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Hur JY, Lee S, Shin WR, Kim YH, Ahn JY. The emerging role of medical foods and therapeutic potential of medical food-derived exosomes. NANOSCALE ADVANCES 2023; 6:32-50. [PMID: 38125597 PMCID: PMC10729880 DOI: 10.1039/d3na00649b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Abstract
Medical food is consumed for the purpose of improving specific nutritional requirements or disease conditions, such as inflammation, diabetes, and cancer. It involves partial or exclusive feeding for fulfilling unique nutritional requirements of patients and is different from medicine, consisting of basic nutrients, such as polyphenols, vitamins, sugars, proteins, lipids, and other functional ingredients to nourish the patients. Recently, studies on extracellular vesicles (exosomes) with therapeutic and drug carrier potential have been actively conducted. In addition, there have been attempts to utilize exosomes as medical food components. Consequently, the application of exosomes is expanding in different fields with increasing research being conducted on their stability and safety. Herein, we introduced the current trends of medical food and the potential utilization of exosomes in them. Moreover, we proposed Medi-Exo, a exosome-based medical food. Furthermore, we comprehensively elucidate various disease aspects between medical food-derived exosomes (Medi-Exo) and therapeutic natural bionanocomposites. This review highlights the therapeutic challenges regarding Medi-Exo and its potential health benefits.
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Affiliation(s)
- Jin-Young Hur
- Department of Microbiology, Chungbuk National University 1 Chungdae-Ro, Seowon-Gu Cheongju 28644 South Korea +82-43-264-9600 +82-43-261-2301 +82-43-261-3575
| | - SeonHyung Lee
- Department of Bioengineering, University of Pennsylvania 210 S 33rd St. Philadelphia PA 19104 USA
| | - Woo-Ri Shin
- Department of Microbiology, Chungbuk National University 1 Chungdae-Ro, Seowon-Gu Cheongju 28644 South Korea +82-43-264-9600 +82-43-261-2301 +82-43-261-3575
- Department of Bioengineering, University of Pennsylvania 210 S 33rd St. Philadelphia PA 19104 USA
| | - Yang-Hoon Kim
- Department of Microbiology, Chungbuk National University 1 Chungdae-Ro, Seowon-Gu Cheongju 28644 South Korea +82-43-264-9600 +82-43-261-2301 +82-43-261-3575
| | - Ji-Young Ahn
- Department of Microbiology, Chungbuk National University 1 Chungdae-Ro, Seowon-Gu Cheongju 28644 South Korea +82-43-264-9600 +82-43-261-2301 +82-43-261-3575
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Schoch K, McConkie-Rosell A, Walley N, Bhambhani V, Feyma T, Pizoli CE, Smith EC, Tan QKG, Shashi V. Parental perspectives of episodic irritability in an ultra-rare genetic disorder associated with NACC1. Orphanet J Rare Dis 2023; 18:269. [PMID: 37667351 PMCID: PMC10476425 DOI: 10.1186/s13023-023-02891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND A recurrent de novo variant (c.892C>T) in NACC1 causes a neurodevelopmental disorder with epilepsy, cataracts, feeding difficulties, and delayed brain myelination (NECFM). An unusual and consistently reported feature is episodic extreme irritability and inconsolability. We now characterize these episodes, their impact on the family, and ascertain treatments that may be effective. Parents of 14 affected individuals provided narratives describing the irritability episodes, including triggers, behavioral and physiological changes, and treatments. Simultaneously, parents of 15 children completed the Non-communicating Children's Pain Checklist-Revised (NCCPC-R), a measure to assess pain in non-verbal children. RESULTS The episodes of extreme irritability include a prodromal, peak, and resolving phase, with normal periods in between. The children were rated to have extreme pain-related behaviors on the NCCPC-R scale, although it is unknown whether the physiologic changes described by parents are caused by pain. Attempted treatments included various classes of medications, with psychotropic and sedative medications being most effective (7/15). Nearly all families (13/14) describe how the episodes have a profound impact on their lives. CONCLUSIONS NECFM caused by the recurrent variant c.892C>T is associated with a universal feature of incapacitating episodic irritability of unclear etiology. Further understanding of the pathophysiology can lead to more effective therapeutic strategies.
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Affiliation(s)
- Kelly Schoch
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Allyn McConkie-Rosell
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Nicole Walley
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Vikas Bhambhani
- Division of Genetics and Genomic Medicine, Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Timothy Feyma
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Carolyn E Pizoli
- Division of Neurology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Edward C Smith
- Division of Neurology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Queenie K-G Tan
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Vandana Shashi
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
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Ucuncu Egeli T, Tufekci KU, Ural C, Durur DY, Tuzun Erdogan F, Cavdar Z, Genc S, Keskinoglu P, Duman N, Ozkan H. A New Perspective on the Pathogenesis of Infantile Colic: Is Infantile Colic a Biorhythm Disorder? J Pediatr Gastroenterol Nutr 2023; 77:171-177. [PMID: 37098054 DOI: 10.1097/mpg.0000000000003815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVES In this study, we investigated the relationship between infantile colic, migraine, and biorhythm regulation, by evaluating biochemical and molecular parameters. STUDY DESIGN Healthy infants with and without infantile colic were eligible for this prospective cohort study. A questionnaire was applied. Between the 6th and 8th postnatal weeks, day and night circadian histone gene H3f3b mRNA expression and spot urine excretion of serotonin, cortisol, and 6-sulphatoxymelatonin were analyzed. RESULTS Among the 95 infants included, 49 were diagnosed with infantile colic. In the colic group, defecation difficulty, sensitivity to light/sound, and maternal migraine frequency increased and sleep disruption was typical. In the melatonin analysis, the difference between day and night levels was significant in the control group, indicating an established circadian rhythm ( P = 0.014). In the colic group, there was no day-night difference ( P = 0.216) in melatonin, but serotonin levels were higher at night. In the cortisol analysis, day-night values were similar in both groups. Day-night variability of H3f3b mRNA levels between the groups was significant, indicating circadian rhythm disturbance in the colic group compared to the control group ( P = 0.003). Fluctuations in circadian genes and hormones expected in healthy rhythm were revealed in the control group, but were missing in the colic group. CONCLUSION Due to the gaps in the etipathogenesis in infantile colic, a unique effective agent has not been discovered so far. This study, which demonstrated for the first time that infantile colic is a biorhythm disorder using molecular methods, fills the gap in this regard and points to a completely different perspective in terms of treatment.
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Affiliation(s)
- Tugba Ucuncu Egeli
- From the Department of Neonatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Kemal Ugur Tufekci
- Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey
- Vocational School of Health Services, Izmir Democracy University, Izmir, Turkey
| | - Cemre Ural
- the Department of Molecular Medicine, Health Science Institute, Dokuz Eylul University, Izmir, Turkey
| | - Devrim Yagmur Durur
- Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey
- Michigan Technological Houghton, Houghton, MI
| | - Funda Tuzun Erdogan
- From the Department of Neonatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Zahide Cavdar
- the Department of Molecular Medicine, Health Science Institute, Dokuz Eylul University, Izmir, Turkey
| | - Sermin Genc
- Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey
- the Department of Neuroscience, Health Science Institute, Dokuz Eylul University, Izmir, Turkey
| | - Pembe Keskinoglu
- the Department of Biostatistics and Medical Informatics, Basic Medical Sciences, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Nuray Duman
- From the Department of Neonatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hasan Ozkan
- From the Department of Neonatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Frattale I, Ruscitto C, Papetti L, Ursitti F, Sforza G, Moavero R, Ferilli MAN, Tarantino S, Balestri M, Vigevano F, Mazzone L, Valeriani M. Migraine and Its Equivalents: What Do They Share? A Narrative Review on Common Pathophysiological Patterns. Life (Basel) 2021; 11:1392. [PMID: 34947923 PMCID: PMC8705894 DOI: 10.3390/life11121392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 01/02/2023] Open
Abstract
Migraine is the first in order of frequency of the neurological disorders, affecting both adult and paediatric populations. It is also the first cause of primary headaches in children. Migraine equivalents are periodic disorders that can be associated with migraine or considered as prognostic features of a future migraine manifestation. Despite the mechanisms underlying migraine and its equivalents are not entirely clear, several elements support the hypothesis of common pathophysiological patterns shared by these conditions. The aim of this review is thus to analyze the literature in order to highlight which currently known mechanisms may be common between migraine and its equivalents.
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Affiliation(s)
- Ilaria Frattale
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
| | - Claudia Ruscitto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
| | - Laura Papetti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Fabiana Ursitti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Giorgia Sforza
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Michela Ada Noris Ferilli
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Samuela Tarantino
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Martina Balestri
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Hospital of Rome, 00165 Rome, Italy; (I.F.); (C.R.); (R.M.); (L.M.)
| | - Massimiliano Valeriani
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (F.U.); (G.S.); (M.A.N.F.); (S.T.); (M.B.); (F.V.)
- Center for Sensory-Motor Interaction, Aalborg University, 9220 Aalborg Øst, Denmark
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LenglarT L, Caula C, Moulding T, Lyles A, Wohrer D, Titomanlio L. Brain to Belly: Abdominal Variants of Migraine and Functional Abdominal Pain Disorders Associated With Migraine. J Neurogastroenterol Motil 2021; 27:482-494. [PMID: 34642268 PMCID: PMC8521460 DOI: 10.5056/jnm20290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Migraine is one of the most frequent causes of primary headache and 9% of children suffer from migraines. Most children will continue to experience migraine attacks as adults, therefore it is imperative that we have a thorough understanding of this major health issue. This article considers the so-called abdominal variants of migraine, which are more commonly seen in children rather than adults: abdominal migraine, cyclic vomiting syndrome, and infantile colic. Other functional abdominal pain disorders such as irritable bowel syndrome and functional dyspepsia have also been linked to migraine in clinical studies. The common pathophysiological root of these diseases seems to be the gut-brain axis mechanism. Abdominal variants of migraine are considered pediatric precursors of migraine whereas the functional abdominal pain disorders related to migraine seem to share a pathophysiological root with no temporarily link as for today. In this review we aim to describe the epidemiological background, the current pathophysiological theories and the relationship of each disease to migraine. This review is the first to compile abdominal variants of migraine and functional abdominal pain disorders associated with migraine and we endeavor to elucidate the broad spectrum of migraine-related episodes in children.
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Affiliation(s)
- Léa LenglarT
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Caroline Caula
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Thomas Moulding
- Department of Specialty and Integrated Medicine, The Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Annabel Lyles
- Department of Oncology, The Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Delphine Wohrer
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France.,Pediatric Migraine and Neurovascular Diseases Unit, APHP - Hopital Robert Debré, Paris, France.,Paris University, INSERM U1141, DHU Protect, Paris, France
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Fifteen-Years Follow-Up in a Cohort of Children with Functional Gastrointestinal Disorders: Prevalence and Risk Factors to Develop Neuropsychiatric Disorders and Other Comorbidities. CHILDREN-BASEL 2021; 8:children8100838. [PMID: 34682103 PMCID: PMC8534479 DOI: 10.3390/children8100838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022]
Abstract
Background: Functional gastrointestinal disorders (FGIDs) are chronic and recurrent disorders, which affect up to 23% of children and adolescents and represent 50% of gastroenterological accesses. The association between FGIDs diagnosed at paediatric age and the onset of migraine or headache and neuropsychiatric diseases in adolescence and adulthood is widely reported in the literature. However, there is still limited knowledge about the long-term prognosis and risk factors for neuropsychiatric pathologies and other comorbidities. Aim: The aim is to assess the prevalence and persistence of FGIDs as well as the occurrence of migraine or headache and neuropsychiatric disorders in a cohort of patients diagnosed with FGIDs 15 years ago compared with a control group of peers. Materials and methods: We enrolled a group of patients diagnosed with FGIDs at paediatric age, at least 10 years ago (FGIDs group, n = 79; median age 23), and control subjects (control group, n = 201; median age 23). In both groups, an online questionnaire created explicitly for the study was submitted in order to investigate the presence of chronic intestinal diseases, migraine, headache or neuropsychiatric disorders. Results: 45.6% (36 out of 79) of patients previously diagnosed with FGIDs still suffer from FGIDs versus 12% (24 out of 201) of healthy controls (p < 0.0001). The prevalence of chronic organic gastrointestinal disorders was comparable in the two groups (2.5% in FGIDs group versus 1% in healthy group, p = 0.3). Thirty-three percent (26 out of 79) of FGIDs patients reported headache or migraine versus 13% (26 out of 201) of healthy peers (p < 0.001). No differences were found regarding the prevalence of anxiety and depression. Conclusion: The outcome at 15 years of FGIDs was characterized by a high prevalence of persisting functional symptoms along with a significant incidence of headaches and migraines. Abbreviation: FGIDs: Functional gastrointestinal disorders; IBS: Inflammatory Bowel Syndrome.
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7
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Hatami M, Soveid N, Lesani A, Djafarian K, Shab-Bidar S. Migraine and Obesity: Is There a Relationship? A Systematic Review and Meta-Analysis of Observational Studies. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 20:863-870. [PMID: 34259152 DOI: 10.2174/1871527320666210713114840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/01/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Many studies have evaluated the risk of migraine headache in obese persons, suggesting controversial conclusions-this systematic review and meta-analysis of the observational studies aimed to clarify the association between migraine and obesity. METHODS Scopus and PubMed electronic databases were systematically searched up to February 2019 for observational studies providing data dealing with migraine disorder in obese subjects, as well as normal-weight controls. The random-effects model was applied to assess pool effect size and inter-study heterogeneity by conducting subgroup analyses. RESULTS Among 1122 publications, 16 studies (10 cross-sectional, five cohort studies, and one case-control study) were detected and were included in the meta-analysis. The pooled data analysis illustrated an elevated risk of migraine headaches (Prevalence ratio estimate = 1.29, 95% CI, 1.15 -1.44; P = 0.000) in obese individuals than normal-weight persons. Subgroup analyses revealed that geographical distribution was an essential source of heterogeneity (p= 0.04). So that significantly greater migraine prevalence was found in European and Asian patients, but no statistically significant relationship was seen in American patients with obesity. CONCLUSIONS Based on a cumulative meta-analysis of available studies indicating an association between migraine and obesity, obesity can be appropriately considered an overall risk factor for migraine headaches. Additional high-quality original studies considering frequency, severity, and duration of headache must clarify confident evidence.
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Affiliation(s)
- Mahsa Hatami
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Neda Soveid
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Azadeh Lesani
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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8
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Witten A, Marotta D, Cohen‐Gadol A. Developmental innervation of cranial dura mater and migraine headache: A narrative literature review. Headache 2021; 61:569-575. [DOI: 10.1111/head.14102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/25/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Andrew Witten
- Indiana University School of Medicine Indianapolis IN USA
| | - Dario Marotta
- Alabama College of Osteopathic Medicine Dothan AL USA
- Department of Neurology Division of Neuropsychology University of Alabama at Birmingham Birmingham AL USA
| | - Aaron Cohen‐Gadol
- Department of Neurological Surgery Indiana University Indianapolis IN USA
- The Neurosurgical Atlas Indianapolis IN USA
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Kazanasmaz H, Calik M, Gümüş H, Koyuncu I, Kazanasmaz Ö. Investigation of the plasma copeptin level in cases with childhood migraine. Hum Exp Toxicol 2020; 40:952-959. [PMID: 33295228 DOI: 10.1177/0960327120979349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Copeptin is a hypothalamic stress hormone that is synthesized in the hypothalamus together with Arginine-vasopressin and circulated from the neurohypophysis in equimolar amounts and can indicate the individual stress level. The aim of this study was to investigate the plasma copeptin level for childhood migraine headache. In this study, total oxidant status (TOS); total antioxidant status (TAS); oxidative stress index (OSI); and copeptin were measured in the plasma samples of 61 migraine patients and 60 matched healthy participants. The median plasma copeptin levels in the patients group and control group were 298.25 and 194.35 pg/mL, respectively. Copeptin levels were significantly higher in migraine patients than in the healthy control group. The specificity and sensitivity of copeptin for 249.5 pg/dL cut off value predicting diagnosis of migraine were 67% and 64%, respectively. In addition, TOS and OSI levels were found to be higher and TAS levels were significantly lower in patients with migraine than healthy controls. Plasma copeptin levels are thought to increase in cases of childhood migraine secondary to increased oxidative stress. In the diagnosis of childhood migraine cases, it can be used together with oxidative stress biomarkers such as TAS, TOS and OSI as a complementary parameter.
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Affiliation(s)
- Halil Kazanasmaz
- 111374Harran University, Faculty of Medicine, Department of Pediatrics, Sanliurfa, Turkey
| | - Mustafa Calik
- 111374Harran University, Faculty of Medicine, Department of Pediatric Neurology, Sanliurfa, Turkey
| | - Huseyin Gümüş
- 111374Harran University, Faculty of Medicine, Department of Pediatrics, Sanliurfa, Turkey
| | - Ismail Koyuncu
- 111374Harran University, Faculty of Medicine, Department of Medical Biochemistry, Sanliurfa, Turkey
| | - Özlem Kazanasmaz
- 218511Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Department of Pediatrics, Sanliurfa, Turkey
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10
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Raucci U, Borrelli O, Di Nardo G, Tambucci R, Pavone P, Salvatore S, Baldassarre ME, Cordelli DM, Falsaperla R, Felici E, Ferilli MAN, Grosso S, Mallardo S, Martinelli D, Quitadamo P, Pensabene L, Romano C, Savasta S, Spalice A, Strisciuglio C, Suppiej A, Valeriani M, Zenzeri L, Verrotti A, Staiano A, Villa MP, Ruggieri M, Striano P, Parisi P. Cyclic Vomiting Syndrome in Children. Front Neurol 2020; 11:583425. [PMID: 33224097 PMCID: PMC7667239 DOI: 10.3389/fneur.2020.583425] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Cyclic Vomiting Syndrome (CVS) is an underdiagnosed episodic syndrome characterized by frequent hospitalizations, multiple comorbidities, and poor quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. CVS mainly occurs in pre-school or early school-age, but infants and elderly onset have been also described. The etiopathogenesis is largely unknown, but it is likely to be multifactorial. Recent evidence suggests that aberrant brain-gut pathways, mitochondrial enzymopathies, gastrointestinal motility disorders, calcium channel abnormalities, and hyperactivity of the hypothalamic-pituitary-adrenal axis in response to a triggering environmental stimulus are involved. CVS is characterized by acute, stereotyped and recurrent episodes of intense nausea and incoercible vomiting with predictable periodicity and return to baseline health between episodes. A distinction with other differential diagnoses is a challenge for clinicians. Although extensive and invasive investigations should be avoided, baseline testing toward identifying organic causes is recommended in all children with CVS. The management of CVS requires an individually tailored therapy. Management of acute phase is mainly based on supportive and symptomatic care. Early intervention with abortive agents during the brief prodromal phase can be used to attempt to terminate the attack. During the interictal period, non-pharmacologic measures as lifestyle changes and the use of reassurance and anticipatory guidance seem to be effective as a preventive treatment. The indication for prophylactic pharmacotherapy depends on attack intensity and severity, the impairment of the QoL and if attack treatments are ineffective or cause side effects. When children remain refractory to acute or prophylactic treatment, or the episode differs from previous ones, the clinician should consider the possibility of an underlying disease and further mono- or combination therapy and psychotherapy can be guided by accompanying comorbidities and specific sub-phenotype. This review was developed by a joint task force of the Italian Society of Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) to identify relevant current issues and to propose future research directions on pediatric CVS.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Giovanni Di Nardo
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale “F. Del Ponte,” University of Insubria, Varese, Italy
| | | | | | - Raffaele Falsaperla
- Neonatal Intensive Care and Pediatric Units, S. Marco Hospital, Vittorio Emanuele Hospital, Catania, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Michela Ada Noris Ferilli
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Saverio Mallardo
- Pediatric Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Diego Martinelli
- Division of Metabolism, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | - Alberto Spalice
- Child Neurology Division, Department of Pediatrics, “Sapienza,” University of Rome, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Agnese Suppiej
- Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Massimiliano Valeriani
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Letizia Zenzeri
- Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Annamaria Staiano
- Section of Pediatrics, Department of Translational Medical Science, “Federico II” University of Naples, Naples, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
- Institute for Research, Hospitalization and Health Care (IRCCS) “G. Gaslini” Institute, Genova, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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11
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Baaleman DF, Di Lorenzo C, Benninga MA, Saps M. The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice. Curr Gastroenterol Rep 2020; 22:21. [PMID: 32193635 DOI: 10.1007/s11894-020-00760-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW To evaluate the impact of the implementation of the Rome IV criteria on pediatric gastrointestinal practice. RECENT FINDINGS In 2016, the Rome IV criteria were published, providing an update of symptom-based criteria to diagnose children with functional gastrointestinal disorders (FGIDs). For neonates and toddlers, Wessel's criteria for diagnosing infant colic were abandoned, and a differentiation was made between toilet-trained and non-toilet-trained children in the diagnosis of functional constipation. For children and adolescents, two new disorders (functional nausea and functional vomiting) are described, and in the diagnosis of functional dyspepsia, pain does not have to be the chief complaint anymore. This change has made functional dyspepsia the most common functional abdominal pain disorder, exceeding the prevalence of irritable bowel syndrome (IBS). Lastly, the diagnosis of abdominal migraine was narrowed, causing an appropriate drop in its prevalence.
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Affiliation(s)
- Desiree F Baaleman
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Holtz Children's Hospital, Miller School of Medicine, University of Miami, Miami, FL, USA
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12
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The Relationship between Infant Colic and Migraine as well as Tension-Type Headache: A Meta-Analysis. Pain Res Manag 2019; 2019:8307982. [PMID: 31316683 PMCID: PMC6604354 DOI: 10.1155/2019/8307982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/25/2019] [Accepted: 05/09/2019] [Indexed: 01/01/2023]
Abstract
Background Infant colic is a common benign disease during early infancy. Migraine and tension-type headache (TTH) are the most common primary headache forms among pediatric population. Several studies have investigated the incidence of infant colic in patients with migraine and TTH. The meta-analysis was to assess the relationship between infant colic and migraine as well as TTH. Methods PubMed, Web of Science, and Cochrane Library were searched until August 16, 2018, for potential studies. Data were extracted by two independent authors and analyzed using RevMan 5.2 software. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine the association between infant colic and migraine as well as TTH, respectively. Results A total of 148 studies were found, and 7 studies were finally included. A higher incidence of colic during infancy was revealed in migraine patients than controls (P=0.05, OR: 2.51, 95% CI: 1.32-4.77) and TTH subjects (P=0.02, OR: 0.33, 95% CI: 0.13-0.86), respectively. And no significances were found between TTHs with controls (P=0.51, OR: 1.17, 95% CI: 0.73-1.89). Conclusion This meta-analysis indicated that migraine was associated with increased incidence of infantile colic history, but TTH incidence was not relevant with the incidence of infantile colic history.
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13
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Romano C, Dipasquale V, Rybak A, Comito D, Borrelli O. An overview of the clinical management of cyclic vomiting syndrome in childhood. Curr Med Res Opin 2018; 34:1785-1791. [PMID: 29484898 DOI: 10.1080/03007995.2018.1445983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This narrative review provides an update on cyclic vomiting syndrome pathogenesis, diagnosis and management, based upon studies published after the 2008 North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) official recommendations. The review began with a comprehensive PubMed/Medline search for "cyclic vomiting syndrome", "periodic syndromes" and "pediatrics" from 2000 up to October 2017. Additional papers were identified by reviewing the re-ference lists of retrieved publications. Cyclic vomiting syndrome is a severe, debilitating disorder of the brain-gut axis with unclear pathogenesis, that significantly affects long-term quality of life of affected children and their families. The 2008 NASPGHAN recommendations defined the major clinical, diagnostic and therapeutic peculiarities. Over the last 10 years, advancements in pathogenesis and diagnostic criteria have been made, and new prophylactic and therapeutic strategies have been proposed. These aspects are discussed in this manuscript. For the pediatrician, the major aim is to have early clinical suspicion to avoid diagnostic delay and to start adequate, phase-related, symptom-tailored management.
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Affiliation(s)
- Claudio Romano
- a Division of Childhood Gastroenterology and Cystic Fibrosis, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Italy
| | - Valeria Dipasquale
- a Division of Childhood Gastroenterology and Cystic Fibrosis, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Italy
| | - Anna Rybak
- b Division of Neurogastroenterology and Motility, Department of Gastroenterology , Great Ormond Street Hospital and UCL , London , UK
| | - Donatella Comito
- a Division of Childhood Gastroenterology and Cystic Fibrosis, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Italy
| | - Osvaldo Borrelli
- b Division of Neurogastroenterology and Motility, Department of Gastroenterology , Great Ormond Street Hospital and UCL , London , UK
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14
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Albers L, von Kries R, Straube A, Heinen F, Obermeier V, Landgraf MN. Do pre-school episodic syndromes predict migraine in primary school children? A retrospective cohort study on health care data. Cephalalgia 2018; 39:497-503. [PMID: 30079745 DOI: 10.1177/0333102418791820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the relative risk, predictive value and population attributable risk fraction of pre-school episodic syndromes for later migraine in primary school age children. METHODS This retrospective cohort study used health insurance data on 55,035 children born in 2006 with no diagnosis of migraine up to the age of 5 years. The relative risk, probability and population attributable risk fraction of migraine prompting a physician visit at the age of 6-10 years in children with episodic syndromes included in the International Classification of Headache Disorders (benign paroxysmal torticollis, benign paroxysmal vertigo, cyclic vomiting syndrome, recurrent abdominal symptoms and abdominal migraine) and those not included in the International Classification of Headache Disorders (pavor nocturnus, somnabulism and bruxism) diagnosed up to the age of 5 years were determined. RESULTS The period prevalence of individual episodic syndromes ranged between 0.01% and 1.40%. For episodic syndromes included in the International Classification of Headache Disorders (recurrent abdominal symptoms and abdominal migraine) and for the episodic syndromes not included in the International Classification of Headache Disorders (somnambulism), the risk for later migraine was increased by factors of 2.08, 21.87 and 3.93, respectively. The proportion of risk for migraine in primary school children explained by any episodic syndromes included in the International Classification of Headache Disorders was 2.18% and for any episodic syndromes not included in the International Classification of Headache Disorders it was 0.59%. CONCLUSION Several pre-school episodic syndromes are risk factors for migraine in primary school age children. The fraction of migraine in primary school age children explained by prior episodic syndromes, however, is below 3%. A probability to develop primary school age migraine above 50% was only observed for abdominal migraine.
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Affiliation(s)
- Lucia Albers
- 1 Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rüdiger von Kries
- 1 Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Straube
- 2 University Hospital, Department of Neurology, Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Heinen
- 3 Dr von Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Viola Obermeier
- 1 Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mirjam N Landgraf
- 3 Dr von Hauner Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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15
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Soriano-Ramos M, Núñez Enamorado N, Navarro-Abia V, Simón de las Heras R. Lactante con tortícolis aguda al despertar. An Pediatr (Barc) 2018; 88:174-175. [DOI: 10.1016/j.anpedi.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022] Open
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Karsan N, Prabhakar P, Goadsby PJ. Characterising the premonitory stage of migraine in children: a clinic-based study of 100 patients in a specialist headache service. J Headache Pain 2016; 17:94. [PMID: 27770403 PMCID: PMC5074936 DOI: 10.1186/s10194-016-0689-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/11/2016] [Indexed: 01/03/2023] Open
Abstract
Background The premonitory stage of migraine attacks, when symptomatology outside of pain can manifest hours to days before the onset of the headache, is well recognised. Such symptoms have been reported in adults in a number of studies, and have value in predicting an impending headache. These symptoms have not been extensively studied in children. We aimed to characterise which, if any, of these symptoms are reported in children seen within a Specialist Headache Service. Methods We reviewed clinic letters from the initial consultation of children and adolescents seen within the Specialist Headache Service at Great Ormond Street Hospital between 1999 and 2015 with migraine in whom we had prospectively assessed clinical phenotype data. We randomly selected 100 cases with at least one premonitory symptom recorded in the letter. For these patients, the age at headache onset, presence of family history of headache, headache diagnosis, presence of episodic syndromes which may be associated with headache, developmental milestones, gestation at birth, mode of delivery and presence of premonitory symptoms occurring before or during headache were recorded. Results Of the 100 patients selected, 65 % were female. The age range of the patients was 18 months to 15 years at the time of headache onset. The most common diagnosis was chronic migraine in 58 %, followed by episodic migraine (29 %), New Daily Persistent Headache with migrainous features (8 %) and hemiplegic migraine (5 %). A history of infantile colic was noted in 31 % and was the most common childhood episodic syndrome associated with migraine. The most common premonitory symptoms recorded were fatigue, mood change and neck stiffness. The commonest number of reported premonitory symptoms was two. Conclusion Premonitory symptoms associated with migraine are reported in children as young as 18 months, with an overall clinical phenotype comparable to adults. Better documentation of this stage will aid parents and clinicians to better understand the phenotype of attacks, better recognise migraine and thus initiate appropriate management. Larger studies with a broader base are warranted to understand the extent and implications of these symptoms for childhood and adolescent migraine.
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Affiliation(s)
- N Karsan
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P Prabhakar
- Department of Paediatric Neurology, Great Ormond Hospital for Children NHS Foundation Trust, London, UK
| | - P J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, SE5 9PJ, UK.
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Guidetti V, Faedda N, Siniatchkin M. Migraine in childhood: biobehavioural or psychosomatic disorder? J Headache Pain 2016; 17:82. [PMID: 27619362 PMCID: PMC5016316 DOI: 10.1186/s10194-016-0675-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 12/12/2022] Open
Abstract
It is well documented that headache is a multifactorial disorder which includes not only genetic, biological, medical and neuropsychological factor but also psychological and personality traits. The close relationship between stress and migraine attacks and the significant psychiatric comorbidities in migraine provide evidence of a “paradigm” of tight interaction between somatic and psychological aspects in paediatric migraine. In particular in younger children, an uncomfortable situation, a psychological problem or an emotional distress is rarely expressed directly but usually through physical symptoms. So migraine may be considered as a disorder of psychobiological adaptation in which genetic predisposition interplays with internal and/or external environmental influences such as psycho-emotional, climatic, hormonal, dietary or other factors.
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Affiliation(s)
- Vincenzo Guidetti
- Department of Pediatric and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli, 108, 00185, Rome, Italy.
| | - Noemi Faedda
- Department of Pediatric and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli, 108, 00185, Rome, Italy
| | - Michael Siniatchkin
- Department of Medical Psychology and Medical Sociology, Christian-Albrechts-University, Kiel, Germany
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18
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Le Gal J, Michel JF, Rinaldi VE, Spiri D, Moretti R, Bettati D, Romanello S, Berlese P, Lualdi R, Boizeau P, Viala J, Bellaiche M, Zuccotti GV, Crichiutti G, Alberti C, Titomanlio L. Association between functional gastrointestinal disorders and migraine in children and adolescents: a case-control study. Lancet Gastroenterol Hepatol 2016; 1:114-121. [PMID: 28404068 DOI: 10.1016/s2468-1253(16)30038-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders and migraine are both common causes of medical attention. We have previously shown an association between migraine and infant colic. In this case-control study, we aimed to establish whether there is an association between migraine and other functional gastrointestinal disorders in children and adolescents. METHODS We included children and adolescents aged 6-17 years presenting to the emergency department of four tertiary hospitals in France and Italy. Patients diagnosed with either migraine or tension-type headache by the hospital's paediatric neurologist were enrolled as cases. Patients presenting to the emergency department with minor trauma and no history of recurrent headache were enrolled as controls. Investigators masked to a patient's group allocation diagnosed functional gastrointestinal disorders using the Rome III diagnostic criteria. Univariable and multivariable analyses were done to identify specific disorders and baseline factors associated with migraines and tension-type headache. FINDINGS Between Nov 1, 2014, and Jan 31, 2015, we enrolled 648 controls and 424 cases (257 patients with migraine and 167 with tension-type headache). 83 (32%) children and adolescents in the migraine group were diagnosed with functional gastrointestinal disorders compared with 118 (18%) in the control group (p<0·0001). Multivariable logistic regression showed a significant association between migraine and three gastrointestinal disorders: functional dyspepsia (odds ratio 10·76, 95% CI 3·52-32·85; p<0·0001), irritable bowel syndrome (3·47, 1·81-6·62; p=0·0002), and abdominal migraine (5·87, 1·95-17·69; p=0·002). By contrast, there was an inverse association between migraine and functional constipation (0·34, 0·14-0·84, p=0·02). 41 (25%) participants with tension-type headache had functional gastrointestinal disorders, which did not significantly differ from the prevalence of these disorders in the control group (p=0·07); no significant association was noted between any functional gastrointestinal disease and tension-type headaches. INTERPRETATION Three abdominal-pain-related functional gastrointestinal disorders were associated with migraine in children and adolescents. These findings are of value to the diagnosis and management of these common diseases. Future studies should investigate whether antimigraine drugs are of benefit in functional gastrointestinal disorders. FUNDING None.
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Affiliation(s)
- Julie Le Gal
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Jean-Francois Michel
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Victoria Elisa Rinaldi
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Daniele Spiri
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Raffaella Moretti
- Pediatric Migraine and Neurovascular Diseases Unit, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy; INSERM, U1141, DHU PROTECT, Paris, France
| | - Donatella Bettati
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Silvia Romanello
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Pediatric Migraine and Neurovascular Diseases Unit, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Paola Berlese
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Rosa Lualdi
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Priscilla Boizeau
- Unit of Clinical Epidemiology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM, CIC 1426, Paris, France
| | - Jerome Viala
- Department of Pediatric Gastroenterology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM UMR1149 Paris, France
| | - Marc Bellaiche
- Department of Pediatric Gastroenterology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Crichiutti
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Corinne Alberti
- Unit of Clinical Epidemiology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM, CIC 1426, Paris, France
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Pediatric Migraine and Neurovascular Diseases Unit, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM, U1141, DHU PROTECT, Paris, France.
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19
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Balaban CD, Yates BJ. What is nausea? A historical analysis of changing views. Auton Neurosci 2016; 202:5-17. [PMID: 27450627 DOI: 10.1016/j.autneu.2016.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 12/27/2022]
Abstract
The connotation of "nausea" has changed across several millennia. The medical term 'nausea' is derived from the classical Greek terms ναυτια and ναυσια, which designated the signs and symptoms of seasickness. In classical texts, nausea referred to a wide range of perceptions and actions, including lethargy and disengagement, headache (migraine), and anorexia, with an awareness that vomiting was imminent only when the condition was severe. However, some recent articles have limited the definition to the sensations that immediately precede emesis. Defining nausea is complicated by the fact that it has many triggers, and can build-up slowly or rapidly, such that the prodromal signs and symptoms can vary. In particular, disengagement responses referred to as the "sopite syndrome" are typically present only when emetic stimuli are moderately provocative, and do not quickly culminate in vomiting or withdrawing from the triggering event. This review considers how the definition of "nausea" has evolved over time, and summarizes the physiological changes that occur prior to vomiting that may be indicative of nausea. Also described are differences in the perception of nausea, as well as the accompanying physiological responses, that occur with varying stimuli. This information is synthesized to provide an operational definition of nausea.
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Affiliation(s)
- Carey D Balaban
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Bill J Yates
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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20
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Gofshteyn JS, Stephenson DJ. Diagnosis and Management of Childhood Headache. Curr Probl Pediatr Adolesc Health Care 2016; 46:36-51. [PMID: 26750538 DOI: 10.1016/j.cppeds.2015.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
Headache is one of the most common chief complaints seen in the pediatrician's office. Oftentimes, identifying the etiology of headache and differentiating primary and secondary causes can present a diagnostic conundrum. Understanding the most common causes of primary and secondary headache is vital to making a correct diagnosis. Here we review the typical presentations of the most common primary headache disorders and the approach to evaluation of the pediatric patient presenting with headache. Diagnostic workup, including the key features to elicit on physical examination, when to order head imaging, and the use of other ancillary tests, is discussed. Current treatment modalities and their indications are reviewed. We will also describe some of the new, emerging therapies that may alter the way we manage headache in the pediatric population. Headache can, at times, be a frustrating symptom seen in the pediatrician's office, but here we hope to better elucidate the approach to evaluation, management, and treatment as well as provide some hope in regards to more effective upcoming therapies.
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Affiliation(s)
| | - Donna J Stephenson
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA.
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21
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Green A, Kabbouche M, Kacperski J, Hershey A, O'Brien H. Managing Migraine Headaches in Children and Adolescents. Expert Rev Clin Pharmacol 2016; 9:477-82. [PMID: 26824175 DOI: 10.1586/17512433.2016.1135050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The diagnosis and management of migraine headaches can be challenging in children and adolescents. The description of migraine in this population may include symptoms that are not typically described in adults. Treatment options for pediatric migraine is increasing, however remain limited. This article will go through the key components to diagnosing migraine in pediatric patients as well as give options for short and long-term management.
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Affiliation(s)
- Antoinette Green
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA
| | - Marielle Kabbouche
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.,b UC Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
| | - Joanne Kacperski
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.,b UC Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
| | - Andrew Hershey
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.,b UC Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
| | - Hope O'Brien
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.,b UC Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
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