High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series.
High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series.
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DOI：
10.1186/1471-2377-11-102
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发表时间：
2011-08-16
期刊：
影响因子：
2.6
通讯作者：
Boles RG
中科院分区：
文献类型：
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作者：
Boles RG
周期性呕吐综合征（CVS），定义为反复发作的恶心和呕吐，是一种相对常见的致残性和历史上难以治疗的疾病，与偏头痛和线粒体功能障碍有关。有限的数据表明，抗偏头痛疗法阿米替林和赛庚啶，以及脑靶向辅因子辅酶Q10和L-肉毒碱，在预防发作方面有效。一名临床医生对42例符合既定CVS诊断标准的患者进行了回顾性病历审查，发现30例病例有可用的结局数据。参与者接受了一个松散的协议，包括禁食避免，辅酶Q10和L-肉毒碱，并在难治性病例中加入阿米替林（或赛庚啶，在那些< 5年）。治疗药物的血药浓度监测在管理中占有突出地位。23例患者的呕吐症状缓解，3例和1例患者的呕吐症状分别改善> 75%和> 50%。在3例治疗失败的患者中，2例不能耐受阿米替林（与仅> 50%疗效的儿童情况相同），1例患有多发性先天性胃肠道畸形。排除后一种情况，治疗开始时的实质疗效（> 75%应答）为26/29，能够耐受该方案（包括高剂量阿米替林）的患者为26/26。我们的数据表明，一个协议组成的尿道靶向辅因子（辅酶Q10和左旋肉碱）加阿米替林（或可能赛庚啶在学龄前儿童）加上血药浓度监测是非常有效的预防呕吐发作。
Cyclic vomiting syndrome (CVS), defined by recurrent stereotypical episodes of nausea and vomiting, is a relatively-common disabling and historically difficult-to-treat condition associated with migraine headache and mitochondrial dysfunction. Limited data suggests that the anti-migraine therapies amitriptyline and cyproheptadine, and the mitochondrial-targeted cofactors co-enzyme Q10 and L-carnitine, have efficacy in episode prophylaxis. A retrospective chart review of 42 patients seen by one clinician that met established CVS diagnostic criteria revealed 30 cases with available outcome data. Participants were treated on a loose protocol consisting of fasting avoidance, co-enzyme Q10 and L-carnitine, with the addition of amitriptyline (or cyproheptadine in those < 5 years) in refractory cases. Blood level monitoring of the therapeutic agents featured prominently in management. Vomiting episodes resolved in 23 cases, and improved by > 75% and > 50% in three and one additional case respectively. Among the three treatment failures, two could not tolerate amitriptyline (as was also the case in the child with only > 50% efficacy) and one had multiple congenital gastrointestinal anomalies. Excluding the latter case, substantial efficacy (> 75% response) was 26/29 at the start of treatment, and 26/26 in those able to tolerate the regiment, including high dosages of amitriptyline. Our data suggest that a protocol consisting of mitochondrial-targeted cofactors (co-enzyme Q10 and L-carnitine) plus amitriptyline (or possibly cyproheptadine in preschoolers) coupled with blood level monitoring is highly effective in the prevention of vomiting episodes.