BACKGROUND The medical treatment for severe pallid breath-holding spells accompanied with severe bradycardia or transient cardiac arrest is controversial. Although various medications have been reported to be effective, patients treated with pacemaker insertion are not always evaluated for pharmacological therapy beforehand. CASE REPORT A 9-month-old boy developed pallid breath-holding spells. At 15 months of age, a Holter electrocardiogram revealed 12 s of asystole during a breath-holding spell. Treatment with low-dose theophylline sustained-release dry syrup (5.3 mg/kg/day) led to complete control of the spells. The peak concentration of theophylline was 4.4 μg/mL which was below the therapeutic range for bronchial asthma. When he turned 3 years and 5 months of age, theophylline treatment was discontinued without recurrence of pallid breath-holding spells. DISCUSSION Theophylline is now infrequently used to treat pediatric bronchial asthma due to its limited effect coupled with its side effects, which include headache, digestive symptoms, and theophylline-associated convulsions. The effectiveness of theophylline as a treatment for pallid breath-holding spells has been reported in several reports. In our case, the theophylline dosage was approximately half the amount described in previous reports. CONCLUSIONS In this case, low-dose theophylline was adequate in controlling the pallid breath-holding spells. Because theophylline-associated seizures are a major concern, we suggest an evaluation of low-dose theophylline for treating patients with severe pallid breath-holding spells without febrile convulsions or epilepsy before proceeding with permanent pacemaker insertion. Further development of preventive strategies for theophylline-associated seizures and characterization of patients who respond well to theophylline treatment is required.

中文翻译：

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用低剂量茶碱治疗严重的苍白屏气发作

背景技术对于伴有严重心动过缓或短暂性心脏骤停的严重苍白屏气发作的药物治疗存在争议。尽管已报告多种药物有效，但植入起搏器治疗的患者并不总是事先进行药物治疗评估。病例报告 一名 9 个月大的男孩出现了苍白的屏气法术。在 15 个月大时，动态心电图显示在屏气期间出现 12 秒的心搏停止。用低剂量茶碱缓释干糖浆（5.3 毫克/公斤/天）治疗导致完全控制了咒语。茶碱的峰值浓度为 4.4 μg/mL，低于支气管哮喘的治疗范围。当他满 3 岁零 5 个月大时，茶碱治疗停止，苍白屏气发作没有复发。讨论 茶碱现在很少用于治疗小儿支气管哮喘，因为其作用有限，而且副作用包括头痛、消化系统症状和茶碱相关的抽搐。几份报告都报道了茶碱治疗苍白屏气发作的有效性。在我们的案例中，茶碱的剂量大约是之前报告中描述的量的一半。结论 在这种情况下，低剂量茶碱足以控制苍白的屏气发作。因为茶碱相关的癫痫发作是一个主要问题，我们建议在继续植入永久性起搏器之前，评估低剂量茶碱用于治疗无热性惊厥或癫痫的严重苍白屏气发作患者。需要进一步制定茶碱相关癫痫发作的预防策略，并确定对茶碱治疗反应良好的患者的特征。