A New Approach to the Prophylaxis of Cyclic Vomiting: Topiramate

Sezer, Oya Balci; Sezer, Taner

doi:10.5056/jnm16035

Cited by 29 publications

(34 citation statements)

References 20 publications

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“…If standard agents are either ineffective or poorly tolerated, other medications are used including antiemetics such as aprepitant, anticonvulsants, mitochondrial supplements as well as prokinetic agents, other tricyclic or tetracyclic antidepressants, and Ca 2+ -channel blockers [ 1 – 3 , 5 , 8 , 10 – 12 , 14 , 21 , 24 , 30 ]. The most frequently used anticonvulsants include topiramate and phenobarbital [ 10 , 24 ]. However, both medications can adversely affect cognitive function.…”

Section: Multifaceted Treatment By Phase Of the Illnessmentioning

confidence: 99%

“…Migraine-related (90% of our cohort) CVS, either by having a family history of migraines (94%) or personal migraines (38%), constituted the majority of patients and had a substantially higher response rate to antimigraine therapy (80 vs. 36%); therefore, beginning with antimigraine therapy makes sense [ 19 ]. When standard therapy fails, this group is treated with anticonvulsants such as topiramate and phenobarbital [ 10 , 24 ]. Abortive triptans are more effective in those with milder episodes lasting less than 24 h.…”

Section: Treatment By Comorbidity Subgrouping and Genetic Profilementioning

confidence: 99%

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Managing cyclic vomiting syndrome in children: beyond the guidelines

2018

Eur J Pediatr

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Cyclic vomiting syndrome (CVS) in children is characterized by frequent hospitalizations, multiple comorbidities, and poor quality of life. In the absence of robust data, the treatment of CVS remains largely empiric starting with the 2008 NASPGHAN Consensus Statement recommendations of cyproheptadine for children < 5 years of age and amitriptyline for those ≥ 5 years with propranolol serving as the second-line agent. Comprehensive management begins with lifestyle alterations, and extends to medications, supplements, and stress reduction therapies. Standard drug therapy is organized by the four phases of the illness: (1) interictal (preventative medications and mitochondrial supplements), (2) prodromal (abortive agents), (3) vomiting (fluids/energy substrates, antiemetics, analgesics, and sedatives) and (4) recovery (supportive care and nutrition). Because the response to treatment is heterogeneous, clinicians often trial several different preventative strategies including NK1 antagonists, cautious titration of amitriptyline to higher doses, anticonvulsants, Ca2+-channel blockers, and other TCA antidepressants. When the child remains refractory to treatment, reconsideration of possible missed diagnoses and further mono- or combination therapy and psychotherapy can be guided by accompanying comorbidities (especially anxiety), specific subphenotype, and when available, genotype. For hospital intervention, IV fluids with 10% dextrose, antiemetics, and analgesics can lessen symptoms while effective sedation in some instances can truncate severe episodes.Conclusion: Although management of CVS remains challenging to the clinician, approaches based upon recent literature and accumulated experience with subgroups of patients has led to improved treatment of the refractory and hospitalized patient. What is Known: • Cyclic vomiting syndrome is a complex disorder that remains challenging to manage. • Previous therapy has been guided by the NASPGHAN Consensus Statement of 2008. What is New: • New prophylactic approaches include NK1 antagonists and higher dosages of amitriptyline. • Strategies based upon comorbidities and subphenotype are helpful in refractory patients.

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Section: Multifaceted Treatment By Phase Of the Illnessmentioning

confidence: 99%

Section: Treatment By Comorbidity Subgrouping and Genetic Profilementioning

confidence: 99%

Managing cyclic vomiting syndrome in children: beyond the guidelines

2018

Eur J Pediatr

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“…episodes,andonly6%didnotrespond. 30 In a retrospective study of18adultstreatedwithprophylactictopiramate,72%had≥50% reduction in frequency/severity of CVS episodes. Some patients on topiramate were also receiving AT and mitochondrial supplements in this study.…”

mentioning

confidence: 99%

Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association

Venkatesan

Levinthal

Tarbell

et al. 2019

Neurogastroenterology Motil

122

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The increasing recognition of cyclic vomiting syndrome (CVS) in adults prompted the development of these evidence‐based guidelines on the management of CVS in adults, which was sponsored by the American Neurogastroenterology and Motility Society (ANMS) and the Cyclic Vomiting Syndrome Association (CVSA). GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework was used and a professional librarian performed the literature search. The expert committee included the President of the CVSA who brought a patient perspective into the deliberations. The committee makes recommendations for the prophylaxis of CVS, treatment of acute attacks, diagnosis, and overall management of CVS. The committee strongly recommends that adults with moderate‐to‐severe CVS receive a tricyclic antidepressant (TCA), such as amitriptyline, as a first‐line prophylactic medication and receive topiramate or aprepitant as alternate prophylactic medications. Zonisamide or levetiracetam and mitochondrial supplements (Coenzyme Q10, L‐carnitine, and riboflavin) are conditionally recommended as alternate prophylactic medications, either alone or concurrently with other prophylactic medications. For acute attacks, the committee conditionally recommends using serotonin antagonists, such as ondansetron, and/or triptans, such as sumatriptan or aprepitant to abort symptoms. Emergency department treatment is best achieved with the use of an individualized treatment protocol and shared with the care team (example provided). The committee recommended screening and treatment for comorbid conditions such as anxiety, depression, migraine headache, autonomic dysfunction, sleep disorders, and substance use with referral to appropriate allied health services as indicated. Techniques like meditation, relaxation, and biofeedback may be offered as complementary therapy to improve overall well‐being and patient care outcomes.

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“…Drugs used for prophylaxis are anti-migraine drugs (ex: propranolol, sumitriptan), anti-convulsants (ex: phenobarbitone, topiramate), tricyclic anti-depressants (ex: amitriptyline) prokinetics (ex: erythromycin). 8,9,10…”

Section: Discussionmentioning

confidence: 99%

A case series of cyclic vomiting syndrome in paediatric patients at a tertiary care hospital in Chennai, Tamil Nadu, India

Mittal

Ravichandran

Elayaraja

2018

Int J Contemp Pediatr

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Background: Cyclic vomiting syndrome is an increasingly recognized disorder with sudden, repeated episodes of severe nausea, vomiting, and physical exhaustion that occur with no apparent cause. It is more common in children than adults. However, we don’t often see a diagnosis of cyclic vomiting syndrome being made. Hereby we report 7 cases of cyclical vomiting.Methods: This is a retrospective study. Medical records of 5 years were review and consecutive paediatric patients discharged with a diagnosis of cyclic vomiting syndrome were identified, data collected and analysed.Results: Total of 7 cases were found, all of which were adolescents. The mean age was 13.28. 57.14% (4) were females and 42.86% (3) were boys. 42.86% (3) presented with complications. 14.28% (1) had an association with menstrual cycles and 14.28% (1) had an association with psychological stress.Conclusions: Cyclic vomiting syndrome should be kept in mind when a child presents with multiple episodes of vomiting, especially when repeated admissions have been made for the same. Early diagnosis and treatment can improve the quality of life.

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A New Approach to the Prophylaxis of Cyclic Vomiting: Topiramate

Cited by 29 publications

References 20 publications

Managing cyclic vomiting syndrome in children: beyond the guidelines

Managing cyclic vomiting syndrome in children: beyond the guidelines

Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association

A case series of cyclic vomiting syndrome in paediatric patients at a tertiary care hospital in Chennai, Tamil Nadu, India

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