Peripheral Neurostimulation to Control Intractable Occipital Neuralgia

Weiner, Richard L.; Reed, Kenneth L.; Alò, Kenneth M.; Fuller, Michelle

doi:10.1097/00006123-199909000-00165

Cited by 78 publications

(104 citation statements)

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“…PNS was used for a long time in neuropathic pain [77] before being studied in headaches, first in occipital neuralgia [78], and more recently in migraines.…”

Section: Peripheral Neurostimulation (Pns)mentioning

confidence: 99%

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

Paemeleire

Louis²,

Magis

et al. 2014

Acta Neurol Belg

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Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres

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“…PNS was used for a long time in neuropathic pain [77] before being studied in headaches, first in occipital neuralgia [78], and more recently in migraines.…”

Section: Peripheral Neurostimulation (Pns)mentioning

confidence: 99%

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

Paemeleire

Louis²,

Magis

et al. 2014

Acta Neurol Belg

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“…37 At a mean follow-up of 22 months, 70% of the 10 patients with stimulators continued to experience 50% or more reduction in pain; similar results are cited in other studies. 25,41 Despite the favorable outcomes associated with peripheral nerve stimulation, it is important to note that Slavin et al's and others' studies had relatively short follow-up durations. The permanent placement of a foreign device has significant disadvantages: limited battery life, risk of lead migration or scar formation leading to device failure, and infections that prompt device removal.…”

Section: Alternatives To Dorsal Root Rhizotomymentioning

confidence: 99%

Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia

Gande

Chivukula

Moossy³

et al. 2016

JNS

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OBJECT Occipital neuralgia (ON) causes chronic pain in the cutaneous distribution of the greater and lesser occipital nerves. The long-term efficacy of cervical dorsal root rhizotomy (CDR) in the management of ON has not been well described. The authors reviewed their 14-year experience with CDR to assess pain relief and functional outcomes in patients with medically refractory ON. METHODS A retrospective chart review of 75 ON patients who underwent cervical dorsal root rhizotomy, from 1998 to 2012, was performed. Fifty-five patients were included because they met the International Headache Society's (IHS) diagnostic criteria for ON, responded to CT-guided nerve blocks at the C-2 dorsal nerve root, and had at least one follow-up visit. Telephone interviews were additionally used to obtain data on patient satisfaction. RESULTS Forty-two patients (76%) were female, and the average age at surgery was 46 years (range 16–80). Average follow up was 67 months (range 5–150). Etiologies of ON included the following: idiopathic (44%), posttraumatic (27%), postsurgical (22%), post–cerebrovascular accident (4%), postherpetic (2%), and postviral (2%). At last follow-up, 35 patients (64%) reported full pain relief, 11 (20%) partial relief, and 7 (16%) no pain relief. The extent of pain relief after CDR was not significantly associated with ON etiology (p = 0.43). Of 37 patients whose satisfaction-related data were obtained, 25 (68%) reported willingness to undergo repeat surgery for similar pain relief, while 11 (30%) reported no such willingness; a single patient (2%) did not answer this question. Twenty-one individuals (57%) reported that their activity level/functional state improved after surgery, 5 (13%) reported a decline, and 11 (30%) reported no difference. The most common acute postoperative complications were infections in 9% (n = 5) and CSF leaks in 5% (n = 3); chronic complications included neck pain/stiffness in 16% (n = 9) and upper-extremity symptoms in 5% (n = 3) such as trapezius weakness, shoulder pain, and arm paresthesias. CONCLUSIONS Cervical dorsal root rhizotomy provides an efficacious means for pain relief in patients with medically refractory ON. In the appropriately selected patient, it may lead to optimal outcomes with a relatively low risk of complications.

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“…Occipital nerve stimulation (ONS) was originally described in the treatment of occipital neuralgia (Weiner and Reed 1999), but it is a promising modality of treatment for chronic rCH based on both retrospective and prospective data. Peripheral nerve stimulation is a minimally invasive and reversible procedure.…”

Section: Neuromodulatory Proceduresmentioning

confidence: 99%