BACKGROUND Cyclic vomiting syndrome(CVS)and its effect on nutritional status has not been well described.AIM To describe the clinical characteristics,treatment and outcomes of children with CVS in Singapore.METHODS Re...BACKGROUND Cyclic vomiting syndrome(CVS)and its effect on nutritional status has not been well described.AIM To describe the clinical characteristics,treatment and outcomes of children with CVS in Singapore.METHODS Retrospective cohort study of pediatric patients aged 1 to 18 years old with CVS diagnosed at KK Women’s and Children’s Hospital in Singapore from 2011 to 2021.RESULTS Thirty-two children(69%female)with CVS were included in the study,with mean age of onset of symptoms at 7(±4)years and mean follow up duration of 5 years.Forty percent(12/32)of patients were underweight at diagnosis with no other identifiable organic cause,with a median body mass index(BMI)z score-3.2(range-2 to-7.5).The incidence of systemic hypertension was 10%(3/32).The overall mean frequency of exacerbations in this cohort of patients was 4(±4)episodes per year.In total,16(50%)patients,who had mean baseline frequency of 6(±5)attacks per year,were commenced on prophylactic treatment.Twelve patients(75%)responded to first-line therapy,whereas 4(25%)required escalation to second-line treatment.With prophylactic treatment,there was an overall improvement in the frequency of attacks with a mean reduction of 5(±3)attacks per year.Also,there was improvement in the BMI z score of these patients from a median of-2.9 to-0.9.CONCLUSION Prophylactic treatment is effective in improving nutritional status as well as reducing symptom frequency and should be considered for patients with complications such as growth failure and significant hypertension.展开更多
The pathophysiology of migraines has been commonly explained by the trigeminovascular theory, although recent studies have suggested that the cause of migraines stems from cortical hyperexcitability. The aim of this s...The pathophysiology of migraines has been commonly explained by the trigeminovascular theory, although recent studies have suggested that the cause of migraines stems from cortical hyperexcitability. The aim of this study was to demonstrate the effectiveness of antiepileptic drugs for treating patients with cephalic hypersensitivity symptoms in Japan. In this study, we assessed the （1） demographics; （2） medical history; （3） treatment status and （4） electroencephalograms of the subjects. This study was performed after approval by the ethics committee at Tokyo Women＇s Medical University. We examined the electroencephalograms of 1,616 patients experiencing daily headaches accompanied by dizziness and cephalic ringing. Of these patients, approximately 80% had migraine without aura, and were asymptomatic before migraine onset. In addition, we measured the effects, dosages, and treatment durations of anti-epileptic drugs commonly prescribed as migraine prophylactics in 172 patients （age ~ standard deviation： 55.8 ~ 14.3 years） with cephalic hypersensitivity symptoms. Our results suggested that the electroencephalogram abnormalities related to cephalic hypersensitivity symptoms were associated with age and photophobia. Anti-epileptic drugs for cephalic hypersensitivity symptoms may be effective for reducing cerebral hypersensitivity. Statistics show that the drugs were markedly effective in about 28% of patients, moderately effective in 52% of patients, and not effective in 20% of patients. Our study suggests that erroneous migraine treatment methods from childhood may exacerbate hypersensitivity of the brain leading to the development of dizziness, tinnitus, or cephalic ringing, and shows that anti-epileptics are effective for treating this condition.展开更多
文摘BACKGROUND Cyclic vomiting syndrome(CVS)and its effect on nutritional status has not been well described.AIM To describe the clinical characteristics,treatment and outcomes of children with CVS in Singapore.METHODS Retrospective cohort study of pediatric patients aged 1 to 18 years old with CVS diagnosed at KK Women’s and Children’s Hospital in Singapore from 2011 to 2021.RESULTS Thirty-two children(69%female)with CVS were included in the study,with mean age of onset of symptoms at 7(±4)years and mean follow up duration of 5 years.Forty percent(12/32)of patients were underweight at diagnosis with no other identifiable organic cause,with a median body mass index(BMI)z score-3.2(range-2 to-7.5).The incidence of systemic hypertension was 10%(3/32).The overall mean frequency of exacerbations in this cohort of patients was 4(±4)episodes per year.In total,16(50%)patients,who had mean baseline frequency of 6(±5)attacks per year,were commenced on prophylactic treatment.Twelve patients(75%)responded to first-line therapy,whereas 4(25%)required escalation to second-line treatment.With prophylactic treatment,there was an overall improvement in the frequency of attacks with a mean reduction of 5(±3)attacks per year.Also,there was improvement in the BMI z score of these patients from a median of-2.9 to-0.9.CONCLUSION Prophylactic treatment is effective in improving nutritional status as well as reducing symptom frequency and should be considered for patients with complications such as growth failure and significant hypertension.
文摘The pathophysiology of migraines has been commonly explained by the trigeminovascular theory, although recent studies have suggested that the cause of migraines stems from cortical hyperexcitability. The aim of this study was to demonstrate the effectiveness of antiepileptic drugs for treating patients with cephalic hypersensitivity symptoms in Japan. In this study, we assessed the （1） demographics; （2） medical history; （3） treatment status and （4） electroencephalograms of the subjects. This study was performed after approval by the ethics committee at Tokyo Women＇s Medical University. We examined the electroencephalograms of 1,616 patients experiencing daily headaches accompanied by dizziness and cephalic ringing. Of these patients, approximately 80% had migraine without aura, and were asymptomatic before migraine onset. In addition, we measured the effects, dosages, and treatment durations of anti-epileptic drugs commonly prescribed as migraine prophylactics in 172 patients （age ~ standard deviation： 55.8 ~ 14.3 years） with cephalic hypersensitivity symptoms. Our results suggested that the electroencephalogram abnormalities related to cephalic hypersensitivity symptoms were associated with age and photophobia. Anti-epileptic drugs for cephalic hypersensitivity symptoms may be effective for reducing cerebral hypersensitivity. Statistics show that the drugs were markedly effective in about 28% of patients, moderately effective in 52% of patients, and not effective in 20% of patients. Our study suggests that erroneous migraine treatment methods from childhood may exacerbate hypersensitivity of the brain leading to the development of dizziness, tinnitus, or cephalic ringing, and shows that anti-epileptics are effective for treating this condition.
