Drugs for Neuropathic Pain Are Promising in Treating Feed-induced Dystonia in Central Nervous System Disabled Children
We appreciate Dr Hauer's viewpoint on treatment options for feed-induced dystonia in children with severe central nervous system disorders. Gabapentin as a medication for central neuropathic pain is promising to play an important role in treating these patients who are less likely to benefit from antigastroesophageal reflux disease (GERD) therapies.
Mordekar et al's (1) report of 12 children with enteral feed–induced dystonia shows us that the cause of this disease is not always Sandifer spasm, which is caused by the mediastinal pain stimuli from GERD. Among the patients suffering from enteral feed–induced dystonia in their clinical center, these 12 patients were not of Sandifer spasm because GERD was excluded by solid clinical evidences. In addition to GERD, foregut dysmotility is now regarded as another cause of enteral feed–induced dystonia, in which anti-GERD treatment including fundoplication should be avoided. Despite recognizing this fact, the treatment for this condition is tough for clinicians. Total parenteral nutrition or other invasive interventions are dilemmas with both obvious pros and cons.
Gabapentin has been proven effective in treating recurrent pain in nonverbal children with severe neurological impairment by Hauer and Solodiuk (2) through a retrospective observation containing 22 patients receiving it. Of the 22 patients, 21 (91%) had a significant decrease in symptoms and no severe adverse events occurred. Gabapentin is effective in controlling central neuropathic pain, which can be triggered by visceral distention, so we believe that it will be useful for patients who have foregut dysmotility. Trials about medications including gabapentin are badly needed.