Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

Topiramate 투여로 호전된 주기성 구토증 1례

Topiramate can reduce the number of episodic attacks in cyclic vomiting syndrome : a case report

  • 염미선 (울산대학교 의과대학 소아과학교실) ;
  • 배근욱 (울산대학교 의과대학 소아과학교실) ;
  • 유수영 (인제대학교 의과대학 소아과학교실) ;
  • 고태성 (울산대학교 의과대학 소아과학교실)
  • Yum, Mi-Sun (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Bae, Keun Wook (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • You, Su Jeong (Department of Pediatrics, Epilepsy Center, College of Medicine, Inje University) ;
  • Ko, Tae Sung (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan)
  • 투고 : 2007.02.26
  • 심사 : 2007.03.15
  • 발행 : 2007.04.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

주기성 구토증(cyclic vomiting syndrome, CVS)은 예측 불가능한 심한 구토가 특별한 원인 없이 시작되어 각 개인마다 일정한 임상 양상을 보이며 수 시간에서 수일간 지속되다가 저절로 호전되는 것을 반복하는 질환으로서, 그 임상 양상은 편두통과 많은 공통점을 보이며 그 병리생리학적 원인이 편두통과 유사한 것으로 추정되어지고 있다. 저자들은 만 3세 경부터 시작된 발작적이고 반복적인 주기적 구토를 주소로 내원한 5세 남아에서 주기적 구토증을 진단하였으며, 이 환아에서 대규모의 임상 연구를 통해 단독 요법으로 편두통의 예방에 효능이 있음이 인정된 광범위 항경련제인 topiramate(TPM)를 투여하여 그 증상이 호전됨을 경험하고 이를 보고하는 바이다.

Cyclic vomiting syndrome (CVS) is a paroxysmal, recurrent vomiting disorder of unknown pathophysiology and target organ. It has been hypothesized that CVS shares the same mechanism as migraine. We describe here a 5-year-old boy with CVS characterized by episodic vomiting attacks. These recurrent vomiting episodes began at 3 years of age, occurred every month and lasted for 5 days at a time. At the time of admission, no abnormal physical or neurological findings were observed and laboratory findings, including brain MRI and endoscopic examination, revealed nothing specific. The vomiting episodes were self-limited but recurrent and severely interrupted his daily life. When this patient was treated with topiramate, he showed a marked increase of symptom-free periods.

키워드

참고문헌

  1. Lanzi G, Balottin U, Ottolini A, Rosano BF, Fazzi E, Arisi D. Cyclic vomiting and recurrent abdominal pains as migraine or epileptic equivalents. Cephalalgia 1983;3:115-8 https://doi.org/10.1046/j.1468-2982.1983.0302115.x
  2. Li BU, Murray RD, Heitlinger LA, Robbins JL, Hayes JR. Is cyclic vomiting syndrome related to migraine? J Pediatr 1999;134:567-72 https://doi.org/10.1016/S0022-3476(99)70242-8
  3. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004;24 Suppl 1:9-160 https://doi.org/10.1111/j.1468-2982.2003.00824.x
  4. To J, Issenman RM, Kamath MV. Evaluation of neurocardiac signals in pediatric patients with cyclic vomiting syndrome through power spectral analysis of heart rate variability. J Pediatr 1999;135:363-6 https://doi.org/10.1016/S0022-3476(99)70135-6
  5. Rashed H, Abell TL, Familoni BO, Cardoso S. Autonomic function in cyclic vomiting syndrome and classic migraine. Dig Dis Sci 1999;44 Suppl 8:74-8
  6. Li BU, Misiewicz L. Cyclic vomiting syndrome: a braingut disorder. Gastroenterol Clin North Am 2003;32:997- 1019 https://doi.org/10.1016/S0889-8553(03)00045-1
  7. Silberstein SD, Loder E, Forde G, Papadopoulos G, Fairclough D, Greenberg S. The impact of migraine on daily activities: effect of topiramate compared with placebo. Curr Med Res Opin 2006;22:1021-9 https://doi.org/10.1185/030079906X104731
  8. Bussone G, Usai S, D'Amico D. Topiramate in migraine prophylaxis: data from a pooled analysis and open-label extension study. Neurol Sci 2006;27 Suppl 2:159-63 https://doi.org/10.1007/s10072-006-0593-z
  9. Brandes JL, Saper JR, Diamond M, Couch JR, Lewis DW, Schmitt J, et al. Topiramate for migraine prevention: a randomized controlled trial. JAMA 2004;291:965-73 https://doi.org/10.1001/jama.291.8.965
  10. Winner P, Pearlman EM, Linder SL, Jordan DM, Fisher AC, Hulihan J. Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. Headache 2005;45:1304-12 https://doi.org/10.1111/j.1526-4610.2005.00262.x
  11. Li BU, Issenman RM, Sarna SK. Consensus statement-2nd International Scientific Symposium on CVS. The Faculty of The 2nd International Scientific Symposium on Cyclic Vomiting Syndrome. Dig Dis Sci 1999;44 Suppl 8:9-11
  12. Welch KM. Scientific basis of migraine: speculation on the relationship to cyclic vomiting. Dig Dis Sci 1999;44 Suppl 8:26-30
  13. Hornby PJ. Central neurocircuitry associated with emesis. Am J Med 2001;111 Suppl 8A:106-12 https://doi.org/10.1016/S0002-9343(01)00849-X
  14. Li BU. Cyclic vomiting syndrome: Age-old syndrome and new insights. Semin Pediatr Neurol 2001;8:13-21
  15. Fleisher DR. Cyclic vomiting syndrome: a paroxismal disorder of brain-gut interaction. J Pediatr Gastroenterol Nutr 1997;25 Suppl 1:13-5 https://doi.org/10.1097/00005176-199700002-00007
  16. Cheon JM, Um MR, Kee MH, Beck NS. Clinical evaluation of cyclic vomiting syndrome. J Korean Pediatr Soc 2000;43:1223-31
  17. Cupini LM, Santorelli FM, Iani C, Fariello G, Calabresi P. Cyclic vomiting syndrome, migraine, and epilepsy: a common underlying disorder? Headache 2003;43:407-9 https://doi.org/10.1046/j.1526-4610.2003.03078.x
  18. Diener HC, Tfelt-Hansen P, Dahlof C, Lainez MJ, Sandrini G, Wang SJ, et al. Topiramate in migraine prophylaxisresults from a placebo-controlled trial with propranolol as an active control. J Neurol 2004;251:943-50
  19. Shank RP, Gardocki JF, Streeter AJ, Maryanoff BE. An overview of the preclinical aspects of topiramate: pharmacology, pharmacokinetics, and mechanism of action. Epilepsia 2000;41 Suppl 1:3-9 https://doi.org/10.1111/j.1528-1157.2000.tb02163.x
  20. Akerman S, Goadsby PJ. Topiramate inhibits cortical spreading depression in rat and cat: impact in migraine aura. Neuroreport 2005;16:1383-7 https://doi.org/10.1097/01.wnr.0000175250.33159.a9