Craniofacial Peripheral Nerve Stimulation

Harland, Tessa A.; Zbrzeski, Claudia; DiMarzio, Marisa; Khazen, Olga; Staudt, Michael; Pilitsis, Julie G.

doi:10.1093/neuros/nyaa447_542

Cited by 1 publication

(6 citation statements)

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“…Long-term clinical outcomes: There was a total of 105 patients with chronic migraine out of 5 studies combined (18, [21][22][23][24]. Primary outcomes differed from study to study.Primary outcomes varied in that they assessed for a change in pain frequency or severity in the cases of Palmisani and Rodrigo or an assessment only for change in pain severity alone as in Harland and Miller as well as in the percentage of change ((≥30% in Miller vs. ≥ 50% in Harland) (21)(22)(23)(24). Please refer to Supplementary Table S1 for a description of each study's primary outcome and results.…”

Section: Migrainementioning

confidence: 99%

“…Please refer to Supplementary Table S1 for a description of each study's primary outcome and results. Three studies employed both unilateral and bilateral lead stimulation (18,23,24). Two studies did not specify whether stimulation was continuous or intermittent (23,24).…”

Section: Migrainementioning

confidence: 99%

“…Three studies employed both unilateral and bilateral lead stimulation (18,23,24). Two studies did not specify whether stimulation was continuous or intermittent (23,24). Two studies investigated using continuous stimulation (18, 21).…”

Section: Migrainementioning

confidence: 99%

“…Outcome measures for all studies incorporated pain severity. Harland 23,26,27,29). In the Brewer et al, lead laterality was not specified for occipital neuralgia specifically, but noted that for unilateral headaches, unilateral leads were used and for bilateral headaches, bilateral leads were employed.…”

Section: Occipital Neuralgiamentioning

confidence: 99%

“…Magown also employed intermittent stimulation (28). The stimulation schedule was not discussed in the Harland study (23).…”

Section: Occipital Neuralgiamentioning

confidence: 99%

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Long term outcomes of occipital nerve stimulation

Montenegro

Kissoon

2023

Front. Pain Res.

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BackgroundOccipital nerve stimulation (ONS) has been investigated as a potential treatment for disabling headaches and has shown promise for disorders such as chronic migraine and cluster headache. Long term outcomes stratified by headache subtype have had limited exploration, and literature on outcomes of this neuromodulatory intervention spanning 2 or more years is scarce.MeasuresWe performed a narrative review on long term outcomes with ONS for treatment of headache disorders. We surveyed the available literature for studies that have outcomes for 24 months or greater to see if there is a habituation in response over time. Review of the literature revealed evidence in treatment of occipital neuralgia, chronic migraine, cluster headache, cervicogenic headache, short lasting unilateral neuralgiform headache attacks (SUNHA) and paroxysmal hemicrania. While the term “response” varied per individual study, a total of 17 studies showed outcomes in ONS with long term sustained responses (as defined per this review) in the majority of patients with specific headache types 177/311 (56%). Only 7 studies in total (3 cluster, 1 occipital neuralgia, 1 cervicogenic headache, 1 SUNHA, 1 paroxysmal hemicrania) provided both short-term and long-term responses up to 24 months to ONS. In cluster headache, the majority of patients (64%) were long term responders (as defined per this review) and only a minority of patients 12/62 (19%) had loss of efficacy (e.g., habituation). There was a high number 313/439 (71%) of adverse events per total number of patients in the studies including lead migration, requirements of revision surgery, allergy to surgical materials, infection and intolerable paresthesias.ConclusionsWith the evidence available, the response to ONS was sustained in the majority of patients with cluster headache with low rates of loss of efficacy in this patient population. There was a high percent of adverse events per number of patients in long term follow-up and likely related to the off-label use of leads typically used for spinal cord stimulation. Further longitudinal assessments of outcomes in occipital nerve stimulation with devices labelled for use in peripheral nerve stimulation are needed to evaluate the extent of habituation to treatment in headache.

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