Abstract
Objective: To compare the efficacy of amitriptyline, cyproheptadine, and topiramate in prophylaxis of cyclic vomiting syndrome (CVS).
Background: CVS is a common functional gastrointestinal disorder characterized by recurrent episodes of nausea and vomiting. It is classified as one of the episodic syndromes that may be associated with migraine. There is no certain treatment for the condition although some migraine medications are recommended.
Design/Methods: We conducted two single-blinded randomized clinical trials during 2015–2016 in Isfahan, Iran and combined their results. One hundred children 3–15 years old with diagnosis of CVS (based on Rome Ш criteria) were included in three groups of amitriptyline (32 cases), cyproheptadine (32 cases), and topiramate (36 cases). They were followed for 3–6 months looking for frequency and duration of attacks as the primary outcome.
Results: The mean age (SD) in amitriptyline, cyproheptadine, and topiramate groups were 8.40 (2.07), 7.56 (2.55), and 8.10 (2.36), respectively (P-value=0.346). There was no statistically significant difference between distribution of genders in groups (P-value=0.965). There was no statistically significant difference between monthly frequency and duration of attacks before intervention between three groups (P-value=0.166 and P-value=0.270, respectively). Monthly frequency of attacks after intervention in amitriptyline, cyproheptadine, and topiramate groups were 0.34 (0.55), 0.63 (0.71), and 1.06 (1.72), respectively (P-value=0.041). Also, the mean duration of attacks in three groups were 1.88 (4.40), 2.16 (2.52), and 3.31 (3.76), respectively (P-value=0.231). With respect to overall efficacy, 65.6% in amitriptyline group, 50% in cyproheptadine group, and 38.9% in topiramate group became symptom-free after intervention (P-value=0.088).
Conclusions: We found that amitriptyline is the superior medication for prophylaxis of CVS compared to cyproheptadine and topiramate, although other medications also seemed to be beneficial.
Study Supported by:
The studies are funded by Vice-chancellor of Research and Technology of Isfahan University of Medical Sciences.
Clinical trial registry: IRCT2014030416844N1 and IRCT2015102316844N2 on Iranian Registry of Clinical Trials (www.irct.ir).
Disclosure: Dr. Badihian has nothing to disclose. Dr. Badihian has nothing to disclose. Dr. Bagherian has nothing to disclose. Dr. Saneian has nothing to disclose. Dr. Yaghini has nothing to disclose.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Hastening the Diagnosis of Amyotrophic Lateral Sclerosis
Dr. Brian Callaghan and Dr. Kellen Quigg