","year":"2008","journal-title":"Epileptic Disord"},{"issue":"3","key":"2021120903061904200_B4","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1136\/adc.53.3.193","article-title":"Reflex anoxic seizures (\u201cwhite breath-holding\u201d): nonepileptic vagal attacks.","volume":"53","author":"Stephenson","year":"1978","journal-title":"Arch Dis Child"},{"issue":"1","key":"2021120903061904200_B5","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/000992289002900102","article-title":"Pallid breath-holding spells. 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