Occipital Nerve Stimulation for Refractory Occipital Pain after Occipitocervical Fusion: Expanding Indications

Ghaemi, Kazem; Capelle, Hans‐Holger; Kinfe, Thomas M.; Krauss, Joachim K.

doi:10.1159/000175802

Cited by 18 publications

(8 citation statements)

References 19 publications

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“…Our report on ONS for occipital neuralgia was quickly followed by a myriad of studies evaluating its application to various neuropathic maladies afflicting the occipito-cervical region, including occipital neuralgia, cervicogenic headache, and other intractable C-2 mediated headaches [13–18, 19•, 20••, 21, 22•]. All groups reported consistent, remarkable success rates on the order of 70–100 % (mean 89 %) (Table 1).…”

Section: History Of Neuromodulation and Headachesmentioning

confidence: 99%

Peripheral Neuromodulation and Headaches: History, Clinical Approach, and Considerations on Underlying Mechanisms

Reed¹

2012

Curr Pain Headache Rep

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Implantable peripheral neurostimulation was introduced in 1969 as a potential treatment for certain neuropathic pain syndromes, primarily involving the limbs. While a few early studies included implants for occipital neuralgia, serious interest in its potential as a treatment for head pain came only after our 1999 report of positive findings in a series of patients with occipital neuralgia. Subsequent investigators confirmed these initial findings, and then extended the application to patients with various primary headache disorders, including migraine. While most found a therapeutic response, the degree of that response varied significantly, and analysis suggests that the issue of paresthesia concordancy may be central, both in explaining the data, as well as providing direction for future endeavors. Therefore, while at present peripheral neurostimulation is gaining increasing acceptance as a treatment for chronic headaches, the precise clinical indications and procedures, as well as the underlying neurophysiological mechanisms, are still being worked out.

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Section: History Of Neuromodulation and Headachesmentioning

confidence: 99%

Peripheral Neuromodulation and Headaches: History, Clinical Approach, and Considerations on Underlying Mechanisms

Reed¹

2012

Curr Pain Headache Rep

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“…The effect of subcutaneous occipital nerve stimulation has been evaluated for various pain syndromes [21,22,25] . We have also shown the usefulness of occipital nerve stimulation in the treatment of refractory occipital pain after occipitocervical fusion, showing marked improvement with a follow-up of 12 months [26] . Goroszeniuk et al [27] reported 3 patients treated with SPNS of whom one suffered from chronic anterior chest pain after coronary bypass grafting.…”

Section: Discussionmentioning

confidence: 78%

Subcutaneous Peripheral Neurostimulation for the Treatment of Severe Chronic Poststernotomy Neuralgia

Peyravi¹,

Capelle²,

Fischer

et al. 2011

Stereotact Funct Neurosurg

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Objective:Poststernotomy pain frequently develops after sternotomy in thoracic and cardiovascular surgery, and may affect patients’ quality of life. In some cases of severe poststernotomy neuralgia, pharmacologic therapy does not provide adequate relief. Case Report: We report on a 42- year-old woman who underwent sternotomy for aortic and mitral valve replacement. She developed severe chronic poststernotomy neuralgia that was refractory to medical treatment. After local anesthesia markedly but only transiently alleviated pain, we considered the option of subcutaneous peripheral neurostimulation (SPNS). Plate electrodes were implanted bilaterally in the parasternal region at the site of maximal pain. After a period of test stimulation, the electrodes were connected to a dual-channel implantable pulse generator. SPNS induced paresthesias in the painful area. Revision surgery was necessary twice because of electrode migration. Chronic SPNS markedly alleviated pain (visual-analog scale, VAS, 9/10 preoperatively, 2/10 postoperatively) and allodynia (VAS 9/10 preoperatively, 2/10 postoperatively) at the last available follow-up, 15 months postoperatively. Conclusions: SPNS may be a viable treatment option in patients with severe chronic poststernotomy neuralgia.

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“…In the past few years, the application of ONS has been widened to include a large number of primary and secondary headache disorders, such as migraine, chronic cluster headache, new daily persistent headache, hemicrania continua, chronic post-traumatic headache, chronic headache attributed to whiplash injury, cervicogenic headache, and occipital neuropathy. [13][14][15][16][17][18][19] Identification of specific headache diagnoses that respond to ONS remains a challenge. 13 Recently, ONS has been evaluated in clinical trials in migraine and chronic cluster headaches.…”

Section: Occipital Nerve Stimulation: Historymentioning

confidence: 99%

“…13,41 As for the secondary headache disorders and cranial neuralgias, data from case reports and case series are available in chronic post-traumatic headaches, chronic headache attributed to whiplash injury, cervicogenic headaches, occipital neuropathic pain (see ICHD-II 13.12) and occipital neuralgia. 13,14 In a retrospective case series, eight patients with occipital neuropathic pain had an average overall percentage pain relief at long-term follow-up of 80%. 13 All eight patients experienced pain relief within a week after the start of ONS treatment, even with some patients within the first 24 hours.…”

Section: Ons: Efficacymentioning

confidence: 99%

Occipital Nerve Stimulation for Headache Disorders

Paemeleire

Bartsch

2010

Neurotherapeutics

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Summary:Occipital nerve stimulation (ONS) was originally described in the treatment of occipital neuralgia. However, the spectrum of possible indications has expanded in recent years to include primary headache disorders, such as migraine and cluster headaches. Retrospective and some prospective studies have yielded encouraging results, and evidence from controlled clinical trials is emerging, offering hope for refractory headache patients. In this article we discuss the scientific rationale to use ONS to treat headache disorders, with emphasis on the trigeminocervical complex. ONS is far from a standardized technique at the moment and the recent literature on the topic is reviewed, both with respect to the procedure and its possiblecomplications. An important way to move forward in the scientific evaluation of ONS to treat refractory headache is the clinical phenotyping of patients to identify patients groups with the highest likelihood to respond to this modality of treatment. This requires multidisciplinary assessment of patients. The development of ONS as a new treatment for refractory headache offers an exciting prospect to treat our most disabled headache patients. Data from ongoing controlled trials will undoubtedly shed new light on some of the unresolved questions.

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Occipital Nerve Stimulation for Refractory Occipital Pain after Occipitocervical Fusion: Expanding Indications

Cited by 18 publications

References 19 publications

Peripheral Neuromodulation and Headaches: History, Clinical Approach, and Considerations on Underlying Mechanisms

Peripheral Neuromodulation and Headaches: History, Clinical Approach, and Considerations on Underlying Mechanisms

Subcutaneous Peripheral Neurostimulation for the Treatment of Severe Chronic Poststernotomy Neuralgia

Occipital Nerve Stimulation for Headache Disorders

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