Expert Opinion :
This child has a seizure like episode but apart from uprolling of eyes, there are no other features of seizures. Bluish discoloration of lips and fingers suggests cyanosis. Cyanosis is usually not a part of seizures unless there are prolonged seizure activity and hypoxia. Seizure like activity and cyanosis can occur with a breath holding spell but this child has no provoking factor, does not have breath holding and so it seems unlikely. Though the child does not have cyanosis at rest, the hemoglobin is high in this child and the child does get cyanosed when she gets these episodes. Thus, it suggests that the child may be having cyanotic spells. The age of appearance of cyanotic spells is usually around 6 months of age which is present in this child. Thus, there may be an underlying cyanotic heart disease in the child which may be having tetralogy of Fallot (TOF) physiology and causing spells. TOF physiology usually leads to a single second heart sound and there would be a soft systolic murmur. However if the pulmonary stenosis is more peripheral in the pulmonary arteries, the second heart sound may be normal. Also, there may be absence of murmur. In this child, echocardiography showed right pulmonary artery stenosis with TOF physiology. Thus, not every uprolling of eyes is a seizure and not every seizure like spell with cyanosis is a breath holding spell.