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Kollenburg L, Kurt E, Mulleners W, Abd-Elsayed A, Yazdi C, Schatman ME, Yong RJ, Cerda IH, Pappy A, Ashina S, Robinson CL, Dominguez M. Four Decades of Occipital Nerve Stimulation for Headache Disorders: A Systematic Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01271-1. [PMID: 38907793 DOI: 10.1007/s11916-024-01271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE OF REVIEW Chronic headaches are a significant source of disability worldwide. Despite the development of conventional strategies, a subset of patients remain refractory and/or experience side effects following these treatments. Hence, occipital nerve stimulation (ONS) should be considered as an alternative strategy for intractable chronic headaches. This review aims to provide a comprehensive overview of the effectiveness, safety, mechanisms and practical application of ONS for the treatment of headache disorders. RECENT FINDINGS Overall response rate of ONS is 35.7-100%, 17-100%, and 63-100% in patients with cluster headache, chronic migraine and occipital neuralgia respectively. Regarding the long-term effectivity in all groups, 41.6-88.0% of patients remain responders after ≥ 18.3 months. The most frequently reported adverse events include lead migration/fracture (13%) and local pain (7.3%). Based on our results, ONS can be considered a safe and effective treatment for chronic intractable headache disorders. To support more widespread application of ONS, additional research with larger sample sizes should be conducted.
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Affiliation(s)
- Linda Kollenburg
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Pain & Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim Mulleners
- Department of Pain & Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Alaa Abd-Elsayed
- School of Medicine and Public Health, Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - R Jason Yong
- Harvard Medical School, Brigham and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, MA, USA
| | - Ivo H Cerda
- Harvard Medical School, Brigham and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, MA, USA
| | - Adlai Pappy
- Harvard Medical School, Brigham and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, MA, USA
| | - Sait Ashina
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christopher Louis Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Moises Dominguez
- Department of Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, 520 E 70th St, New York, NY, 10021, USA.
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Lansbergen CS, de Vos CC, Brandt RB, Ferrari MD, Huygen FJPM, Fronczek R. Occipital nerve stimulation in medically intractable chronic cluster headache. Eur J Neurol 2024; 31:e16212. [PMID: 38230580 DOI: 10.1111/ene.16212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Casper S Lansbergen
- Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cecile C de Vos
- Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Roemer B Brandt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank J P M Huygen
- Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Robblee J. Breaking the cycle: unraveling the diagnostic, pathophysiological and treatment challenges of refractory migraine. Front Neurol 2023; 14:1263535. [PMID: 37830088 PMCID: PMC10565861 DOI: 10.3389/fneur.2023.1263535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Background Refractory migraine is a poorly described complication of migraine in which migraine has chronified and become resistant to standard treatments. The true prevalence is unknown, but medication resistance is common in headache clinic patient populations. Given the lack of response to treatment, this patient population is extremely difficult to treat with limited guidance in the literature. Objective To review the diagnostic, pathophysiological, and management challenges in the refractory migraine population. Discussion There are no accepted, or even ICHD-3 appendix, diagnostic criteria for refractory migraine though several proposed criteria exist. Current proposed criteria often have low bars for refractoriness while also not meeting the needs of pediatrics, lower socioeconomic status, and developing nations. Pathophysiology is unknown but can be hypothesized as a persistent "on" state as a progression from chronic migraine with increasing central sensitization, but there may be heterogeneity in the underlying pathophysiology. No guidelines exist for treatment of refractory migraine; once all guideline-based treatments are tried, treatment consists of n-of-1 treatment trials paired with non-pharmacologic management. Conclusion Refractory migraine is poorly described diagnostically, its pathophysiology can only be guessed at by extension of chronic migraine, and treatment is more the art than science of medicine. Navigating care of this refractory population will require multidisciplinary care models and an emphasis on future research to answer these unknowns.
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Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Dignity Health, St Joseph’s Hospital and Medical Center, Lewis Headache Clinic, Barrow Neurological Institute, Phoenix, AZ, United States
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Türk CÇ, Topsoy C, Mutlucan UO, Gür E, Yilmaz K, Elter O, Genç F, Süren D. Histopathological changes in tissues surrounding vagal nerve stimulation generators: A retrospective analysis of revision surgeries. Acta Neurochir (Wien) 2023; 165:2171-2178. [PMID: 37393559 DOI: 10.1007/s00701-023-05701-8] [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] [Received: 05/15/2023] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Vagal nerve stimulation (VNS) is an effective treatment for patients with epilepsy, depression, and other neuropsychiatric conditions. Understanding the tissue changes associated with VNS devices is crucial for optimizing patient outcomes and device development. This study aimed to investigate the histopathological changes in the tissues surrounding the VNS generator and explore potential correlations with clinical factors and battery performance. METHODS A total of 23 patients who underwent VNS generator revision surgery owing to battery depletion were included. Tissue samples from the areas surrounding the VNS generator were obtained and analyzed for histopathological changes. Demographic and device-related variables were also recorded. RESULTS Capsule formation was observed in all patients. Acute inflammation were not detected in any case. Perivascular lymphocytic infiltration, foreign-body giant cell reaction (FBGCR), and calcification were observed in 8.7%, 26.1%, and 43.5% of patients, respectively. Crystalloid foreign body appearance was noted in 4 patients. The median output current of the generator was higher in patients with lymphocytic infiltration than in those without lymphocytic infiltration. The median off time was higher in patients with skin retraction than in those without skin retraction. Moreover, discomfort was associated with the presence of FBGCR. CONCLUSION Our study provides insights into the tissue changes associated with the VNS generator, with capsule formation being a common response. Crystalloid foreign body appearance was not reported previously. Further research is needed to understand the relationship between these tissue changes and VNS device performance, including the potential impact on battery life. These findings may contribute to VNS therapy optimization and device development.
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Affiliation(s)
- Cezmi Çağri Türk
- Department of Neurosurgery, University of Health Sciences, Hamidiye School of Medicine, Istanbul, Turkey.
- Antalya Education and Research Hospital, Neurosurgery Clinic, Antalya, Turkey.
| | - Ceren Topsoy
- Department of Pathology, University of Health Sciences, Hamidiye School of Medicine, Istanbul, Turkey
| | - Umut Ogün Mutlucan
- Antalya Education and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Erdal Gür
- Antalya Education and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Kerem Yilmaz
- Department of Neurosurgery, University of Health Sciences, Hamidiye School of Medicine, Istanbul, Turkey
- Antalya Education and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Oktay Elter
- Department of Neurosurgery, University of Health Sciences, Hamidiye School of Medicine, Istanbul, Turkey
- Antalya Education and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Fatma Genç
- Department of Neurology, University of Health Sciences, Hamidiye School of Medicine, Istanbul, Turkey
| | - Dinç Süren
- Department of Pathology, University of Health Sciences, Hamidiye School of Medicine, Istanbul, Turkey
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