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. 2016 Oct 27;7(10):e198. doi: 10.1038/ctg.2016.55

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Copyright © 2016 The Author(s) the American College of Gastroenterology

Clinical and Translational Gastroenterology is an open-access journal published by Nature Publishing Group. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

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Graphical representation of the CVS threshold concept. In panel (a), two successive CVS triggers (a and b) summate to increase neuronal excitability to a point that crosses the CVS threshold. This then precipitates a CVS attack (represented at the top of the panel to mirror Figure 1a). In panel (b), the same two successive CVS triggers (a and b) now do not reach the CVS threshold, which has been raised by prophylactic medications that decrease neuronal excitability within key neural circuits. The lack of a CVS attack is represented by a solid black line at the top of the panel. In panel (c), the CVS threshold remains the same, but the impact of CVS triggers is minimized by interventions such that the summative impact of exposure to the triggers is now not sufficient to precipitate a CVS attack. Again, the lack of a CVS attack is represented by a solid black line at the top of the panel.