EFFECTIVENESS OF ORAL IRON VS. THEOPHYLLINE AND IRON COMBINATION THERAPY IN CHILDREN WITH BREATH-HOLDING SPELLS

Abstract

Background:  Breath-holding spells are no epileptic paroxysmal events in young children, and can be a source of parental anxiety. These episodes are associated with iron-deficiency, and the benefits of theophylline remain uncertain. Objectives: To compare the efficacy of iron alone and iron plus theophylline on the frequency and severity of breath holding spells and to determine demographic and clinical factors that were associated with the efficacy of the treatment. Methodology: A non-randomized controlled trial was conducted in Khyber Teaching Hospital Peshawar with 110 children aged 6 months to 5 years who presented with breath holding spells to the Department of Pediatrics. After 12 weeks, participants were then divided into two groups – one taking oral iron and the other taking oral iron and theophylline. These included assessment of the frequency and severity of the spells, laboratory indices, caregiver satisfaction and treatment response. Complete remission, partial remission, and no response were defined by a change in spell frequency. Descriptive statistics, Mann–Whitney U, chi square, Fisher's exact and Wilcoxon signed-rank tests were used to analyze data, and p<0.05 was considered significant. Results: No significant difference was found between groups when evaluating the amount of reduction in spell frequency from baseline to 12 weeks (p<0.001). Complete remission was achieved in 58.2% of those treated with iron alone and 83.6% of those treated with both iron and combination therapy (p=0.006). There were also fewer spells in the combination group at month 2 (p=0.002) and 3 (p=0.02) and a larger mean percentage reduction at 12 weeks (94.1% versus 78.3% p=0.002). Only a significant association of treatment allocation with complete remission was seen. Conclusion: Oral iron was effective in reducing breath-holding spells, and the combination of theophylline and oral iron resulted in a higher remission rate and improved symptom control. Effectiveness and safety needs to be confirmed in larger randomized trials.