Extended Long-Term Effects of Cervical Vagal Nerve Stimulation on Headache Intensity/Frequency and Affective/Cognitive Headache Perception in Drug Resistant Complex-Partial Seizure Patients

Pintea, Bogdan; Hampel, Kevin G.; Boström, Jan; Surges, Rainer; Vatter, Hartmut; Lendvai, Ilana S.; Kinfe, Thomas M.

doi:10.1111/ner.12540

Cited by 7 publications

(15 citation statements)

References 36 publications

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“…In the time period from 2012 to the present, an RCT with implantable VNS in purely primary headache disorder patients has not been published, in consistence with a recent review in the field [56]. A large (n = 325) retrospective clinical study demonstrated that implantable VNS had beneficial effects on daily headache/migraine intensity (VAS = 5.4 in the VNS group versus 7.8 in the group on best medical treatment) and affective/cognitive pain perception (21 in the VNS group versus 16 in the group on best medical treatment) in patients with drug-resistant focal epilepsy [57] (Table 4).…”

Section: Cross-over Studies Of Implantable Ons In CMmentioning

confidence: 79%

Therapeutic strategies that act on the peripheral nervous system in primary headache disorders

Tajti

Delia

Nyári

et al. 2019

Expert Review of Neurotherapeutics

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Introduction: Acute and preventive treatment of primary headache disorders is not completely resolved with regard to efficacy, safety, and tolerability. Hence, peripheral and central neuromodulation can provide therapeutic alternatives in drug-resistant cases. Peripheral targets of neuromodulation include invasive and non-invasive neurostimulation and electrical and chemical nerve and ganglion blockades. Areas covered: A PubMed search of papers published from January 2012 to October 2018 was conducted. The goal of this review was to analyze the efficacy and safety of invasive (implantable) peripheral neurostimulation methods (the occipital nerve, the cervical branch of vagal nerve, the sphenopalatine ganglion) and non-invasive (transcutaneous) peripheral neurostimulation methods (the occipital nerve, the supraorbital nerve, and the cervical and auricular branches of the vagal nerve), based on the results of published clinical trials and case series. Acting also on the peripheral nervous system, peripheral nerve (i.e. greater occipital nerve) and ganglion (i.e. sphenopalatine ganglion) blockades, botulinum neurotoxin type A-hemagglutinin complex therapies, and calcitonin generelated peptide-related monoclonal antibody treatments in this patient population are also discussed. Expert opinion: This review summarizes the latest results on the therapeutic strategies acting on the periphery in primary headache disorders. These therapeutic options are minimally invasive or noninvasive, efficacious, safe, and well tolerated. ARTICLE HISTORY

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Section: Cross-over Studies Of Implantable Ons In CMmentioning

confidence: 79%

Therapeutic strategies that act on the peripheral nervous system in primary headache disorders

Tajti

Delia

Nyári

et al. 2019

Expert Review of Neurotherapeutics

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“…Mainly due to the low number of patients investigated and the study design, evidence-based conclusion about iVNS head pain outcome is limited (Table 1). 5–10…”

Section: General Characteristics and Class Of Evidence Of Cervical Vnmentioning

confidence: 99%

“…The majority of the published iVNS data consist of case series or retrospective analyses, predominantly in patients with refractory focal seizures with co-occurring chronic headache (commonly migraine) with follow-up varying from 3 months to 14 years 3,5–10. For surgically implanted VNS, a multicenter, randomized controlled study has not yet been carried out, as seizure mostly represented the primary indication.…”

Section: Cervical Invasive (Surgically Implanted) Vns and Primary Heamentioning

confidence: 99%

“…Including migraine and cluster headache, both pilot studies demonstrated encouraging efficacy in terms of 50% reduction in severity/frequency with adjunctive iVNS 8,9. More recently, a retrospective, large database analysis found a sustained, clinically meaningful impact of iVNS in seizure-related CDH and migraine 10. In spite of this marked observed effect, iVNS requires surgical implantation and has been associated with a considerable percentage of implantation- and/or stimulation-associated side effects, diminishing the otherwise beneficial VNS outcome 3.…”

Section: Introductionmentioning

confidence: 99%

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Spotlight on cervical vagus nerve stimulation for the treatment of primary headache disorders: a review

Lendvai

Maier

Scheele

et al. 2018

JPR

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ObjectivesCervical noninvasive vagus nerve stimulation (nVNS) emerged as an adjunctive neuromodulation approach for primary headache disorders with limited responsiveness to pharmacologic and behavioral treatment. This narrative review evaluates the safety and efficacy of invasive and noninvasive peripheral nerve stimulation of the cervical branch of the vagal nerve (afferent properties) for primary headache disorders (episodic/chronic migraine [EM/CM] and cluster headache [ECH/CCH]) and provides a brief summary of the preclinical data on the possible mechanism of action of cervical vagus nerve stimulation (VNS) and trigemino-nociceptive head pain transmission.Materials and methodsA systematic search of published data was performed in PubMed for randomized controlled trials (RCTs) and prospective cohort clinical studies assessing the efficacy/safety and cost-effectiveness of cervical VNS in primary headache disorders and related preclinical studies.ResultsThree RCTs were identified for ECH/CCH (ACT-1, ACT-2 and PREVA), one RCT for migraine (EVENT) and several prospective cohort studies and retrospective analyses for both headache disorders. In ACT-1, a significantly higher response rate, a higher pain-free rate and a decrease in mean attack duration were found in nVNS-treated ECH/CCH patients compared to sham stimulation. ACT-2 confirmed these findings (e.g., significantly higher pain-free attacks, pain severity decline and increased responder-rate [defined as ≥50% reduction]). The PREVA study demonstrated the superiority of adjunctive nVNS to standard care alone and observed a significantly higher attack reduction (p=0.02) and responder rate (defined as ≥50% reduction). For CM, the EVENT study assessed a significantly higher frequency of decline in the open-label phase. Mostly transient mild/moderate adverse events were recorded, and no severe device-related adverse events occurred.ConclusionCervical nVNS represents a novel, safe and efficient adjunctive treatment option for primary headache disorders. In particular, preliminary observations suggest enhanced nVNS responsiveness in favor of episodic subtypes (EM and ECH). However, preclinical studies are urgently warranted to dissect the mechanism of action.

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“…Differences of pain perception were previously evaluated by our group in patients with chronic headache and epilepsy with and without VNS depending on their antiepileptic medication, such as topiramate, a drug described as a modifier of the thalamocortical loop. 6 Although both types of neuromodulation (VNS and ANT-DBS) were reported to positively influence the headache of epilepsy patients, it remains unclear if they influence a common effect loop or may differ regarding their effect on pain perception.…”

Section: Introductionmentioning

confidence: 99%

Headache Perception in an Epilepsy Patient with Neuromodulation by Anterior Thalamic Nuclei Deep Brain Stimulation: A Case Report

Pintea

Surges

Boström

2020

J Neurol Surg A Cent Eur Neurosurg

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Objective Headache disorders are frequently associated with epilepsy. Some neuromodulation techniques for refractory epilepsy have been reported to positively influence the associated chronic headache. However, the exact mechanism of action of vagus nerve stimulation (VNS) and anterior thalamic nuclei-deep brain stimulation (ANT-DBS) on pain perception is unclear. Method We report a structured assessment of pain perception in a patient who experienced headache relief after ANT-DBS for refractory focal epilepsy and compare it with pain perception of epilepsy patients with chronic headache who were treated with and without VNS. Results The pain-associated symptoms in the ANT-DBS case were on the Pain Anxiety Symptoms Scale (PASS-40) subscore “physiological anxiety” closer to the control collective, whereas in patients with VNS, this was more likely for the PASS-40 subscores “cognitive anxiety” or “escape and avoidance.” Conclusion ANT-DBS and VNS may influence epilepsy-associated chronic headache in different ways.

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Extended Long-Term Effects of Cervical Vagal Nerve Stimulation on Headache Intensity/Frequency and Affective/Cognitive Headache Perception in Drug Resistant Complex-Partial Seizure Patients

Cited by 7 publications

References 36 publications

Therapeutic strategies that act on the peripheral nervous system in primary headache disorders

Therapeutic strategies that act on the peripheral nervous system in primary headache disorders

Spotlight on cervical vagus nerve stimulation for the treatment of primary headache disorders: a review

Headache Perception in an Epilepsy Patient with Neuromodulation by Anterior Thalamic Nuclei Deep Brain Stimulation: A Case Report

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