Indeed, the short latency between the stimulus and the attack has been emphasized as an important distinction from the more familiar (at least in older children and adults) vasovagal syncope.
Video recordings of other forms of anoxic seizures (vasovagal syncopes) suggest that there may be marked asymmetry.
However, it is only relatively recently that their pathophysiology has begun to be understood, and in consequence, their separation from reflex anoxic seizures has been recognized.
Although minor bumps to the head are reported as the most common precipitants to reflex anoxic seizures, many other stimuli may also be involved.
Pain, especially from emotion (surprise, fear, annoyance, frustration, and excitement), crying, and fever were provocative factors.
When one considers the vast range of situations in which a child (or adult) can be surprised, frightened, upset, or merely excited, it is easy to understand how reflex anoxic seizures can occur in special settings, such as bathing and water immersion; in the anesthetic room; when witnessing "blood and gore"; at the dentist office, school, place of worship, or the hairdresser's; and whilst watching television.
Hence, in unsteady toddlers, minor bumps to the head are likely to predominate, whilst in the older child, adolescent, and adult, factors such as the sight of blood or venipuncture are likely to be more relevant.
In this regard, note that beyond the toddler stage, children with reflex anoxic seizures may report out-of-body experiences with a dream-like quality.
The attacks have been reported to generally reach a peak in frequency towards the end of the first or beginning of the second year of life.
Presumably because the precipitants to the attacks generally require a degree of mobility, descriptions of reflex anoxic seizures before the age of 6 months are rare.
Also, there are many descriptions of attacks starting in later childhood and in adult life, although in such cases, the precipitants tend to be different, for example, involving bloodletting (Roddy et al. 1983) or dental extractions.