Reflex Anoxic Seizure in a 13-Year-Old Healthy Girl by Performing the “Mess Trick” and “Fainting Lark”

Abstract

“Mess Trick” is the process of simultaneous squatting with hyperventilation followed by sudden erect posturing to induce syncope. “Fainting Lark” is the “mess trick” combined with forced valsalva while erect. This rare behavior, when identified, has been isolated to autistic, cognitively impaired children. More unlikely is this behavior discovered in the cognitively-well population. A 13-year-old healthy girl presented with a first episode of seizure. The seizure was unprovoked according to the history provided by the patient and an eyewitness. Routine radiology and laboratory analysis could not reveal an etiologic source. After speaking with the adolescent in the absence of her parents, she admitted playing a “black-out” game performing the “mess trick” and “fainting lark.” The resultant myoclonic jerks were the result of intentionally provoked syncope. Therefore, high-risk behaviors should be included in the differential of first episode of unprovoked seizure in a healthy adolescent.

Keywords

mess trick - fainting lark - reflex anoxic seizure

• References

• 1 Section AH, Authority OH. The choking game: a fact sheet for parents and teachers. April 2012. Available at http://public.health.oregon.gov/HealthyPeopleFamilies/Youth/Documents/FactSheetCG.pdf . Accessed June 21, 2016
• 2 Howard P, Leathart GL, Dornhorst AC, Sharpey-Schafer EP. The mess trick and the fainting lark. BMJ 1951; 2 (4728) 382-384
• 3 Gastaut H, Zifkin B, Rufo M. Compulsive respiratory stereotypies in children with autistic features: polygraphic recording and treatment with fenfluramine. J Autism Dev Disord 1987; 17 (3) 391-406
• 4 Murphy JV, Wilkinson IA, Pollack NH. Death following breath holding in an adolescent. Am J Dis Child 1981; 135 (2) 180-181
• 5 DiMario FJ. Non-Epileptic Childhood Paroxysmal Disorders. New York, NY: Oxford University Press; 2009
• 6 Stephenson JBP. Fits and Faints. Philadelphia, PA: Mac Keith Press; 1990