I agree that iron deficiency anaemiais an important associated "finding of breath holding spells and correction of anaemia definitely helps in controlling recurrences of breath holding spells. In study by Donma(1), 9 (23%) patients in piracetam group and 9 (24%) patients in placebo group were having iron deficiency anemia. All these patients were treated with oral iron preparation and responded favorably to this form of therapy.

I also agree with the point that counselling of parents is the cornerstone of treatment of this otherwise benign disease. Results of this study(1) have suggested piracetam as an alternative option for the treatment of breath holding spells. Dr. Mittal's suggestion, that piracetam can be used for treatment of those patients who experience breath holding spells despite counselling, needs to be investigated. In absence of sufficient data this expensive therapy can not be recommended as a routine, even for severe and refractory cases of breathholding spells.

                Ravindra Kumar Garg,
        Department of Neurology,
institute of Medical Sciences,
       Banaras Hindu University,
Varanasi,
india.