title: Cyclic Vomiting Syndrome in Infants and Children: A Clinical Follow-Up Study.
abstract: BACKGROUND
  Cyclic vomiting syndrome is characterized by recurrent vomiting that is associated with increased adrenocorticotropic hormone and antidiuretic hormone levels during cyclic vomiting syndrome attacks. However, both prognosis and treatment remain unclear. We therefore evaluated the clinical features, prognosis, and effectiveness of the prophylaxis of cyclic vomiting syndrome as well as the relationship between symptoms and adrenocorticotropic hormone/antidiuretic hormone levels.
  
  
  METHODS
  We included 31 patients with cyclic vomiting syndrome who were admitted to Teikyo University between 1996 and 2008. All patients were diagnosed with cyclic vomiting syndrome based on the criteria of the second edition of the International Headache Classification. The patients (25 of 31) were followed until 2013.
  
  
  RESULTS
  The median overall duration of the disorder was 66 (3-179) months. Follow-up was completed for 25 patients with cyclic vomiting syndrome, of whom 44% (n = 11) developed migraine. Valproic acid, valproic acid with phenobarbital, phenobarbital, and amitriptyline were effective in nine, four, three, and one patients, respectively. Abnormally high adrenocorticotropic hormone (n = 17) and antidiuretic hormone (n = 18) levels were found among the 25 patients for whom follow-up data were available. The following correlations were significant: attack duration and adrenocorticotropic hormone levels (correlation coefficient: 0.5153, P = 0.0084) and attack duration and antidiuretic hormone levels (correlation coefficient: 0.5666, P = 0.0031). Antidiuretic hormone levels in patients with bilious vomiting were higher than in those without bilious vomiting (P = 0.048).
  
  
  CONCLUSIONS
  Most patients with cyclic vomiting syndrome recovered completely and benefited from prophylactic therapy, although half of them developed migraines.
authors: Department of Pediatrics, Teikyo University School of Medicine, Itabashi-Ku, Tokyo, Japan. Electronic address: t-hikita@ra2.so-net.ne.jp.
authors: Toshiyuki
authors: T
authors: Hikita
authors: Department of Pediatrics, Teikyo University School of Medicine, Itabashi-Ku, Tokyo, Japan.
authors: Hiroko
authors: H
authors: Kodama
authors: Department of Pediatrics, Teikyo University School of Medicine, Itabashi-Ku, Tokyo, Japan.
authors: Kaori
authors: K
authors: Ogita
authors: Department of Pediatrics, Teikyo University School of Medicine, Itabashi-Ku, Tokyo, Japan.
authors: Sono
authors: S
authors: Kaneko
authors: Department of Pediatrics, Teikyo University School of Medicine, Itabashi-Ku, Tokyo, Japan.
authors: Natsue
authors: N
authors: Nakamoto
authors: Department of Pediatrics, Teikyo University School of Medicine, Itabashi-Ku, Tokyo, Japan.
authors: Masakazu
authors: M
authors: Mimaki
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008881:Migraine Disorders / Q000150:complications; D012189:Retrospective Studies; D014667:Vasopressins / Q000378:metabolism; D014839:Vomiting / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism
chemical_list: D000927:Anticonvulsants; D014667:Vasopressins; D000324:Adrenocorticotropic Hormone
keywords: International Headache Classification; adrenocorticotropic hormone; antidiuretic hormone; migraine; prophylactic therapy