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Niu J, Wang C, Wang X, Lu G. Temporary Gasserian ganglion stimulation utilizing SNM electrode in subacute herpetic trigeminal neuralgia. Front Neurol 2024; 15:1435272. [PMID: 39087013 PMCID: PMC11289525 DOI: 10.3389/fneur.2024.1435272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Objective Gasserian ganglion stimulation (GGS) is a neuromodulation technique that has been extensively applied in treating postherpetic trigeminal neuralgia. However, permanent implantation of GGS was preferred in most treatment approaches. Few studies have investigated temporary GGS for the treatment of acute/subacute herpetic trigeminal neuralgia. Moreover, previous research has reported lead dislocation when utilizing traditional electrodes, which was associated with poor pain relief. In GGS research, preventing the accidental displacement of lead following implantation has consistently been a primary objective. Methods We report a case of a 70-year-old woman with subacute herpetic trigeminal neuralgia who underwent temporary GGS for 14 days utilizing a sacral neuromodulation (SNM) quadripolar-tined lead. Computed tomography-guided percutaneous foramen ovale (FO) puncture and temporary SNM electrode implantation were performed during the surgery. A telephone interview was conducted to record a 12-month follow-up. Results At admission, zoster-related trigeminal pain severity was assessed to be 9/10 on the visual analog scale (VAS). After a 14-day GGS treatment, the pain assessed on the VAS score reduced to 1/10 at discharge but increased to 4/10 at the 12-month follow-up after surgery. Additionally, the anxiety level improved from 58 points to 35 points on the Self-Rating Anxiety Scale (SAS), and the depression level improved from 62 points to 40 points on the Self-Rating Depression Scale (SDS). The Physical Component Summary score of the 12-item Short-Form Health Survey (SF-12) increased from 33.9 to 47.0, and the Mental Component Summary (MCS) score of the SF-12 increased from 27.4 to 41.9. Conclusion Temporary GGS might be a potentially effective treatment for subacute herpetic trigeminal neuralgia, and an SNM electrode might be a good choice for reducing the risk of dislocation.
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Affiliation(s)
- Jiejie Niu
- Department of Pain Management, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chenhui Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xing Wang
- Department of Radiotherapy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guijun Lu
- Department of Pain Management, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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2
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Niemeyer CS, Harlander-Locke M, Bubak AN, Rzasa-Lynn R, Birlea M. Trigeminal Postherpetic Neuralgia: From Pathophysiology to Treatment. Curr Pain Headache Rep 2024; 28:295-306. [PMID: 38261232 PMCID: PMC10940365 DOI: 10.1007/s11916-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant challenges due to its persistent and debilitating nature. This review explores the clinical characteristics of TG-PHN, analyzes its pathophysiological underpinnings, and addresses existent and potential therapies. RECENT FINDINGS TG-PHN is one of the most common and complex PHN locations. It has distinguishing clinical and pathophysiological characteristics, starting with viral triggered injuries to the trigeminal ganglion (TG) and peripheral tissue and involving the ascending and descending brain modulation pathways. Current therapies include vaccines, oral and topical medications, and interventional approaches, like nerve blocks and neurostimulation. This review covers TG-PHN's clinical and physiological components, treatment options, and potential future targets for improved management. By exploring the complexities of this condition, we aim to contribute to developing more effective and targeted therapies for patients suffering from trigeminal PHN.
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Affiliation(s)
- Christy S Niemeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Harlander-Locke
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachael Rzasa-Lynn
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marius Birlea
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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3
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Krog L, Maloney J, Pew S, Adeleye O, Johnson B, Glenn B, Gill B, Tieppo Francio V, Pagan-Rosado R, Whitney M, Sinha N, Strand N. Cervical Spinal Cord Stimulation: A Review. Curr Pain Headache Rep 2024; 28:239-249. [PMID: 38147282 DOI: 10.1007/s11916-023-01200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE OF REVIEW This literature review critically examines existing studies on cervical spinal cord stimulation (cSCS) for the treatment of chronic pain. The objective is to evaluate the current evidence, identify knowledge gaps, and collate data to inform clinical decision-making and suggest future research avenues. The review covers indications, contraindications, surgical and anesthetic approaches, trials, efficacy, and complications of cSCS. RECENT FINDINGS Recent advancements highlight the evolving role of cSCS in chronic pain management. New neuromodulation techniques involve optimal placement of leads based on the pain's innervation level, maximizing therapeutic outcomes. Contemporary studies underscore the broadening benefits of cSCS, including enhanced functional abilities and sleep quality. However, alongside these innovations come challenges; emerging data bring attention to complications such as hardware issues and infections. Significantly, modern research emphasizes the crucial role of accurate patient selection, factoring in prior therapy responses and comprehensive evaluations. cSCS emerges as a promising tool for chronic pain management, with benefits beyond mere pain relief. As surgical techniques, patient selection criteria, and postoperative care refine, the potential of cSCS expands to benefit a broader patient demographic. However, further comprehensive research is necessary to enhance its application, validate its role earlier in treatment, and ultimately ameliorate the lives of those with chronic pain.
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Affiliation(s)
- Lucky Krog
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
| | | | - Scott Pew
- Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Brooks Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Brett Glenn
- College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Benjamin Gill
- Department of Anesthesiology and Pain Medicine, University of Utah, Salt Lake City, UT, USA
| | - Vinicius Tieppo Francio
- University of Kansas Medical Center, Department of Anesthesiology and Pain Medicine, Kansas City, KS, USA
| | | | | | - Neil Sinha
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Natalie Strand
- Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
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4
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Towne BV, Girgiss CB, Schuster NM. Use of spinal cord stimulation in treatment of intractable headache diseases. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S6-S10. [PMID: 37833045 DOI: 10.1093/pm/pnad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/17/2023] [Accepted: 06/27/2023] [Indexed: 10/15/2023]
Abstract
Headache diseases remain one of the leading causes of disability in the world. With the development of neuromodulation strategies, high cervical spinal cord stimulation (hcSCS) targeting the trigeminocervical complex has been deployed to treat refractory headache diseases. In this article, we review the proposed mechanism behind hcSCS stimulation, and the various studies that have been described for the successful use of this treatment strategy in patients with chronic migraine, cluster headache, and other trigeminal autonomic cephalalgias.
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Affiliation(s)
- Brooke V Towne
- Department of Anesthesiology, University of California San Diego Health, San Diego, CA 92037, United States
| | - Carol B Girgiss
- School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Nathaniel M Schuster
- Department of Anesthesiology, University of California San Diego Health, San Diego, CA 92037, United States
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5
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Finnern MT, D'Souza RS, Jin MY, Abd-Elsayed AA. Cervical Spinal Cord Stimulation for the Treatment of Headache Disorders: A Systematic Review. Neuromodulation 2023; 26:1309-1318. [PMID: 36513586 DOI: 10.1016/j.neurom.2022.10.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/02/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Chronic headache remains a major cause of disability and pain worldwide. Although the literature has extensively described pharmacologic options for headache treatment and prophylaxis, there remains a paucity of data on the efficacy of neuromodulation interventions for treatment of headache unresponsive to conventional pharmacologic therapy. The primary aim of this review was to appraise the literature for the efficacy of cervical spinal cord stimulation (cSCS) in treating any intractable chronic headache, including migraine headaches (with or without aura), cluster headache, tension headache, and other types of headaches. MATERIALS AND METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed a systematic review by identifying studies in PubMed, Embase (Scopus), Web of Science, and Cochrane Central Register of Controlled Trials that assessed cSCS to treat chronic headache. Data were synthesized qualitatively, with primary outcomes of headache intensity and frequency. The secondary outcome was adverse effects. RESULTS In total, 16 studies comprising 107 patients met the inclusion criteria. Findings were presented based on type of headache, which included migraine headache with or without aura, cluster headache, trigeminal neuropathy, occipital neuralgia, posttraumatic headache, cervicogenic headache, short-lasting unilateral neuralgiform headache with autonomic symptoms, and poststroke facial pain. Per the Grading of Recommendations, Assessment, Development and Evaluations criteria, there was very low-quality evidence that cSCS is associated with a decrease in migraine headache frequency, migraine headache intensity, and trigeminal neuropathy intensity. Placement for cSCS leads ranged from C1 to C4. CONCLUSIONS Our review suggests promising data from observational studies that cSCS may be helpful in decreasing frequency and intensity of chronic intractable headache. Future well-powered, randomized controlled trials are needed.
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Affiliation(s)
- Michael T Finnern
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Max Y Jin
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Alaa A Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
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Basha AKMM, Simry HAM, Abdelbar AE, Sabry H, Raslan AM. Outcome of Surgical Treatments of Chronic Pain Caused by Trigeminal Neuropathy. World Neurosurg 2023; 170:e57-e69. [PMID: 36273728 DOI: 10.1016/j.wneu.2022.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Trigeminal neuropathy represents a subset of several facial pain syndromes that are difficult to diagnose and treat. Although many surgical modalities are available, outcomes remain suboptimal. The aim of this study is to present our experience in management of trigeminal neuropathy with a focus on the effectiveness and long-term efficacy of the different surgical procedures. METHODS A single-center retrospective cohort study was conducted from December 2012 until February 2020. RESULTS Twenty-eight patients (19 females, 9 males) were included in this study. They had 40 surgical interventions. At last follow-up, 1 patient (33.3%) treated by spinal cord stimulation (SCS) had no pain recurrence and 2 patients (66.6%) had their devices removed because of therapeutic failure. Median time to pain recurrence after SCS was 19.5 months (interquartile range [IQR], 29.79 months). Six patients were treated with peripheral nerve stimulation (PNS). At last follow-up, 2 patients had satisfactory pain relief, whereas half of the patients had no improvement. For the 17 patients treated with computed tomography-guided trigeminal tractotomy/nucleotomy, true failure occurred 7 times in 6 patients. Median time to pain recurrence was 5.6 months (IQR, 6.2). Of the 6 patients treated with caudalis DREZ, 3 (50%) had satisfactory pain relief for >1 year and the median time to pain recurrence was 3.9 months (IQR, 29.53). CONCLUSIONS Trigeminal neuropathy is a difficult to treat entity of facial pain syndromes. The long-term efficacy of available interventions does not meet patients' satisfaction. More organized prospective studies with longer follow-up are needed to define the patient population best served by each surgical modality.
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Affiliation(s)
| | | | | | - Hatem Sabry
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Ahmed M Raslan
- Department of Neurosurgery, Oregon Health and Science University, Oregon, Portland, USA
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7
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Gupta M, Chitneni A, Ghorayeb J, Schnetzer B, Klusek M. Cervical Spinal Cord Stimulation for Trigeminal Neuralgia: a Narrative Review. Curr Pain Headache Rep 2022; 26:639-645. [PMID: 35716273 DOI: 10.1007/s11916-022-01066-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a chronic neuropathic pain condition affecting one or more divisions of the fifth cranial (trigeminal) nerve. TN is defined by recurrent unilateral electric shock-like pain that is abrupt in both onset and termination. The pain is triggered by innocuous sensory stimuli and is classified as either classic TN, related to vascular compression; secondary TN, due to a tumor along the trigeminal nerve or an underlying disease like multiple sclerosis; or idiopathic TN. Among the various therapies available for TN, carbamazepine remains the first-line treatment. Newer medications have demonstrated efficacy in patients who do not respond to or cannot tolerate carbamazepine. When medical management and neuroablative procedures fail, spinal cord stimulation (SCS) serves as a promising and popular option, with an estimated 34,000 SCS procedures performed annually worldwide. SCS employs the implantation of electrical leads in the epidural space to manage pain. PURPOSE OF REVIEW A review of literature was conducted to explore the use of cervical spinal cord stimulation (SCS) for the treatment of trigeminal neuralgia. METHODS A MEDLINE/PubMed search using the search terms "spinal cord stimulation" and "trigeminal neuralgia" was employed to find any case reports and research studies (retrospective studies, double-blinded studies, observational studies) on the topic. No date limiters were used for the search. The initial search resulted in 76 non-duplicate entries from the database. After application of the search criteria, 58 studies were excluded because they were not relevant to the study. A further detailed review of the included articles was conducted by all the reviewers. During this phase of the review, additional 6 studies were excluded. A total of 11 studies were included: 7 case reports and 4 retrospective review studies. RECENT FINDINGS In the review, we discuss 7 different case reports on the use of cervical SCS for trigeminal neuralgia and an additional 4 retrospective studies reviewing outcomes and pain relief in patients who underwent treatment. The case reports and retrospective studies reviewed demonstrated that TN patients realized > 50% pain relief following permanent electrode implantation. In all the cases discussed, complications from SCS were rare and/or not reported. Additionally, most of the cases report that patients who had adequate pain relief from SCS were able to wean off, or significantly reduce, oral medications given the vast improvement in pain reduction. CONCLUSIONS Cervical spinal cord stimulation (SCS) is a safe and effective procedure for patients with trigeminal neuralgia (TN) who have refractory pain despite the use of medications. In many cases, the procedure provides an adequate level of pain relief with very few complications or side effects. The vast majority of current research on the use of cervical SCS for TN currently consists of case reports and retrospective analysis. In order to further evaluate the efficacy of SCS for treatment, large-scale randomized controlled studies or observational studies need to be conducted to properly evaluate SCS as a treatment modality for trigeminal neuralgia.
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Affiliation(s)
- Mayank Gupta
- Kansas Pain Management and Neuroscience Research Center, Overland Park, KS, USA
| | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital-Columbia and Cornell, New York, NY, USA.
| | - Joe Ghorayeb
- Physical Medicine & Rehabilitation, University of Medicine and Health Sciences, New York, NY, USA
| | | | - Malvina Klusek
- Peconic Bay Medical Center/Northwell Health, Riverhead, NY, USA
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8
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Li S, Li J, Xu H, Liu Y, Yang T, Yuan H. Progress in the efficacy and mechanism of spinal cord stimulation in neuropathological pain. IBRAIN 2022; 8:23-36. [PMID: 37786421 PMCID: PMC10529196 DOI: 10.1002/ibra.12020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 10/04/2023]
Abstract
Neuropathic pain (NP) is a long-term recurrent disease caused by somatosensory nervous system injury, with spontaneous pain, hyperalgesia, ectopic pain, and paresthesia as the main clinical manifestations. It adversely affects patients' quality of life. NP treatments often include medication, physical therapy, and invasive therapy; the first two therapies are generally ineffective for some NP patients. These patients sometimes rely on invasive therapy to alleviate pain. Spinal cord stimulation (SCS) is a very effective therapeutic method. SCS is a neuroregulatory method that involves placing the electrodes on the corresponding painful spinal cords. Pain is greatly alleviated after SCS. SCS has been proven to be an effective therapeutic method for the treatment of neurological pain. Furthermore, SCS provides a feasible approach for patients with unsuccessful drug treatment. This paper reviews the relevant literature of spinal cord electrical stimulation, focusing on the mechanism of action, clinical application, clinical efficacy and technical progress of spinal cord electrical stimulation. SCS is widely used in the treatment of NP diseases such as postherpetic neuralgia, back surgery failure syndrome, and phantom limb pain. With advancements in science and technology, tremendous progress has also been made in the spinal cord electrical stimulation method and good momentum has been maintained.
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Affiliation(s)
- Shun‐Lian Li
- Department of AnesthesiaZunyi Medical UniversityZunyiGuizhouChina
| | - Jing Li
- Department of AnesthesiaZunyi Medical UniversityZunyiGuizhouChina
| | - Hui‐Chan Xu
- Department of AnesthesiaZunyi Medical UniversityZunyiGuizhouChina
| | - Yu‐Cong Liu
- Department of AnesthesiaZunyi Medical UniversityZunyiGuizhouChina
| | - Ting‐Ting Yang
- Department of AnesthesiaZunyi Medical UniversityZunyiGuizhouChina
| | - Hao Yuan
- School of Basic MedicineKunming Medical UniversityKunmingYunnanChina
- Department of Spine SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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9
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The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Best Practices for Cervical Neurostimulation. Neuromodulation 2022; 25:35-52. [DOI: 10.1016/j.neurom.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022]
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10
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Zhao L, Song T. Case Report: Short-Term Spinal Cord Stimulation and Peripheral Nerve Stimulation for the Treatment of Trigeminal Postherpetic Neuralgia in Elderly Patients. Front Neurol 2021; 12:713366. [PMID: 34413827 PMCID: PMC8368125 DOI: 10.3389/fneur.2021.713366] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: We aimed to report on the use of short-term high cervical spinal cord stimulation (SCS) combined with peripheral nerve stimulation (PNS) to successfully treat trigeminal postherpetic neuralgia (TPHN) affecting the V2 and V3 divisions. We also sought to use a novel PNS approach to the maxillary nerve next to the external opening of the foramen rotundum (FR) to treat TPHN at the V2 division. Method: Two elderly patients successfully treated with different neuromodulation methods for TPHN are presented in this case series. Results: The first case referred to an 83-year-old Chinese female patient with V2 and V3 TPHN who experienced a significant pain relief using a combination of short-term high cervical SCS at the C1–C2 level and PNS on the infraorbital nerve (ION). Case 2 was a 68-year-old Chinese male patient with V1 and V2 TPHN that obtained an excellent pain relief after having received short-term PNS on the supraorbital nerve (SON), the supratrochlear nerve (STN), and the maxillary nerve. Both reported improvements in their quality of life and ability to perform daily tasks during a 3-month follow-up period. Conclusions: Short-term high cervical SCS at the C1–C2 spinal segments may be a feasible method to treat recent-onset V3 TPHN in elderly patients. Additionally, by placing the stimulation lead next to the external FR opening, we demonstrated a novel PNS approach to the maxillary nerve not previously reported for TPHN therapy.
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Affiliation(s)
- Lin Zhao
- Department of Pain, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Tao Song
- Department of Pain, The First Affiliated Hospital of China Medical University, Shenyang, China
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11
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Asimakidou E, Matis GK. Spinal cord stimulation in the treatment of peripheral vascular disease: a systematic review - revival of a promising therapeutic option? Br J Neurosurg 2021; 36:555-563. [PMID: 33703962 DOI: 10.1080/02688697.2021.1884189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Peripheral vascular disease (PVD) is caused by a blood circulation disorder of the arteries and Critical Limb Ischemia (CLI) is the advanced state of PVD. For patients with surgically non-reconstructable CLI, Spinal Cord Stimulation (SCS) appears to be an alternative therapeutic option. OBJECTIVE The aim of our study was to investigate the efficacy of SCS in non-reconstructable CLI compared with the conservative treatment and re-appraise the existing literature in light of the recent advances in neuromodulation. METHODS We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using electronic databases and reference lists for article retrieval. RESULTS A total of 404 records were identified and finally 6 randomised controlled trials (RCTs), a Cochrane review and a meta-analysis were included in our systematic review. The studies assessed the efficacy of tonic SCS in the treatment of patients with non-reconstructable CLI compared with the conservative treatment. There is moderate to high quality evidence suggesting, that tonic SCS has beneficial effects for patients suffering from non-reconstructable CLI in terms of limb salvage, pain relief, clinical improvement and quality of life. The contradictory conclusions of the two meta-analyses regarding the efficacy of SCS for limb salvage at 12 months refer rather to the magnitude of the beneficial effect than to the effect itself. So far, the current literature provides evidence about the traditional tonic SCS but there is a lack of studies investigating the efficacy of new waveforms in the treatment of non-reconstructable CLI. CONCLUSION SCS represents an alternative for PVD patients with non-reconstructable CLI and the existing literature provides encouraging clinical results, that should not be neglected. Instead, they should be re-appraised in light of the recent advances in neuromodulation with the emergence of novel waveform technologies and neuromodulation targets.
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Affiliation(s)
- Evridiki Asimakidou
- Department of Stereotactic and Functional Neurosurgery, University Cologne Hospital, Cologne, Germany
| | - Georgios K Matis
- Department of Stereotactic and Functional Neurosurgery, University Cologne Hospital, Cologne, Germany
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12
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Kohan L, Patel J, Abd-Elsayed A, Riley M. Neuromodulation for the Trigeminal Nerve. TRIGEMINAL NERVE PAIN 2021:155-168. [DOI: 10.1007/978-3-030-60687-9_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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13
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Jones MR, Rosenow JM. Importance of Laterality in Cervical Spinal Cord Stimulation for Facial Pain: Case Report and Anatomic Review. Oper Neurosurg (Hagerstown) 2020; 19:E83-E86. [PMID: 31828351 DOI: 10.1093/ons/opz381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/13/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Chronic neuropathic facial pain is a debilitating disease that can be approached with multiple different treatment modalities. Cervical spinal cord stimulation has been demonstrated to be effective for patients suffering from neuropathic facial pain. Consensus does not exist in the literature regarding technique for placement. CLINICAL PRESENTATION A 49-yr-old female presented with chronic intractable neuropathic facial pain. She underwent a successful percutaneous spinal cord stimulation trial, followed by placement of a paddle electrode for permanent implantation. The paddle electrode failed to duplicate the pain relief of her trial. Measurement of the width of the paddle demonstrated that it was 2 mm smaller than the separation of the percutaneous trial electrodes. Electrodes with wider interelectrode distance were then placed with satisfactory pain relief. CONCLUSION Although conventional spinal cord stimulation targets the dorsal columns, cervical spinal cord stimulation for facial pain targets the spinal trigeminal nucleus. The effectiveness of stimulation may be increased with a more laterally positioned electrode in order to recruit the more laterally positioned spinal trigeminal nucleus. This case report illustrates the importance of this anatomic consideration.
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Affiliation(s)
- Michael R Jones
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
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14
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Fishman MA, Antony A, Esposito M, Deer T, Levy R. The Evolution of Neuromodulation in the Treatment of Chronic Pain: Forward-Looking Perspectives. PAIN MEDICINE 2020; 20:S58-S68. [PMID: 31152176 PMCID: PMC6600066 DOI: 10.1093/pm/pnz074] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The field of neuromodulation is continually evolving, with the past decade showing significant advancement in the therapeutic efficacy of neuromodulation procedures. The continued evolution of neuromodulation technology brings with it the promise of addressing the needs of both patients and physicians, as current technology improves and clinical applications expand. Design This review highlights the current state of the art of neuromodulation for treating chronic pain, describes key areas of development including stimulation patterns and neural targets, expanding indications and applications, feedback-controlled systems, noninvasive approaches, and biomarkers for neuromodulation and technology miniaturization. Results and Conclusions The field of neuromodulation is undergoing a renaissance of technology development with potential for profoundly improving the care of chronic pain patients. New and emerging targets like the dorsal root ganglion, as well as high-frequency and patterned stimulation methodologies such as burst stimulation, are paving the way for better clinical outcomes. As we look forward to the future, neural sensing, novel target-specific stimulation patterns, and approaches combining neuromodulation therapies are likely to significantly impact how neuromodulation is used. Moreover, select biomarkers may influence and guide the use of neuromodulation and help objectively demonstrate efficacy and outcomes.
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Affiliation(s)
| | | | | | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia
| | - Robert Levy
- Institute for Neuromodulation, Boca Raton, Florida, USA
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15
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Bina RW, Palsma RS, Weinand ME, Kasoff WS. Peripheral Nerve Stimulation for Refractory Trigeminal Pain: Recent Single‐Institution Case Series With Long‐Term Follow‐Up and Review of the Literature. Neuromodulation 2020; 23:796-804. [DOI: 10.1111/ner.13132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/13/2020] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Robert W. Bina
- Department of Neurosurgery University of Arizona School of Medicine Tucson AZ USA
| | - Ryan S. Palsma
- Department of Neurosurgery University of Arizona School of Medicine Tucson AZ USA
| | - Martin E. Weinand
- Department of Neurosurgery University of Arizona School of Medicine Tucson AZ USA
| | - Willard S. Kasoff
- Department of Neurosurgery University of Arizona School of Medicine Tucson AZ USA
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Aboud T, Schuster NM. Pain Management in Multiple Sclerosis: a Review of Available Treatment Options. Curr Treat Options Neurol 2019; 21:62. [PMID: 31773455 DOI: 10.1007/s11940-019-0601-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Multiple Sclerosis (MS) is a chronic autoimmune disease with no curative treatment available. While recent years have ushered in many effective new disease-modifying therapies for MS, they have not obviated the need for symptomatic treatments for MS-related pain. In this review, we discuss available approaches to control pain, which is one of the most common complaints MS patients have. RECENT FINDINGS The most recent research in this topic is directed towards non-pharmacologic interventions including water exercises, yoga and cannabis. More trials are being conducted on neuromodulation for MS-related neuropathic pain, including transcutaneous electrical nerve stimulation (TENS) and transcranial direct current stimulation (tDCS). Pain control for MS patients is challenging, considering the progressive and relapsing remitting nature of the disease, however, it is a very important aspect of it's management, as it improves mobility, exercise tolerance, concomitant depression and overall quality of life. Future research should focus on the use of neuromodulation in controlling MS pain.
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Affiliation(s)
- Talal Aboud
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Nathaniel M Schuster
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, CA, USA
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17
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Manning A, Ortega RG, Moir L, Edwards T, Aziz TZ, Bojanic S, Green AL, Fitzgerald JJ. Burst or Conventional Peripheral Nerve Field Stimulation for Treatment of Neuropathic Facial Pain. Neuromodulation 2019; 22:645-652. [DOI: 10.1111/ner.12922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/08/2018] [Accepted: 11/06/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Andrew Manning
- Department of NeurosurgeryJohn Radcliffe Hospital Oxford UK
| | | | - Liz Moir
- Department of NeurosurgeryJohn Radcliffe Hospital Oxford UK
| | - Tamara Edwards
- Department of NeurosurgeryJohn Radcliffe Hospital Oxford UK
| | - Tipu Z. Aziz
- Department of NeurosurgeryJohn Radcliffe Hospital Oxford UK
- Nuffield Department of Surgical SciencesUniversity of Oxford Oxford UK
- Nuffield Department of Clinical NeurosciencesUniversity of Oxford Oxford UK
| | - Stana Bojanic
- Department of NeurosurgeryJohn Radcliffe Hospital Oxford UK
| | - Alexander L. Green
- Department of NeurosurgeryJohn Radcliffe Hospital Oxford UK
- Nuffield Department of Surgical SciencesUniversity of Oxford Oxford UK
- Nuffield Department of Clinical NeurosciencesUniversity of Oxford Oxford UK
| | - James J. Fitzgerald
- Department of NeurosurgeryJohn Radcliffe Hospital Oxford UK
- Nuffield Department of Surgical SciencesUniversity of Oxford Oxford UK
- Nuffield Department of Clinical NeurosciencesUniversity of Oxford Oxford UK
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18
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Velásquez C, Tambirajoo K, Franceschini P, Eldridge PR, Farah JO. Upper Cervical Spinal Cord Stimulation as an Alternative Treatment in Trigeminal Neuropathy. World Neurosurg 2018; 114:e641-e646. [PMID: 29548953 DOI: 10.1016/j.wneu.2018.03.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe the indications and outcomes of upper cervical cord stimulation in trigeminal neuropathy. METHODS A consecutive single-center series of patients was retrospectively reviewed. It included 12 patients with trigeminal neuropathy treated with upper cervical spinal cord stimulation. Clinical features, complications, and outcomes were reviewed. RESULTS All patients had a successful trial before the definitive implantation of a spinal cord stimulator at the level of the craniocervical junction. The mean follow-up period was 4.4 years (range, 0.3-21.1 years). The average coverage in the pain zone was 72% and the median baseline, trial, and postoperative numeric rating scale (NRS) was 7, 3, and 3, respectively. When compared with the baseline, the mean reduction achieved in the postoperative average numeric rating scale was 4 points, accounting for a 57.1% pain reduction. The long-term failure rate was 25%. CONCLUSIONS Despite there being enough evidence to consider upper cervical spinal cord stimulation as an effective treatment for patients with neuropathic trigeminal pain, a randomized controlled trial is needed to fully assess its indications and outcomes and compare it with other therapeutic approaches.
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Affiliation(s)
- Carlos Velásquez
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - Kantharuby Tambirajoo
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Paulo Franceschini
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Paul R Eldridge
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Jibril Osman Farah
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Weber K. Neuromodulation and Devices in Trigeminal Neuralgia. Headache 2017; 57:1648-1653. [PMID: 28905370 DOI: 10.1111/head.13166] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/26/2017] [Indexed: 01/03/2023]
Abstract
PREMISE Trigeminal neuralgia is a severe facial pain disorder that has been studied for decades. Classical trigeminal neuralgia (CTN) is either idiopathic or caused by neurovascular compression. The related painful trigeminal neuropathies are often secondary to other causes, such as multiple sclerosis or trauma. PROBLEM Therapies for trigeminal neuralgia and neuropathy have often been pharmacologic or surgical. Pharmacologic therapies are not effective in some cases and often cause side effects, some substantial. Surgery can have comorbidity (such as anesthesia dolorosa, or painful differentiation of the affected nerve distribution) and also is not always effective. There is a desire, as in all chronic conditions, to find effective treatments with minimal morbidity and side effects. POTENTIAL SOLUTIONS We review several devices including neuromodulation, ranging in invasiveness, for treatment of trigeminal neuralgia and neuropathy. We review existing data on sphenopalatine ganglion blocks, transcranial magnetic stimulation, transcortical direct stimulation, deep brain stimulation, spinal cord stimulation, peripheral nerve stimulation, and transcutaneous electrical stimulation for CTN and pain trigeminal neuropathies. We also offer hope for further research in this area with the goal of discovering a device that can provide treatment for many with few side effects and minimal morbidity.
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Affiliation(s)
- Kevin Weber
- Department of Neurology, The Ohio State University, Columbus, Ohio (K.Weber)
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Chang Chien GC, Mekhail N. Alternate Intraspinal Targets for Spinal Cord Stimulation: A Systematic Review. Neuromodulation 2017; 20:629-641. [PMID: 28160397 DOI: 10.1111/ner.12568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Conventional dorsal column spinal cord stimulation (SCS) provides less than optimal pain relief for certain pain syndromes and anatomic pain distributions. Practitioners have sought to treat these challenging therapeutic areas with stimulation of alternate intraspinal targets. OBJECTIVE To identify and systematically review the evidence for the value neuromodulating specific neuronal targets within the spinal canal to achieve relief of chronic pain. METHODS A systematic literature search was conducted using PubMed for clinical trials published from 1966 to March 1, 2015 to identify neurostimulation studies that employed non-dorsal column intraspinal stimulation to achieve pain relief. Identified studies on such targeted intraspinal stimulation were reviewed and graded using Evidence Based Interventional Pain Medicine criteria. RESULTS We found a total of 13 articles that satisfied our search criteria on targeted, non-dorsal column intraspinal stimulation for pain. We identified five studies on neurostimulation of the cervicomedullary junction, six studies on neurostimulation of the dorsal root ganglion, two studies on the neurostimulation of the conus medullaris, unfortunately none was found on intraspinal nerve root stimulation. LIMITATIONS The limitations of this review include the relative paucity of well-designed prospective studies on targeted SCS. CONCLUSIONS Clinical use of intraspinal neurostimulation is expanding at a very fast pace. Intraspinal stimulation of non-dorsal column targets may well be the future of neurostimulation as it provides new clinically significant neuromodulation of specific therapeutic targets that are not well or not easily addressed with conventional dorsal column SCS. In addition, they may avoid undesired stimulation induced paraesthesia, particularly in non-painful areas of the body.
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Affiliation(s)
- George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA.,Center for Regenerative Medicine, Southern California University of Health Sciences, Whittier, CA, USA
| | - Nagy Mekhail
- Evidence Based Pain Management Research, Cleveland Clinic, Cleveland, OH, USA
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Maniam R, Kaye AD, Vadivelu N, Urman RD. Facial Pain Update: Advances in Neurostimulation for the Treatment of Facial Pain. Curr Pain Headache Rep 2016; 20:24. [DOI: 10.1007/s11916-016-0553-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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22
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Lee S, Abd-Elsayed A. Some Non-FDA Approved Uses for Neuromodulation: A Review of the Evidence. Pain Pract 2015; 16:935-47. [DOI: 10.1111/papr.12405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Samuel Lee
- University of Cincinnati College of Medicine; University of Cincinnati; Cincinnati Ohio U.S.A
| | - Alaa Abd-Elsayed
- Department of Anesthesiology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin U.S.A
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Deer TR, Mekhail N, Petersen E, Krames E, Staats P, Pope J, Saweris Y, Lad SP, Diwan S, Falowski S, Feler C, Slavin K, Narouze S, Merabet L, Buvanendran A, Fregni F, Wellington J, Levy RM. The appropriate use of neurostimulation: stimulation of the intracranial and extracranial space and head for chronic pain. Neuromodulation Appropriateness Consensus Committee. Neuromodulation 2015; 17:551-70; discussion 570. [PMID: 25112890 DOI: 10.1111/ner.12215] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 04/17/2014] [Accepted: 05/13/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain. METHODS The INS board of directors chose an expert panel, the Neuromodulation Appropriateness Consensus Committee (NACC), to evaluate the peer-reviewed literature, current research, and clinical experience and to give guidance for the appropriate use of these methods. The literature searches involved key word searches in PubMed, EMBASE, and Google Scholar dated 1970-2013, which were graded and evaluated by the authors. RESULTS The NACC found that evidence supports extracranial stimulation for facial pain, migraine, and scalp pain but is limited for intracranial neuromodulation. High cervical spinal cord stimulation is an evolving option for facial pain. Intracranial neurostimulation may be an excellent option to treat diseases of the nervous system, such as tremor and Parkinson's disease, and in the future, potentially Alzheimer's disease and traumatic brain injury, but current use of intracranial stimulation for pain should be seen as investigational. CONCLUSIONS The NACC concludes that extracranial nerve stimulation should be considered in the algorithmic treatment of migraine and other disorders of the head. We should strive to perfect targets outside the cranium when treating pain, if at all possible.
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Pahapill PA. A Novel Nonanchoring Technique for Implantation of Paddle Leads in the Cervical Spine Under Conscious Sedation. Neuromodulation 2015; 18:472-6; discussion 476-7. [PMID: 25809094 DOI: 10.1111/ner.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/31/2014] [Accepted: 01/20/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Spinal cord stimulation (SCS) revision surgery remains common, with a negative impact on cost-effectiveness and outcomes. The primary goal of this report was to retrospectively study the need for revision surgery in a cohort of complex regional pain syndrome type I (CRPS-1) patients with newly implanted cervical surgical paddle leads, focusing on a method of implantation to reduce the need for revision surgery. METHODS Fifteen patients underwent implantation of paddle SCS leads in the cervical spine with cervical laminotomies under conscious sedation for CRPS-1 from 2008 to 2012. Electrodes were not anchored and 11 of the electrodes were three-column paddle leads. A disinterested third party performed initial chart reviews, supplemented by subsequent telephone interviews. The need for revision surgery was the endpoint. A single surgeon performed all implants with a consistent method. RESULTS There were no paddle electrode lead revisions required for suboptimal lead placement, fracture, migration, or infection at a median follow-up period of 22 months. CONCLUSIONS This study is the first to report on: 1) cervical electrode implantation with no anchoring; and 2) cervical paddle lead implantation (including three-column paddles) performed under conscious sedation. The specific method of nonanchoring of the paddle implants under conscious sedation may have contributed to low electrode lead revision rates.
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25
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Cervical and cervicomedullary spinal cord stimulation for chronic pain: Efficacy and outcomes. Clin Neurol Neurosurg 2014; 127:33-41. [DOI: 10.1016/j.clineuro.2014.09.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/12/2014] [Accepted: 09/28/2014] [Indexed: 11/22/2022]
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Sharma M, Shaw A, Deogaonkar M. Surgical Options for Complex Craniofacial Pain. Neurosurg Clin N Am 2014; 25:763-75. [DOI: 10.1016/j.nec.2014.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Neuromodulation of chronic headaches: position statement from the European Headache Federation. J Headache Pain 2013; 14:86. [PMID: 24144382 PMCID: PMC4231359 DOI: 10.1186/1129-2377-14-86] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/20/2013] [Indexed: 01/19/2023] Open
Abstract
The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile.
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Rasskazoff SY, Slavin KV. Neuromodulation for cephalgias. Surg Neurol Int 2013; 4:S136-50. [PMID: 23682340 PMCID: PMC3654780 DOI: 10.4103/2152-7806.110662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/05/2013] [Indexed: 01/05/2023] Open
Abstract
Headaches (cephalgias) are a common reason for patients to seek medical care. There are groups of patients with recurrent headache and craniofacial pain presenting with malignant course of their disease that becomes refractory to pharmacotherapy and other medical management options. Neuromodulation can be a viable treatment modality for at least some of these patients. We review the available evidence related to the use of neuromodulation modalities for the treatment of medically refractory craniofacial pain of different nosology based on the International Classification of Headache Disorders, 2(nd) edition (ICHD-II) classification. This article also reviews the scientific rationale of neuromodulation application in management of cephalgias.
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30
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Advances in Spinal Cord Stimulation for Treatment of Chronic Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0010-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Neurostimulation techniques for the treatment of primary headache syndromes, particularly of chronic cluster headache, have received much interest in recent years. Occipital nerve stimulation (ONS) has yielded favourable clinical results and, despite the limited numbers of published cases, is becoming a routine treatment for refractory chronic cluster headache in specialized centres. Meanwhile, other promising techniques such as spinal cord stimulation (SCS) or sphenopalate ganglion stimulation have emerged. In this article the current state of clinical research for neurostimulation techniques for chronic cluster headache is reviewed.
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Affiliation(s)
- Tilman Wolter
- Interdisciplinary Pain Centre, University Hospital Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany
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Yampolsky C, Hem S, Bendersky D. Dorsal column stimulator applications. Surg Neurol Int 2012; 3:S275-89. [PMID: 23230533 PMCID: PMC3514915 DOI: 10.4103/2152-7806.103019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/04/2012] [Indexed: 11/25/2022] Open
Abstract
Background: Spinal cord stimulation (SCS) has been used to treat neuropathic pain since 1967. Following that, technological progress, among other advances, helped SCS become an effective tool to reduce pain. Methods: This article is a non-systematic review of the mechanism of action, indications, results, programming parameters, complications, and cost-effectiveness of SCS. Results: In spite of the existence of several studies that try to prove the mechanism of action of SCS, it still remains unknown. The mechanism of action of SCS would be based on the antidromic activation of the dorsal column fibers, which activate the inhibitory interneurons within the dorsal horn. At present, the indications of SCS are being revised constantly, while new applications are being proposed and researched worldwide. Failed back surgery syndrome (FBSS) is the most common indication for SCS, whereas, the complex regional pain syndrome (CRPS) is the second one. Also, this technique is useful in patients with refractory angina and critical limb ischemia, in whom surgical or endovascular treatment cannot be performed. Further indications may be phantom limb pain, chronic intractable pain located in the head, face, neck, or upper extremities, spinal lumbar stenosis in patients who are not surgical candidates, and others. Conclusion: Spinal cord stimulation is a useful tool for neuromodulation, if an accurate patient selection is carried out prior, which should include a trial period. Undoubtedly, this proper selection and a better knowledge of its underlying mechanisms of action, will allow this cutting edge technique to be more acceptable among pain physicians.
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Affiliation(s)
- Claudio Yampolsky
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Abstract
PURPOSE OF REVIEW Most pharmacological treatments of primary headache disorders are partially effective and have cumbersome side effects. Therapies with better efficacy and tolerance are needed. Neurostimulation techniques may have this potential. This is an attempt to summarize the latest clinical trial results published in the field. RECENT FINDINGS Hypothalamic deep brain stimulation is effective in drug-resistant chronic cluster headache (drCCH) but not riskless. Recent anatomical MRI studies indicate that the effective stimulation sites are rather widespread. Occipital nerve stimulation (ONS) seems to be effective in up to 76% of drCCH patients and its benefit long-lasting. A minority of patients are able to abandon preventive drugs. Its mechanism of action appears nonspecific. In chronic migraine, randomized controlled trials of ONS showed recently encouraging results, but long-term studies are missing. An ongoing sham-controlled trial suggests sphenopalatine ganglion neurostimulation (SPGS) efficacy in drCCH acute treatment, but possibly also in preventive therapy. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) modulate cortical excitability and connectivity. TMS could prevent headache when applied over the occipital cortex during the migraine aura. Repetitive TMS and tDCS have provided mixed results in a few small studies and warrant further trials. SUMMARY Neurostimulation therapies inaugurate a new era in headache management and offer a promising alternative to medications. Future studies are necessary to provide evidence-based efficacy data, knowledge on their mode of action and information about their pharmaco-economic advantages.
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Van Buyten JP, Linderoth B. Invasive neurostimulation in facial pain and headache syndromes. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.eujps.2011.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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