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Related Experiment Videos

Autonomic abnormalities in cyclic vomiting syndrome.

Thomas C Chelimsky1, Gisela G Chelimsky

  • 1Department of Neurology, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA. Thomas.chelimsky@uhhospitals.org

Journal of Pediatric Gastroenterology and Nutrition
|February 28, 2007
PubMed
Summary

Cyclic vomiting syndrome (CVS) in children is linked to autonomic dysfunction, particularly affecting the sympathetic nervous system. This autonomic neuropathy may explain CVS symptoms and is often seen alongside a history of migraines.

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Area of Science:

  • Pediatric Gastroenterology
  • Neurology
  • Autonomic Medicine

Background:

  • Cyclic vomiting syndrome (CVS) is known to be associated with migraine.
  • Migraine is also linked to orthostatic tachycardia.
  • However, the connection between CVS and autonomic dysfunction remains under-explored.

Purpose of the Study:

  • To investigate autonomic function in children diagnosed with CVS.
  • To identify potential autonomic nervous system abnormalities contributing to CVS.

Main Methods:

  • Autonomic testing was performed on 6 children meeting diagnostic criteria for CVS.
  • Tests included cardiovascular function (deep breathing, Valsalva maneuver, tilt testing) and sudomotor function.
  • Standard, previously published methods were utilized for all tests.

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Main Results:

  • All patients exhibited normal cardiovascular responses to deep breathing and Valsalva maneuver.
  • Tilt testing revealed a significant heart rate increase (>30 bpm) in all patients.
  • Two patients showed a vasodepressor response, with abdominal pain at blood pressure nadir; a third experienced syncope.
  • Sudomotor tests were abnormal in all 6 children (5 reduced, 1 exaggerated).
  • All patients had a personal or family history of migraine headaches.

Conclusions:

  • CVS is associated with consistent sympathetic autonomic dysfunction, primarily impacting vasomotor and sudomotor systems.
  • Findings suggest an underlying autonomic neuropathy in children with CVS.
  • Symptom occurrence during tilt testing indicates a potential pathophysiologic role for autonomic dysfunction.
  • A vagally modulated sympathetic effect is proposed as the likely mechanism for CVS and gastroparesis.