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Percutaneous Electrical Nerve Field Stimulation for Drug-Refractory Pediatric Cyclic Vomiting Syndrome
Katja Karrento1, Thangam Venkatesan2, Liyun Zhang3
1From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Insights
Percutaneous electrical nerve field stimulation (PENFS) offers long-term relief for pediatric cyclic vomiting syndrome (CVS). This noninvasive therapy significantly reduces CVS episode frequency, duration, and associated disability in children.
Area of Science:
- Neurology
- Pediatric Gastroenterology
Background:
- Cyclic vomiting syndrome (CVS) is a debilitating disorder often resistant to standard pharmaceutical treatments.
- Pediatric CVS presents unique challenges due to its refractory nature and impact on child development.
Purpose of the Study:
- To investigate the efficacy of auricular percutaneous electrical nerve field stimulation (PENFS) as a prophylactic treatment for pediatric CVS.
- To assess the impact of PENFS on CVS episode frequency, duration, nausea, and disability in children.
Main Methods:
- A prospective study enrolled 30 children (8-18 years) with drug-refractory CVS.
- Subjects underwent 6 weeks of auricular PENFS, with outcomes assessed at baseline and extended follow-up (4-6 months).
- Severity was measured by episode frequency-duration scores, nausea, disability, and global response surveys.
Main Results:
- 80% of participants achieved treatment response, with a median response duration of 113 days.
- Significant reductions were observed in CVS frequency-duration scores (P < 0.0001), nausea (P = 0.003), and disability (P = 0.001).
- No serious adverse events were reported during the study.
Conclusions:
- Auricular PENFS demonstrates long-term prophylactic benefits for children suffering from CVS.
- PENFS effectively alleviates key disabling symptoms of pediatric CVS, including attack frequency, duration, and functional impairment.
- This noninvasive neuromodulation technique presents a promising therapeutic option for refractory pediatric CVS.
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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