reflex anoxic seizure

i'm almost POSITIVE this is what hayden has....guess we'll find out!


What is a Reflex Anoxic Seizure?

Reflex Anoxic Seizures (RAS) occur mainly in young children but can occur in adolescents and adults. Any unexpected stimulus, such as pain, shock or a fright causes the heart and breathing to stop, the eyes to roll up into the head, complexion to become deathly white, the body to stiffen and the arms and legs to jerk. After 30 seconds the body relaxes and the heart starts beating, the sufferer is unconscious. One or two minutes later the person may regain consciousness but can appear to be unconscious for over an hour. Upon recovery the person may be very emotional and then fall into a deep sleep for two to three hours. RAS is often misdiagnosed as simple breath-holding or more seriously as epilepsy.

What causes RAS in children?
Reflex Anoxic Seizures are caused by the vagus nerve being over stimulated due to an unexpected stimulus such as pain/shock/fear. It is not known why this should happen in some children.

Does the person's heart stop during a 'near-miss'?('near-miss' refers to an incident when the person stops breathing after a fright or other stimuli, but starts to breathe again before consciousness lost.)
The heart tends to slow down briefly rather than stop during a 'near-miss.'

Will the heart weaken through time?
No, a RAS attack puts no strain on the heart.

Placing the child into the recovery position immediately after the fright or other stimuli and before loss of consciousness seems to lessen the severity of the attack, or result in a 'near-miss'. Is there any medical foundation for this?
This does seem to be the case, although the doctors are unsure why. It should be noted that the person does not always have to be placed in the recovery position. (possibly it reduces the effect of the drop in blood pressure which occurs after the heart stops).

Does a RAS attack cause any damage to the brain, short term/long term?
There is no evidence whatsoever that RAS causes brain damage, The 'fail safe' mechanism in the brain restarts the heartbeat and breathing before the oxygen level is low enough to cause damage.

If the cessation of the heart beat and breathing continues beyond the child's normal reaction time at what point should resuscitation be attempted, and how should this be administered?
It would be extremely unlikely that resuscitation would be needed, because of the 'fail safe' mechanism (see #7 above). However, if the person's heart and breathing has not restarted after a period of two minutes, then, attempting resuscitation in the normal manner would do no harm.

When do children grow out of attacks and what percentages of children continue attacks after school entry age?
Children's attacks tend to lessen as they get older, but they may never 'grow out' of them fully. Unpublished data shows that 75% of children 'grow out' of RAS at around school age; however 1 in 4 continue to have attacks less frequently and less severe.

Why do some children regain consciousness after an attack quicker than others do?
Children are very different in their ability to recover from attacks, partly because of the severity of the attacks, and partially due to their own body's reaction to the attack.

Can a RAS attack occur while the child is sleeping?
Probably not, however there are other heart stopping conditions, notably Prolonged QT Syndrome which do occur during sleep, and while awake especially with exercise. Prolonged QT Syndrome can be diagnose using an electrocardiogram (ECG), and parents are encouraged to have this done, to rule out this diagnosis.

Why does a RAS child have more attacks when with parents?
There ore two theories, one that the child has most attacks as a toddler. A toddler spends most of his/her time at home with a parent. Another theory is that the child feels more relaxed in his home environment, they are not anticipating a fright, and will therefore be more likely to have a RAS attack because the fright was unexpected.

What are the problems facing a RAS child during anaesthesia?
The vagus nerve can be stimulated to produce a RAS attack by pressing the eyeballs (the ocular compression test) and, in anaesthesia when the tube is pushed down the throat. If the person is anaesthetised lying flat, after being given a pre-operation dose of atropine, there will be no further complications. Complications arise where, particularly in dental anaesthesia, the RAS sufferer is anaesthetised sitting up. The intubation causes the RAS attack, and because the body is upright the blood falls to the legs. When the 'fail-safe' mechanism restarts the heart the lack of blood in the heart could cause a cardiac arrest. Complications, including brain damage could then ensue. The advice is always tell the anaesthetist that the child or adult has, or did suffer from RAS, and insist that all anaesthesia is administered while the patient is lying flat.

What does the RAS child feel and experience during the stages of an attack?
A few older children have been able to describe what they experience during an attack and mention that voices sound far away, but that it felt nice. They also say that it is not pleasant coming out of an attack back to consciousness.

Is there a genetic factor in RAS?
Almost certainly. More research is needed to establish what gene actually carries the susceptibility to RAS.

Will my son pass RAS onto his children?
It is quite possible. It is now known that RAS and fainting episodes like RAS can run in families.

What can I say to a child to comfort them during an attack?
It does seem to help to talk to your child calmly and reassuringly during an attack as it would appear that they are aware of at least the sound of voices.

Why does a child with RAS cry for hours after an attack?
Doctors are unsure. It could be due to chemical imbalance in the body after a period of anoxia, or might be due to the child's experience as they come out of the unconscious state. Perhaps the child's subconscious is coping with the emotion and shock of the seizure.
Can a RAS attack be controlled, once the child has experienced a fright or other stimulus?
The child has no control over the process. Some parents find, in the early stages they can avert the attack, by a combination of reassuring the child, talking and placing them down in the recovery position or blowing in their face. Different children respond differently. (In older children biofeedback techniques might be useful)

Any advice on how to cope day to day with family life and a child with RAS?
It is important for the child with RAS to lead a normal healthy life, however, adults in charge of the child at any given time should be aware of the child's condition. Contact the RAS Support Group for further information and advice.

A parent has been advised not to cuddle a child during an attack and let them come round themselves. Is this good advice?
The best advice is to have the child lying in the recovery position (lying on their side), speaking calmly and reassuringly to them, with physical contact (rubbing child's back, patting their arm). Your voice should sound calm and reassuring.

Why does a child's face during a RAS attack go white and not blue?
During a RAS attack the heart stops beating, and breathing stops. Blood vessels constrict and the blood is not able to get to the skin. This results in white pallor to the face. The blood is lacking in oxygen and will be blue colored only noticeable on the lips in the early stages of the attack. During a blue breath holding attack lack of oxygen from the lungs causes blood to turn blue. However, as the heart is still pumping, this 'blue' blood passes through the blood vessels of the face, causing the whole face and the skin of the body to have a blue tinge.

Why does a RAS child sleep for so long after an attack?
Unsure. It is probably the brain recovering from the shock of the attack. During a RAS attack the heart stops beating for normally 5-30 seconds, after about 9-10 seconds lack of blood supply to the brain makes the normal electrical activity in the cerebral cortex (the thinking, conscious part of the brain) turn off. When the heart starts beating again, the cerebral cortex comes on again but is sleepy for up to a couple of hours, as it gets over the 'shock'. This does NO damage to the brain.

What triggers an attack in later years?
Stimuli in later years often differ from the bumps and falls of a toddler with RAS. They can include trapping fingers, stubbing toes, sight of blood etc. Long term research is needed to discover what other stimuli causes these attacks.

What makes the heart restart after an attack?
As the oxygen level decreases in the brain, there is a chemical release (the 'fail-safe' mechanism), which induces the heartbeat and breathing mechanisms to restart.

How does an epileptic attack differ from a RAS attack?
An EEG (brain wave activity) of an epileptic attack would show excessive elective spike or epileptic discharges, which are not present in a RAS attack. During a RAS attack the EEG goes slow for a few seconds then is flat as the cerebral cortex shuts down, then goes slow again during the drowsy recovery phase before returning to normal. A RAS attack is always precipitated by a shock trigger, which is sometimes difficult to identify.
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40. What can be done to prevent a child having attacks?
Prescribe Atropine Sulphate, Atropine Methonitrate or similar medication (iron therapy might help in some children). Unfortunately these medicines do not always work. People with frequent and severe attacks in whom medical treatment has failed or is declined, could be fitted with a pacemaker.