Tuesday, February 2, 2016

Cyclic vomiting

Toshiyuki Hikita, Hiroko Kodama,  Kaori Ogita,  Sono Kaneko,   Natsue Nakamoto,  Masakazu Mimaki.  Cyclic Vomiting Syndrome in Infants and Children: A Clinical Follow-up Study.  Pediatric Neurology. Published Online: January 07, 2016.



Cyclic vomiting syndrome (CVS) is characterized by recurrent vomiting that is associated with increased adrenocorticotropic hormone (ACTH) and antidiuretic hormone (ADH) levels during CVS attacks. However, both prognosis and treatment remain unclear. We therefore evaluated the clinical features, prognosis, and effectiveness of the prophylaxis of CVS as well as the relationship between CVS symptoms and ACTH/ADH levels.


We included 31 patients with CVS who were admitted to Teikyo University between 1996 and 2008. All patients were diagnosed with CVS based on the criteria of the second edition of the International Headache Classification. The patients (25/31) were followed up until 2013.


The median overall duration of the disorder was 66 (3–179) months. Follow-up was completed for 25 patients with CVS, of whom 44% (n = 11) developed migraine. Valproic acid, valproic acid with phenobarbital, phenobarbital, and amitriptyline were effective in 9, 4, 3, and 1 patients, respectively. Abnormally high ACTH (n = 17) and ADH (n = 18) levels were found among the 25 patients for whom follow-up data were available. The following correlations were significant: attack duration and ACTH levels (correlation coefficient: 0.5153, P = 0.0084) and attack duration and ADH levels (correlation coefficient: 0.5666, P = 0.0031). ADH levels in patients with bilious vomiting were higher than in those without bilious vomiting (P = 0.048).


Most patients with CVS fully recovered and benefited from prophylactic therapy, although half of them developed migraines.

Courtesy of:  http://www.mdlinx.com/neurology/medical-news-article/2016/02/01/international-headache-classification-migraine-adrenocorticotropic-hormone/6487393/?category=sub-specialty&page_id=1&subspec_id=317

Moses J, Keilman A, Worley S, Radhakrishnan K, Rothner AD, Parikh S. Approach
to the diagnosis and treatment of cyclic vomiting syndrome: a large single-center
experience with 106 patients. Pediatr Neurol. 2014 Jun;50(6):569-73.



Cyclic vomiting syndrome is characterized by repeated, stereotypical vomiting episodes. The diagnosis is made by exclusion of other organic diseases, which can lead to extensive testing. It has been suggested that these patients can have mitochondrial dysfunction. The aim of the study was to examine the evaluation of our cyclic vomiting patients and to determine whether they had associated, undiagnosed metabolic abnormalities.


This retrospective study included 106 patients aged <21 years at diagnosis. Information regarding medical history, laboratory, and imaging studies were collected. Metabolic studies in plasma and urine were obtained when patients were well and when patients were in a vomiting cycle, including plasma amino acids, acylcarnitines, and urine organic acids.


The mean age at diagnosis was 8.9 ± 5.0 years. Neuroimaging revealed previously unknown intracranial abnormalities in <10% of patients, none of whom explained the vomiting signs. Abdominal ultrasounds revealed abnormalities in 15% of patients during an acute episode and 7% of patients when well. Sixty-one patients had an upper gastrointestinal series, all of which were normal. A total of 92% of patients had laboratory testing with 38% indicating abnormalities possibly suggesting mitochondrial dysfunction.


This large, single-center study further evaluated the need for more focused evaluation in patients with suspected cyclic vomiting syndrome. Thirty-eight percent of our patients had abnormalities in blood and/or urine suggesting mitochondrial dysfunction, which requires more detailed investigation in the future.

See Sicklick vomiting 6/18/15

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