Cardiac Vagal Regulation Is Impeded in Children With Cyclic Vomiting Syndrome

Kołacz, Jacek; Kovacic, Katja; Dang, Linh C.; Li, B U.K.; Lewis, Gregory F.; Porges, Stephen W.

doi:10.14309/ajg.0000000000002207

Cited by 10 publications

(9 citation statements)

References 48 publications

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“…Peripheral stimulation of vagal afferents with central effects on limbic brain regions that process fear and emotions would fit the attenuation in the stress and excitement‐triggered symptom pattern of CVS. Emerging evidence showing impaired peripheral cardio‐inhibitory vagal regulation in children with CVS further supports action of PENFS on an underlying autonomic pathophysiology (17).…”

Section: Discussionmentioning

confidence: 85%

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Percutaneous Electrical Nerve Field Stimulation for Drug-Refractory Pediatric Cyclic Vomiting Syndrome

Karrento,

Venkatesan,

Zhang

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Background: Cyclic vomiting syndrome (CVS) is a disabling condition frequently refractory to pharmacologic therapy. The aim of this study was to evaluate the effects of noninvasive, auricular percutaneous electrical nerve field stimulation (PENFS) as prophylactic therapy for pediatric CVS. Methods: Children 8–18 years with drug-refractory CVS were prospectively enrolled from a tertiary care CVS clinic. Subjects received 6 consecutive weeks of PENFS. CVS severity was quantified by episode frequency and duration score (range 0–25) at baseline and at extended follow-up (4–6 months after end of therapy). Response was classified as ≥50% improvement in either frequency or duration of attacks at extended follow-up. Subjects also completed validated surveys of nausea, disability, and global response. Results: Thirty subjects completed the study. Median (interquartile range, IQR) age was 10.5 (8.5–15.5) years; 60% were female. At follow-up, 80% met criteria for treatment response with a median (IQR) response duration of 113 (61–182) days. The frequency-duration score improved from baseline median (IQR) 12.0 (9.0–16.0) to 3.0 (1.0–6.0) at follow-up, P < 0.0001. Median (IQR) nausea and disability scores decreased from baseline to week 6: 2.1 (1.3–2.7) to 0.9 (0–1.6), P = 0.003 and 47.5 (41.0–53.0) to 38.0 (16.0–51.0), P = 0.001, respectively. At end of therapy, 66% and 55% patients reported global response of at least “moderately better” and “a good deal better,” respectively. There were no serious side effects. Conclusions: This study suggests long-term benefits of PENFS for children with CVS. PENFS improves several disabling aspects of CVS, including episode frequency, duration, and functional disability.

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Section: Discussionmentioning

confidence: 85%

“…A reduced vagal tone was correlated with PENFS treatment response in children with functional abdominal pain, suggesting that suboptimal parasympathetic control may underlie symptoms in some DGBI (16). While the exact mechanisms of CVS remain undefined, prior and newly emerging data points to underlying autonomic nervous system dysfunction (17–20).…”

mentioning

confidence: 99%

Percutaneous Electrical Nerve Field Stimulation for Drug-Refractory Pediatric Cyclic Vomiting Syndrome

Karrento,

Venkatesan,

Zhang

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Vomiting requires coordinated outflow from both the DMNX (which mainly innervates structures below the diaphragm) and the NA (regulating structures above the diaphragm), which synchronize swallowing, respiration, cardiovascular activity, and gastrointestinal function (69). Disruption in any of these pathways may result in sensitization of an urge to vomit and may contribute to recurring cyclic vomiting, which is associated with impaired parasympathetic regulation during times of wellness between vomiting episodes (70).…”

Section: Discussionmentioning

confidence: 99%

Association of Self-Reported Autonomic Symptoms With Sensor-Based Physiological Measures

Kolacz,

Chen,

Nix

et al. 2023

Psychosom Med

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Objective Autonomic regulation of organ and tissues may give rise to disruptions of typical functions. The Body Perception Questionnaire Short Form (BPQ-SF) includes items that were developed to assess autonomic symptoms in daily life. This pair of studies aimed to establish previously unexplored psychometric properties of the BPQ-SF autonomic symptoms scale, develop normative values for clinical and research use, and assess the convergence of self-reports with sensor-based measures. Methods Study 1 reports exploratory and confirmatory factor analysis (CFA) on BPQ-SF autonomic symptom items from a large U.S. population-based online study (n = 2048). In study 2, BPQ-SF scores were examined for associations with heart period, respiratory sinus arrhythmia (RSA), and skin conductance (SC) during seated leg lifts in a community sample (n = 62). Results Study 1 results supported a 2-factor supra- and sub-diaphragmatic autonomic symptom solution (CFA: RMSEA = .040, CFI = .99, TLI = .99), though a 1-factor solution also fit the data well (RMSEA = .080, CFI = .99, TLI = .99). In study 2, HP responses to leg lifts and rests were demonstrated at all autonomic symptom levels. However, low autonomic symptoms were associated with optimal ANS patterns of activation and recovery to baseline levels. Moderate symptoms were associated with prolonged sympathetic activation. The highest symptom levels were associated with impaired ANS coordination across activation and recovery. Conclusion Results support the utility of self-reports of autonomic symptoms in research and clinical applications, with higher symptoms likely indicating autonomic impairment.

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“…Most of us have encountered patients who develop worsening symptoms after starting medications only to adjust the dose or discontinue them. One must question whether this could be related to worsening vagal insufficiency which has been demonstrated in children with DGBIs ( 23 , 24 ). In addition, blocking muscarinic-dependent vagal activation with ACDs could lead to worsening inflammation.…”

mentioning

confidence: 99%

Opinion: Percutaneous electrical nerve field stimulation compared to standard medical therapy in adolescents with functional abdominal pain disorders

Miranda

2024

Front. Pain Res.

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Cardiac Vagal Regulation Is Impeded in Children With Cyclic Vomiting Syndrome

Cited by 10 publications

References 48 publications

Percutaneous Electrical Nerve Field Stimulation for Drug-Refractory Pediatric Cyclic Vomiting Syndrome

Percutaneous Electrical Nerve Field Stimulation for Drug-Refractory Pediatric Cyclic Vomiting Syndrome

Association of Self-Reported Autonomic Symptoms With Sensor-Based Physiological Measures

Opinion: Percutaneous electrical nerve field stimulation compared to standard medical therapy in adolescents with functional abdominal pain disorders

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