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Current Neurology and Neuroscience Reports

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01-03-2017 | Headache (RB Halker, Section Editor)

Recurrent Gastrointestinal Disturbance: Abdominal Migraine and Cyclic Vomiting Syndrome

Authors: Samantha Irwin, Rebecca Barmherzig, Amy Gelfand

Published in: Current Neurology and Neuroscience Reports | Issue 3/2017

Abstract

Primary headache disorders, including migraine, are some of the most common neurological disorders presenting to hospital. Episodic syndromes that may be associated with migraine, including recurrent gastrointestinal disturbances such as abdominal migraine and cyclic vomiting, often pre-date or co-occur with the onset of migraine in a child who is at risk of developing the headache condition. The purpose of this review is to evaluate the two most common episodic syndromes, abdominal migraine and cyclic vomiting syndrome, including their pathophysiology, common presentations, and diagnostic criteria. Differential diagnosis and “red flag” features are outlined, and an approach to diagnostic work-up is offered. Finally, we provide an evidence-based review of management options and long-term prognosis. Future research should include randomized trials for the acute and preventive treatment of these disorders, as well as research as to whether early intervention can prevent progression to migraine and/or mitigate migraine severity.

Goadsby PJ, Lipton RB, Ferrari MD. Migraine — current understanding and treatment. N Engl J Med. 2002;346(4):257–70. doi:10.1056/NEJMra010917.CrossRefPubMed

Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27(3):193–210. doi:10.1111/j.1468-2982.2007.01288.x.CrossRefPubMed

Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia. 2010;30(9):1065–72. doi:10.1177/0333102409355601.CrossRefPubMed

Lewis DW. Pediatric migraine. Pediatr Rev. 2007;28(2):43–53.CrossRefPubMed

Sillanpää M. Changes in the prevalence of migraine and other headaches during the first seven school years. Headache. 1983;23(1):15–9. doi:10.1111/j.1526-4610.1983.hed2301015.x.CrossRefPubMed

Brams W. Abdominal Migraine. J Am Med Assoc. 1922;78:26–7.CrossRef

Wyllie WG. The periodic group of disorders in childhood. Br J Child DIs. 1933;30:1–21.

•• Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalagia. 2013;33(9):629–808. doi:10.1177/0333102413485658. A comprehensive diagnostic criterion for episodic syndromes that may be associated with migraine.CrossRef

Roberts JE, Deshazo RD. Abdominal migraine, another cause of abdominal pain in adults. Am J Med. 2012;125(11):1135–9. doi:10.1016/j.amjmed.2012.06.008.CrossRefPubMed

10.

Teixeira KCS, Montenegro MA, Guerreiro MM. Migraine equivalents in childhood. J Child Neurol. 2013;29(10):1366–9. doi:10.1177/0883073813504459.CrossRefPubMed

11.

Lewis DW. Migraine and migraine variants in childhood and adolescence. Semin Pediatr Neurol. 1995;2(2):127–43. doi:10.1016/S1071-9091(05)80023-3.CrossRefPubMed

12.

• Tarantino S, Capuano A, Torriero R, et al. Migraine equivalents as part of migraine syndrome in childhood. Pediatr Neurol. 2014;51(5):645–9. doi:10.1016/j.pediatrneurol.2014.07.018. Evaluation of the prevalance of migraine equivalents in children with headache.CrossRefPubMed

13.

• Rothner AD, Parikh S. Migraine variants or episodic syndromes that may be associated with migraine and other unusual pediatric headache syndromes. Headache. 2016;56(1):206–14. doi:10.1111/head.12750. A review of the episodic syndromes that may be associated with migraine.CrossRefPubMed

14.

Hindiyeh N, Aurora SK. What the gut can teach us about migraine. Curr Pain Headache Rep. 2015;19(7):501. doi:10.1007/s11916-015-0501-4.CrossRef

15.

Taché Y. Cyclic vomiting syndrome: the corticotropin-releasing-factor hypothesis. Dig Dis Sci. 1999;44(8 Suppl):79S-86S. http://www.ncbi.nlm.nih.gov/pubmed/10490044. Accessed November 8, 2016.

16.

Rashed H, Abell TL, Familoni BO, Cardoso S. Autonomic function in cyclic vomiting syndrome and classic migraine. Dig Dis Sci. 1999;44(8 Suppl):74S-78S. http://www.ncbi.nlm.nih.gov/pubmed/10490043. Accessed November 8, 2016.

17.

Lee LY, Abbott L, Moodie S, Anderson S. Cyclic vomiting syndrome in 28 patients: demographics, features and outcomes. Eur J Gastroenterol Hepatol. 2012;24(8):939–43. doi:10.1097/MEG.0b013e328354fc83.CrossRefPubMed

18.

Devanarayana NM, Rajindrajith S, Benninga MA. Abdominal migraine in children: Association between gastric motility parameters and clinical characteristics. BMC Gastroenterol. 2016;16(1):1–8. doi:10.1186/s12876-016-0435-2.CrossRef

19.

Lin YP, Ni YH, Weng WC, Lee WT. Cyclic vomiting syndrome and migraine in children. J Formos Med Assoc. 2011;110(6):382–7. doi:10.1016/S0929-6646(11)60056-9.CrossRefPubMed

20.

Boles RG, Chun N, Senadheera D. Cyclic vomiting syndrome and mitochondrial DNA mutations. Lancet. 1997;350:1299–300.CrossRefPubMed

21.

Rasquin A, Lorenzo CDI, Forbes D, et al. Childhood functional gastrointestinal disorders. 2006;45(Suppl II):1527–1537. doi:10.1053/j.gastro.2005.08.063.

22.

Abu-Arafeh I, Russell G. Prevalence and clinical features of abdominal migraine compared with those of migraine headache. Arch Dis Child. 1995;72(5):413–7. doi:10.1136/adc.72.5.413.CrossRefPubMedPubMedCentral

23.

Mortimer MJ, Kay J, Jaron A. Clinical epidemiology of childhood abdominal migraine in an urban general practice. Dev Med Child Neurol. 1993;35(3):243–8. doi:10.1111/j.1469-8749.1993.tb11629.x.CrossRefPubMed

24.

Carson L, Lewis D, Tsou M, et al. Abdominal migraine: An under-diagnosed cause of recurrent abdominal pain in children. Headache. 2011;51(5):707–12. doi:10.1111/j.1526-4610.2011.01855.x.CrossRefPubMed

25.

Al-Twaijri WA, Shevell MI. Pediatric migraine equivalents: Occurrence and clinical features in practice. Pediatr Neurol. 2002;26(5):365–8. doi:10.1016/S0887-8994(01)00416-7.CrossRefPubMed

26.

• Lewis ML, Palsson OS, Whitehead WE, et al. Prevalence of functional gastrointestinal disorders in children and adolescents. J Pediatr. 2016;0(0):220–6. doi:10.1016/j.jpeds.2016.04.008. A review of epidemiology and prevalence of CVS and AM in a pediatric population.

27.

Symon DN, Russell G. Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine. Arch Dis Child. 1995;72(1):48–50. doi:10.1136/adc.72.1.48.CrossRefPubMedPubMedCentral

28.

Dignan F, Abu-Arafeh I, Russell G. The prognosis of childhood abdominal migraine. Arch Dis Child. 2001;84(5):415–8. doi:10.1136/adc.84.5.415.CrossRefPubMedPubMedCentral

29.

Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. 2003;111(1):1–11. doi:10.1542/peds.111.1.e1.

30.

Popovich DM, Schentrup DM, McAlhany AL. Recognizing and diagnosing abdominal migraines. J Pediatr Heal Care. 2010;24(6):372–7. doi:10.1016/j.pedhc.2009.11.003.CrossRef

31.

Feldman W, McGrath P, Hodgson C, Ritter H, Shipman RT. The use of dietary fiber in the management of simple, childhood, idiopathic, recurrent, abdominal pain. Results in a prospective, double-blind, randomized, controlled trial. Am J Dis Child. 1985;139(12):1216–1218. http://www.ncbi.nlm.nih.gov/pubmed/2998181. Accessed November 8, 2016.

32.

Barr RG, Levine MD, Watkins JB. Recurrent abdominal pain of childhood due to lactose intolerance. N Engl J Med. 1979;300(26):1449–52. doi:10.1056/NEJM197906283002602.CrossRefPubMed

33.

Russell G, Abu-Arafeh I, Symon DNK. Abdominal migraine: evidence for existence and treatment options. Paediatr Drugs. 2002;4(1):1–8.CrossRefPubMed

34.

Sanders R, Cleghorn G, Shepherd W, Patrick M. Predictors of clinical improvement in children with recurrent abdominal pain. Behav Cogn Psychother. 1996;24(1):27–38.CrossRef

35.

Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral Headache Treatment: History, Review of the Empirical Literature, and Methodological Critique. Headache J Head Face Pain. 2005;45(s2):S92–S109. doi:10.1111/j.1526-4610.2005.4502003.x.CrossRef

36.

Becker WJ. Acute migraine treatment. Contin Lifelong Learn Neurol. 2015;21:953–72. doi:10.1212/CON.0000000000000192.CrossRef

37.

Kakisaka Y, Wakusawa K, Haginoya K, et al. Efficacy of sumatriptan in two pediatric cases with abdominal pain-related functional gastrointestinal disorders: does the mechanism overlap that of migraine? J Child Neurol. 2010;25(2):234–7. doi:10.1177/0883073809336875.CrossRefPubMed

38.

Raina M, Chelimsky G, Chelimsky T. Intravenous dihydroergotamine therapy for pediatric abdominal migraines. Clin Pediatr (Phila). 2013;52(10):918–21. doi:10.1177/0009922813492879.CrossRef

39.

Worawattanakul M, Rhoads JM, Lichtman SN, Ulshen MH. Abdominal migraine: prophylactic treatment and follow-up. J Pediatr Gastroenterol Nutr. 1999;28(1):37–40. doi:10.1097/00005176-199901000-00010.CrossRefPubMed

40.

Madani S, Cortes O, Thomas R. Cyproheptadine use in children with functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2016;62(3):409–13. doi:10.1097/MPG.0000000000000964.CrossRefPubMed

41.

Saps M, Li BUK. Chronic abdominal pain of functional origin in children. Pediatr Ann. 2006;35(4):246, 249–256. http://www.ncbi.nlm.nih.gov/pubmed/16637553. Accessed November 8, 2016.

42.

Lewis DW. Pediatric migraine. Neurol Clin. 2009;27(2):481–501. doi:10.1016/j.ncl.2008.11.003.CrossRefPubMed

43.

Kothare SV. Efficacy of flunarizine in the prophylaxis of cyclical vomiting syndrome and abdominal migraine. Eur J Paediatr Neurol. 2005;9(1):23–6. doi:10.1016/j.ejpn.2004.11.002.CrossRefPubMed

44.

Lewis DW, Yonker M, Winner P, Sowell M. The treatment of pediatric migraine. Pediatr Ann. 2005;34(6):448–60.CrossRefPubMed

45.

Catto-Smith AG, Ranuh R. Abdominal migraine and cyclical vomiting. Semin Pediatr Surg. 2003;12(4):254–8. doi:10.1053/j.sempedsurg.2003.08.006.CrossRefPubMed

46.

Tan V, Sahami AR, Peebles R, Shaw RJ. Abdominal migraine and treatment with intravenous valproic acid. Psychosom J Consult Liaison Psychiatry. 2006;47(4):353–5. doi:10.1176/appi.psy.47.4.353.

47.

Woodruff AE, Cieri NE, Abeles J, Seyse SJ. Abdominal migraine in adults: a review of pharmacotherapeutic options. Ann Pharmacother. 2013;47(6). doi:10.1345/aph.1R620.

48.

Newman LC. Rebound Abdominal Pain: Noncephalic pain in abdminal migraine is exacerbated by medication overuse. doi:10.1196/annals.1340.034.

49.

Abu-Arafeh I, Russell G. Cyclical vomiting syndrome in children: a population-based study. J Pediatr Gastroenterol Nutr. 1995;21(4):454–8. doi:10.1111/j.1365-2982.2012.01960.x.CrossRefPubMed

50.

• Drumm BR. Cyclical vomiting syndrome in children: a population-based study. J Pediatr Gastroenterol Nutr. 1995;21(4):454–8. doi:10.1111/j.1365-2982.2012.01960.x. A prospective study of clinical characteristics and outcomes in a pediatric population with CVS.CrossRef

51.

Bhatia V, Deswal S, Seth S, Kapoor A, Sibal A, Gopalan S. Prevalence of functional gastrointestinal disorders among adolescents in Delhi based on Rome III criteria: A school-based survey. Indian J Gastroenterol. 2016;35(August):1–5. doi:10.1007/s12664-016-0680-x.

52.

Lee LYW, Abbott L, Mahlangu B, Moodie SJ, Anderson S. The management of cyclic vomiting syndrome: a systematic review. Eur J Gastroenterol Hepatol. 2012;24(9):1001–6. doi:10.1097/MEG.0b013e328355638f.CrossRefPubMed

53.

Kumar N, Bashar Q, Reddy N, et al. Cyclic Vomiting Syndrome (CVS): is there a difference based on onset of symptoms--pediatric versus adult? BMC Gastroenterol. 2012;12:52. doi:10.1186/1471-230X-12-52.CrossRefPubMedPubMedCentral

54.

• Lagman-Bartolome AM, Lay C. Pediatric migraine variants: a review of epidemiology, diagnosis, treatment, and outcome. Curr Neurol Neurosci Rep. 2015;15(6):34. doi:10.1007/s11910-015-0551-3. An overview of the episodic syndromes that may be associated with migraine in children.CrossRefPubMed

55.

Pacheva IH, Ivanov IS. Migraine variants - Occurrence in pediatric neurology practice. Clin Neurol Neurosurg. 2013;115(9):1775–83. doi:10.1016/j.clineuro.2013.04.012.CrossRefPubMed

56.

•• Li B, Lefevre F, Chelimsky GG, et al. North American society for pediatric gastroenterology, hepatology, and nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008;47(3):379–93. doi:10.1097/MPG.0b013e318173ed39. Consensus statement on the evaluation and treatment approaches to children with CVS.CrossRefPubMed

57.

Haghighat M, Rafie SM, Dehghani SM, Fallahi GH, Nejabat M. Cyclic vomiting syndrome in children: Experience with 181 cases in southern Iran. World J Gastroenterol. 2007;13(12):1833–6.CrossRefPubMedPubMedCentral

58.

Lindley KJ, Andrews PL. Pathogenesis and treatment of cyclical vomiting. J Pediatr Gastroenterol Nutr. 2005;41 Suppl 1:S38–40. doi:10.1097/01.scs.0000180299.04731.cb.CrossRefPubMed

59.

Li B, Fleisher D. Cyclic vomiting syndrome: Features to be explained by a pathophysiologic model. Dig Dis Sci. 1999;44(8 SUPPL.):13S--18S. http://www.ncbi.nlm.nih.gov/pubmed/10490033. Accessed November 8, 2016.

60.

Withers GD, Silburn SR, Forbes D. a. Precipitants and aetiology of cyclic vomiting syndrome. Acta Paediatr. 1998;87(3):272–7. doi:10.1080/08035259850157318.CrossRefPubMed

61.

Li B, Balint J. Cyclic vomiting syndrome: evolution in our understanding of a brain-gut disorder. Adv Pediatr. 2000;47:117–160. http://www.ncbi.nlm.nih.gov/pubmed/10959442. Accessed November 8, 2016.

62.

Hikita T, Kodama H, Kaneko S, et al. Sumatriptan as a treatment for cyclic vomiting syndrome: A clinical trial. Cephalalgia. 2011;31(4):504–7. doi:10.1177/0333102410390398.CrossRefPubMed

63.

Calhoun AH, Pruitt AP. Injectable sumatriptan for cyclic vomiting syndrome in adults: A case series. Headache. 2014;54(9):1526–30. doi:10.1111/head.12444.CrossRefPubMed

64.

Kowalczyk M, Parkman H, Ward L. Adult cyclic vomiting syndrome successfully treated with intranasal sumatriptan. J Gen Intern Med. 2010;25(1):88–91. doi:10.1007/s11606-009-1162-y.CrossRefPubMed

65.

Palmer GM, Cameron DJS. Use of intravenous midazolam and clonidine in cyclical vomiting syndrome: A case report. Paediatr Anaesth. 2005;15(1):68–72. doi:10.1111/j.1460-9592.2005.01369.x.CrossRefPubMed

66.

Abraham MB, Porter P. Clonidine in cyclic vomiting. J Pediatr Gastroenterol Nutr. 2011;53(2):219–21. doi:10.1097/MPG.0b013e31821424c4.CrossRefPubMed

67.

Khasawinah TA, Ramirez A, Berkenbosch JW, Tobias JD. Preliminary experience with dexmedetomidine in the treatment of cyclic vomiting syndrome. Am J Ther. 2003;10(4):303–7. doi:10.1097/00045391-200307000-00012.CrossRefPubMed

68.

Kaul AK& KK. Cyclic vomiting syndrome: a functional disorder. PGHN. 2015;18(4):224–229. doi:10.5223/pghn.2015.18.4.224.

69.

Cristofori F, Thapar N, Saliakellis E, et al. Efficacy of the neurokinin-1 receptor antagonist aprepitant in children with cyclical vomiting syndrome. Aliment Pharmacol Ther. 2014;40(3):309–17. doi:10.1111/apt.12822.CrossRefPubMed

70.

Treepongkaruna S, Jarasvaraparn C, Tanpowpong P, Lertudomphonwanit C. Short- and long-term outcomes of children with cyclic vomiting syndrome. J Med Assoc Thail. 2014;97(10):1077–1083. http://www.ncbi.nlm.nih.gov/pubmed/25632624. Accessed November 8, 2016.

71.

Boles G, Lovett-Barr R, Preston A, Li Uk B, Adams K. Treatment of cyclic vomiting syndrome with co-enzyme Q10 and amitriptyline, a retrospective study. BMC Neurol. 2010;10:10. doi:10.1186/1471-2377-10-10.CrossRefPubMedPubMedCentral

72.

Martinez-Esteve Melnikova A, Schäppi MG, Korff C. Riboflavin in cyclic vomiting syndrome: efficacy in three children. Eur J Pediatr. 2016;175(1):131–5. doi:10.1007/s00431-015-2597-2.CrossRefPubMed

73.

Van Calcar SC, Harding CO, Wolff JA. L-carnitine administration reduces number of episodes in cyclic vomiting syndrome. Clin Pediatr. 2002;41(3):171–4. doi:10.1177/000992280204100307.CrossRef

74.

Forbes D, Withers G. Prophylactic therapy in cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 1995;21 Suppl 1:S57-9. http://www.ncbi.nlm.nih.gov/pubmed/8708871. Accessed November 8, 2016.

75.

Vanderhoof JA, Young R, Kaufman SS, Ernst L. Treatment of cyclic vomiting in childhood with erythromycin. J Pediatr Gastroenterol Nutr. 1995;21 Suppl 1:S60-2. http://www.ncbi.nlm.nih.gov/pubmed/8708873. Accessed November 8, 2016.

76.

Hikita T, Kodama H, Nakamoto N, et al. Effective prophylactic therapy for cyclic vomiting syndrome in children using valproate. Brain Dev. 2009;31(6):411–3. doi:10.1016/j.braindev.2008.07.005.CrossRefPubMed

77.

Fitzpatrick E, Bourke B, Drumm B, Rowland M. Outcome for children with cyclical vomiting syndrome. Arch Dis Child. 2007;92(11):1001–4. doi:10.1136/adc.2007.116608.CrossRefPubMedPubMedCentral

78.

Dignan F, Symon DN, AbuArafeh I, Russell G. The prognosis of cyclical vomiting syndrome. Arch Dis Child. 2001;84:55–7. doi:10.1136/adc.84.1.55.CrossRefPubMedPubMedCentral

79.

Sato T, Igarashi N, Minami S, et al. Recurrent attacks of vomiting, hypertension and psychotic depression: a syndrome of periodic catecholamine and prostaglandin discharge. Acta Endocrinol (Copenh). 1988;117(2):189–197. http://www.ncbi.nlm.nih.gov/pubmed/2837885. Accessed November 8, 2016.

80.

•• Gelfand AA, Gallagher RC. Cyclic vomiting syndrome versus inborn errors of metabolism: A review with clinical recommendations. Headache. 2016;56(1):215–21. doi:10.1111/head.12749. A comprehensive review of CVS and the metabolic mimics of CVS, with recommendations for clinical and diagnostic approach.CrossRefPubMed

81.

Collins BS, Thomas DW. Chronic abdominal pain. Pediatr Rev. 2007;28(9):323–31. doi:10.1542/pir.28-9-323.CrossRefPubMed

82.

Thiessen PN. Recurrent abdominal pain. Pediatr Rev. 2002;23(2):39–46. http://www.ncbi.nlm.nih.gov/pubmed/11826256. Accessed November 8, 2016.

83.

Michael M, Tsatsou K, Ferrie CD. Panayiotopoulos syndrome: An important childhood autonomic epilepsy to be differentiated from occipital epilepsy and acute non-epileptic disorders. Brain Dev. 2010;32(1):4–9. doi:10.1016/j.braindev.2009.03.002.CrossRefPubMed

84.

Simonetto DA, Oxentenko AS, Herman ML, Szostek JH. Cannabinoid hyperemesis: A case series of 98 patients. Mayo Clin Proc. 2012;87(2):114–9. doi:10.1016/j.mayocp.2011.10.005.CrossRefPubMedPubMedCentral

85.

Fitzgerald M, Crushell E, Hickey C. Cyclic vomiting syndrome masking a fatal metabolic disease. Eur J Pediatr. 2013;172(5):707–10. doi:10.1007/s00431-012-1852-z.CrossRefPubMed

86.

Rinaldo P. Mitochondrial fatty acid oxidation disorders and cyclic vomiting syndrome. Dig Dis Sci. 1999;44(8 Suppl):97S-102S. http://www.ncbi.nlm.nih.gov/pubmed/10490047. Accessed November 8, 2016.

87.

Yorns WR, Hardison HH. Mitochondrial dysfunction in migraine. Semin Pediatr Neurol. 2013;20(3):188–93. doi:10.1016/j.spen.2013.09.002.CrossRefPubMed

88.

Zaki EA, Freilinger T, Klopstock T, et al. Two common mitochondrial DNA polymorphisms are highly associated with migraine headache and cyclic vomiting syndrome. Cephalalgia. 2009;29(7):719–28. doi:10.1111/j.1468-2982.2008.01793.x.CrossRefPubMed

89.

Andersen J, Lockhart J, Sugerman K, Weinberg W. Effective prophylactic therapy for cyclic vomiting syndrome in children using amitriptyline or cyproheptadine. J Pediatr Gastroenterol Nutr Nutr. 1996;23(3):359. doi:10.1097/00005176-199610000-00100.CrossRef

90.

Erturk O, Uluduz D, Karaali-Savrun F. Efficacy of nebivolol and amitriptyline in the prophylaxis of cyclic vomiting syndrome. Neurologist. 2010;16(5):313–4. doi:10.1097/NRL.0b013e3181b120a6.CrossRefPubMed

Title: Recurrent Gastrointestinal Disturbance: Abdominal Migraine and Cyclic Vomiting Syndrome
Authors: Samantha Irwin
Rebecca Barmherzig
Amy Gelfand
Publication date: 01-03-2017
Publisher: Springer US
Published in: Current Neurology and Neuroscience Reports / Issue 3/2017
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI: https://doi.org/10.1007/s11910-017-0731-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Recurrent Gastrointestinal Disturbance: Abdominal Migraine and Cyclic Vomiting Syndrome

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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