Imaging Sensory Effects of Occipital Nerve Stimulation: A New Computer-based Method in Neuromodulation

Percutaneous nerve field stimulation (PENS) of the occipital region as a possible predictor for occipital nerve stimulation (ONS) responsiveness in refractory headache disorders? A feasibility study

“…The outcome of minimally invasive ONS may also depend on whether the patient is treated with a subperceptional, perceptional, or supra-perceptional threshold stimulation intensity. All three stimulation modalities provided pain reduction, with supra-perceptional stimulation threshold being superior in a smaller case series (29,30). In general, the stimulation paradigm in our study consisted mainly of a suprathreshold stimulation mode.…”

“…In addition, there are a large number of patients with chronic refractory headache who have failed to achieve sustained pain relief after minimally invasive neuromodulation like ONS. Several questions remain unanswered with regard to presurgical predictors, objective biomarkers at the pre-treatment and treatment stage, and standardized protocols for implantation and stimulation technique (chronic vs. cyclic stimulation mode) in treating refractory headache disorders (27)(28)(29)(30)(31)(32)(33)(34).…”

“…In order to enhance the stimulation setting, Go¨bel and colleagues introduced a computer-based assessment tool permitting the quantitative and qualitative acquisition of ONS-induced paresthetic distribution. Sensory mapping may allow reliable and objective stimulation paradigms, analyzing such standard obtained data in the neuromodulation treatment course (30). The same frequency (100 Hz) and amplitude (300 msec) parameters were defined in our stimulation paradigm in order to obtain comparable and reproducible data.…”

Occipital Nerve Stimulation in Chronic Migraine: The Relationship Between Perceived Sensory Quality, Perceived Sensory Location, and Clinical Efficacy—A Prospective, Observational, Non-Interventional Study

“…After implantation, all subjects used a computer-based method for mapping spatial, cognitive and affective sensory effects of ONS (for details see [ 31 ]). This method enables continuous tracking of the ONS-induced perceived sensory location, the perceived spatial sensory field size, the perceived sensory quality and the rating of clinical effectiveness in the long term.…”

“…The relationship between lead placement, the electrical stimulation parameters, the perceived location of the ONS-induced supra-threshold sensations, the perceived spatial sensory field size, and the perceived sensory qualities with the reported clinical effectiveness are also largely unknown. For the analysis of this relationship, we used a computer-based imaging method [ 31 ] for mapping the ONS-induced perceived sensory location, the perceived spatial sensory field size, as well as the perceived sensory quality in a long-term course over 21 months in weekly time intervals. The aim of this study was to evaluate a potential relationship between supra-threshold-induced sensory perceptions and clinical effectiveness of ONS.…”