Sumatriptan as a treatment for cyclic vomiting syndrome: a clinical trial.

BACKGROUND AND OBJECTIVE: Cyclic vomiting syndrome (CVS) is associated with migraine. This study aimed to evaluate the efficacy of sumatriptan in treating CVS. METHODS: Twelve patients were enrolled in this trial. Sumatriptan was administered either subcutaneously [(age x 4 + 20)/100 x 3 mg] or by nasal spray (NS; 20 mg). Response to the treatment was classified as complete, effective, or noneffective. RESULTS: Eleven patients, who presented with 35 attacks, were treated by subcutaneous injection of sumatriptan. The treatment was responsive in 19 attacks. The efficacy of sumatriptan was high in attacks that occurred in cases with a family history of migraine compared to those without (p = .0482). Five patients were treated with sumatriptan NS for six attacks. The treatment was completely responsive in two of six attacks. We observed no adverse effects associated with sumatriptan treatment in this trial. CONCLUSION: We conclude that sumatriptan has potential efficacy in treating of patients with CVS.

[Assessment of joint attention skill in at-risk infants during follow-up outpatient examination].

We assessed the joint attention skill of infants by a novel method. One hundred eighty infants who were discharged from the NICU of Teikyo University Hospital and subsequently brought to the outpatient clinic for follow-up examinations between 6 and 12 months of corrected age (297 examinations in total) were entered into the study. Infant were sitting on the mother's knees facing the examiner. After confirming the infant's visual axis to the examiner's eyes, the examiner looked at blocks held in the infant's visual field. When the infant looked at the blocks by perceiving the examiner's gaze, the infant was judged to have joint attention skill. Then, when the infant looked at the examiner again, the attitude was estimated as an action for reconfirmation. Sixty percent of the infants at 6 months of age showed joint attention skill, and more than 90 % of infants showed this skill at 9 months of age. At 6 months of age, boys showed that skill significantly more frequently than girls. This new method is very easy to perform, uses only small blocks and can be completed within a few minutes. Therefore, we considered this new method useful for the assessment of joint attention skill in infants during periodic outpatient health clinic examination.

Effective prophylactic therapy for cyclic vomiting syndrome in children using valproate.

This trial sought to evaluate our experience using the antimigraine prophylactic drug, use of valproate for the prophylactic management of cyclic vomiting syndrome (CVS) in children. Thirteen children diagnosed with severe CVS were enrolled. Prophylactic therapy consisted of valproate administered at a dose of 10-40 mg/kg/day. Upon enrollment in the study, all patients underwent diagnostic tests to rule out organic causes of their symptoms. Vomiting was severe enough in all patients to cause dehydration requiring hospitalization for intravenous rehydration. Nine of 13 patients did not respond to numerous previous medical therapies like propranolol, amitriptyline, cyproheptadine, phenobarbital, phenytoin, and carbamazepine. Three of 13 patients required combination therapy with valproate and phenobarbital. Of the 13 patients, two showed complete resolution of their symptoms, nine had marked improvement in their symptoms, as evidenced by infrequent attacks of reduced severity, and two failed to respond to valproate therapy. Four patients experienced relapse with a decreased dosage of valproate. Side effects associated with long-term valproate administration were not observed. Valproate appears to be effective for the prophylactic management of severe CVS, with 85% of all patients achieving at least a reduction in the frequency of attacks.