P23 Piracetam for breath-holding spells

Context Breath-holding spells (BHS) are a non-epileptic event where the child involuntarily stops breathing, typically for less than one minute, varying from several times daily to few month. 1 There two types of BHS: cyanotic and pallid; occurs in response fear or anger, causing oxygen desaturation loss consciousness, pallid can be triggered by pain fear, pallor, desaturation, seizure-like movements. The is 7-year-old girl with Cornelia de Lange syndrome past medical history respiratory infections gastroesophageal reflux disease. She was diagnosed BHS up 120 episodes daily. Her electrolytes, renal function, ferritin haemoglobin levels were within normal ranges. no evidence epilepsy, iron-deficiency anaemia, abnormal neurological findings. Due her severe BHS, case discussed at British Paediatric Sleep Society videoconference consultant, resulting suggestion piracetam trial. This nootropic drug which works restoring cell membrane fluidity neurotransmission anticonvulsant properties, improving neuronal function. 2 Piracetam currently licensed post-anoxic myoclonus adults, very little use BHS. Pharmacist Contribution national, international, local guidelines on treatment A literature review conducted using MEDLINE EMBASE, randomised-controlled trials (RCTs) being analysed: demonstrated 77% complete compared 6% placebo group, statistically significant (p <0.05) 3 , another reduction median overall number attacks/month 5 group <0.001). 4 NHS Networks used contact other centres advice, responses. patient had comparable characteristics those studies, so initiated starting dose 40 mg/kg/day as recommended RCTs. liquid formulation available adults off-label. risk assessment carried out ensure safe approval sought medicines committee. Outcome incidence initially improved desaturations, however increased again coincided teething pain. After an MDT discussion, line clinical trials, reported adverse effects. Lessons Learned Drugs often extrapolated children, either unlicensed off-label basis. thorough required, especially regarding dosing administration, exploring appropriate formulations. To use, required benefits outweigh risks, monitoring place assess any Conclusion Our experience shows that it safely; however, this should individual basis after discussion MDT. Further research and, particular, need guidelines. References Flodine T, Mendez M. Breath Holding Spells [Internet]. 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539782/ [Accessed March 2022] Winblad B. Piracetam: pharmacological properties uses. CNS Drug Reviews 2006; 11 :169–182. Abbaskhanian A, Ehteshami S, Sajjadi Rezai Effects pediatric breath holding spells: randomized double blind controlled Iran J Child Neurology 2012; 6 :9–15. Sawires H, Botrous O. Double-blind, placebo-controlled trial effect breath-holding spells. European Journal Pediatrics 171 :1063–1067.