Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients
Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients
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DOI：
10.1016/s0140-6736(07)60328-6
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发表时间：
2007-03-01
期刊：
影响因子：
168.9
通讯作者：
Goadsby, Peter J.
中科院分区：
文献类型：
--
作者：
Burns, Brian;Watkins, Laurence;Goadsby, Peter J.
背景丛集性头痛是一种以反复发作极度剧烈的头痛为特征的头痛，通常一天发生几次。慢性丛集性头痛患者的病情持续不断，需要多年的日常预防性医疗。方法对8例难治性慢性丛集性头痛患者在枕下区植入电极进行枕神经电刺激。除第一名患者在接受双侧刺激之前先接受单侧刺激外，所有患者在治疗过程中都接受了双侧刺激。在中位数20个月的随访中(双侧刺激的范围为6-27个月)，8名患者中有6名患者报告的反应足够有意义，足以推荐给同样受到影响的慢性丛集性头痛患者。两名患者的发作有显著改善(90%和95%)；三名患者注意到中度改善(40%、60%和20%-80%)，一名患者报告有轻微改善(25%)。攻击的频率和严重程度都有所改善。这些变化发生在几周或几个月的时间里，尽管当设备出现故障(例如，电池耗尽)时，攻击会在几天内再次出现。令人担忧的不良事件是1名患者出现导线移位，4名患者电池耗尽需要更换。解释枕神经刺激治疗丛集性头痛似乎提供了一种安全、有效的治疗方案，可能开启神经刺激疗法治疗原发性头痛综合征的新时代。
Background Cluster headache is a form of primary headache that features repeated attacks of excruciatingly severe headache usually occurring several times a day. Patients with chronic cluster headache have unremitting illness that necessitates daily preventive medical treatment for years. When medically intractable, the condition has previously been treatable only with cranially invasive or neurally destructive methods.Methods Eight patients with medically intractable chronic cluster headache were implanted in the suboccipital region with electrodes for occipital nerve stimulation. Other than the first patient, who was initially stimulated unilaterally before being stimulated bilaterally, all patients were stimulated bilaterally during treatment.Findings At a median follow-up of 20 months (range 6-27 months for bilateral stimulation), six of eight patients reported responses that were sufficiently meaningful for them to recommend the treatment to similarly affected patients with chronic cluster headache. Two patients noticed a substantial improvement (90% and 95%) in their attacks; three patients noticed a moderate improvement (40%, 60%, and 20-80%) and one reported mild improvement (25%). Improvements occurred in both frequency and severity of attacks. These changes took place over weeks or months, although attacks returned in days when the device malfunctioned (eg, with battery depletion). Adverse events of concern were lead migrations in one patient and battery depletion requiring replacement in four.Interpretation Occipital nerve stimulation in cluster headache seems to offer a safe, effective treatment option that could begin a new era of neurostimulation therapy for primary headache syndromes.