Cyclic vomiting with generalized epileptiform discharges responsive to topiramate therapy

Area of Science:

• Pediatric Neurology
• Gastroenterology
• Epileptology

Background:

• Cyclic vomiting syndrome (CVS) is a disorder of recurrent vomiting episodes, often linked to childhood periodic syndromes and migraine precursors.
• CVS has been historically referred to by various names, including abdominal migraine and abdominal epilepsy.
• Topiramate is an established antiepileptic drug also utilized for migraine prophylaxis.

Observation:

• This report details a pediatric case of cyclic vomiting syndrome (CVS).
• The patient exhibited generalized epileptiform discharges on electroencephalogram (EEG).
• The child experienced a positive response to topiramate therapy.

Findings:

• The presented case demonstrates a successful outcome using topiramate in a child with CVS and epileptiform discharges.
• This suggests a potential therapeutic link and shared pathophysiology between CVS, epilepsy, and migraine.
• Topiramate's efficacy highlights its potential role in managing complex CVS cases with neurological comorbidities.

Implications:

• The findings suggest that topiramate may be a viable treatment option for cyclic vomiting syndrome, particularly in cases with associated epileptiform activity.
• This case underscores the overlapping clinical and potential pathophysiological features among cyclic vomiting syndrome, epilepsy, and migraine.
• Further research into the neurobiological connections between these conditions is warranted to optimize diagnostic and therapeutic strategies.