Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study
Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study
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DOI：
10.1016/s1474-4422(07)70058-3
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发表时间：
2007-04-01
期刊：
影响因子：
48
通讯作者：
Schoenen, Jean
中科院分区：
文献类型：
--
作者：
Magis, Delphine;Allena, Marta;Schoenen, Jean
背景耐药慢性尘埃头痛(DrCCH)是一种破坏性的疾病，各种破坏性的治疗方法都没有成功。枕神经刺激(ONS)是治疗顽固性头痛的一种新的安全策略。我们进行了一项ONS治疗drCCH的前瞻性先导试验，以评估临床疗效和疼痛感觉。方法8例drCCH患者在头痛的一侧植入枕下神经刺激器，并被要求在连续ONS前后在日记中记录发作的频率、强度和症状治疗细节。为了检测头部和头外疼痛处理的变化，我们测量了电和压力痛阈值以及伤害性眨眼反射。结果发现，两名患者在16个月和22个月的随访中没有疼痛；其中一名患者仍有偶尔的自主神经发作。有三名患者的发作频率减少了约90%。两名患者，其中一名只做了3个月的植入物，改善了约40%。平均随访15.1个月(SD 9.5，范围3~22)。在ONS期间，攻击强度往往比频率更早地下降，在剩余的攻击中，平均提高50%。除了一名患者外，所有患者都能够大幅减少预防性药物治疗。通过关闭刺激器或由于电池耗尽而中断ONS后，所有改善的患者在几天内都会复发和发作增加。ONS没有显著改变痛阈值。ONS持续时间越长，伤害性瞬目反射的波幅越大。未发生严重不良事件。解释ONS可能是治疗DRCCH的有效方法，而且可能比下丘脑深部刺激更安全。植入和临床显著改善之间的延迟2个月或更长时间表明，该手术是通过上脑干或间脑中枢水平的缓慢神经调节过程进行ADS的。
Background Drug-resistant chronic duster headache (drCCH) is a devastating disorder for which various destructive procedures have been tried unsuccessfully. Occipital nerve stimulation (ONS) is a new, safe strategy for intractable headaches. We undertook a prospective pilot trial of ONS in drCCH to assess clinical efficacy and pain perception.Methods Eight patients with drCCH had a suboccipital neurostimulator implanted on the side of the headache and were asked to record details of frequency, intensity, and symptomatic treatment for their attacks in a diary before and after Continuous ONS. To detect changes in cephalic and extracephalic pain processing we measured electrical and pressure pain thresholds and the nociceptive blink reflex.Findings Two patients were pain free after a follow-up of 16 and 22 months; one of them still had occasional autonomic attacks. Three patients had around a 90% reduction in attack frequency. Two patients, one of whom had had the implant for only 3 months, had improvement of around 40%. Mean follow-up was 15.1 months (SD 9.5, range 3-22). Intensity of attacks tends to decrease earlier than frequency during ONS and, on average, is improved by 50% in remaining attacks. All but one patient were able to substantially reduce their preventive drug treatment. Interruption of ONS by switching off the stimulator or because of an empty battery was followed within days by recurrence and increase of attacks in all improved patients. ONS did not significantly modify pain thresholds. The amplitude of the nociceptive blink reflex increased with longer durations of ONS. There were no serious adverse events.Interpretation ONS could be an efficient treatment for drCCH and could be safer than deep hypothalamic stimulation. The delay of 2 months or more between implantation and significant clinical improvement suggests that the procedure ads via slow neuromodulatory processes at the level of upper brain stem or diencephalic centres.