Reflex anoxic seizure in children
Reflex anoxic seizures (RAS) are paroxysmal, spontaneously reversing short-lived episodes of pronounced bradycardia or transient asystole which causes relative cerebral ischaemia, thereby inducing an anoxic ‘seizure’ or ‘attack’ (Martin 2010). The Founder Patron of the STARS (Syncope Trust and Reflex Anoxic Seizures) organisation Prof John Stephenson in 1993 aptly explained:
‘RAS is the term used for a particular fit which is neither epileptic nor due to cyanotic breathholding, but which rather results from a brief stoppage of the heart through excessive activity of the vagus nerve’ (STARS, 2012).
These events are usually triggered by a painful or frightening stimulus and often can be misdiagnosed as an epileptic seizure (Tidy, 2012). It is important that the paramedic team should remain aware of RAS as a differential diagnosis for a child presenting with an episode of sudden collapse.
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