Aurélie Leplus1,2, Denys Fontaine1,2, Anne Donnet2,3, Jean Regis4, Christian Lucas5,6, Nadia Buisset5, Serge Blond5, Sylvie Raoul7, Evelyne Guegan-Massardier8, Stéphane Derrey9, Bechir Jarraya10,11, Bich Dang-Vu12, Frederic Bourdain12, Dominique Valade13, Caroline Roos13, Christelle Creach14, Stéphan Chabardes15, Pierric Giraud16, Jimmy Voirin17, Jocelyne Bloch18, Sophie Colnat-Coulbois19, François Caire20, Philippe Rigoard21, Laurie Tran2, Coralie Cruzel22, Michel Lantéri-Minet2,23,24. 1. Department of Neurosurgery, Université Côte d'Azur, CHU de Nice, Nice, France. 2. Université Côte d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France. 3. Pain Clinic, Hopital La Timone, Marseille, France. 4. Department of Functional Neurosurgery, Aix-Marseille University, Hopital La Timone, Marseille, France. 5. Pain Clinic, Department of Neurosurgery, CHU de Lille, Lille, France. 6. INSERM U1171, Lille, France. 7. Department of Neurosurgery, CHU de Nantes, Nantes, France. 8. Department of Neurology, CHU de Rouen, Rouen, France. 9. Department of Neurosurgery, CHU de Rouen, Rouen, France. 10. Department of Neurosurgery, Hopital Foch, Suresnes, France. 11. Université de Versailles Saint-Quentin en Yvelines/Université Paris-Saclay, Versailles, France. 12. Pain Department, Hopital Foch, Suresnes, France. 13. Emergency Headache Centre, Hopital Lariboisière, Paris, France. 14. Department of Neurology, CHU de Saint Etienne, Saint Etienne, France. 15. Department of Neurosurgery, CHU de Grenoble-Alpes, Grenoble, France. 16. Department of Neurology, Hopital d'Annecy, Annecy, France. 17. Department of Neurosurgery, Hopitaux Civils de Colmar, Colmar, France. 18. Department of Neurosurgery, CHUV, Lausanne, Switzerland. 19. Department of Neurosurgery, CHU de Nancy, France. 20. Department of Neurosurgery, CHU de Limoges, Limoges, France. 21. Department of Neurosurgery, CHU de Poitiers, Poitiers, France. 22. Université Côte d'Azur, Délégation à la Recherche et à l'Innovation, CHU de Nice, Nice, France. 23. Pain Department, Université Cote d'Azur, CHU de Nice, Nice, France. 24. INSERM/UdA, U1107, Neuro-Dol, Auvergne University, Clermont-Ferrand, France.
Abstract
BACKGROUND: Occipital nerve stimulation (ONS) has been proposed to treat refractory chronic cluster headache (rCCH) but its efficacy has only been showed in small short-term series. OBJECTIVE: To evaluate ONS long-term efficacy in rCCH. METHODS: We studied 105 patients with rCCH, treated by ONS within a multicenter ONS prospective registry. Efficacy was evaluated by frequency, intensity of pain attacks, quality of life (QoL) EuroQol 5 dimensions (EQ5D), functional (Headache Impact Test-6, Migraine Disability Assessment) and emotional (Hospital Anxiety Depression Scale [HAD]) impacts, and medication consumption. RESULTS: At last follow-up (mean 43.8 mo), attack frequency was reduced >50% in 69% of the patients. Mean weekly attack frequency decreased from 22.5 at baseline to 9.9 (P < .001) after ONS. Preventive and abortive medications were significantly decreased. Functional impact, anxiety, and QoL significantly improved after ONS. In excellent responders (59% of the patients), attack frequency decreased by 80% and QoL (EQ5D visual analog scale) dramatically improved from 37.8/100 to 73.2/100. When comparing baseline and 1-yr and last follow-up outcomes, efficacy was sustained over time. In multivariable analysis, low preoperative HAD-depression score was correlated to a higher risk of ONS failure. During the follow-up, 67 patients experienced at least one complication, 29 requiring an additional surgery: infection (6%), lead migration (12%) or fracture (4.5%), hardware dysfunction (8.2%), and local pain (20%). CONCLUSION: Our results showed that long-term efficacy of ONS in CCH was maintained over time. In responders, ONS induced a major reduction of functional and emotional headache-related impacts and a dramatic improvement of QoL. These results obtained in real-life conditions support its use and dissemination in rCCH patients.
BACKGROUND: Occipital nerve stimulation (ONS) has been proposed to treat refractory chronic cluster headache (rCCH) but its efficacy has only been showed in small short-term series. OBJECTIVE: To evaluate ONS long-term efficacy in rCCH. METHODS: We studied 105 patients with rCCH, treated by ONS within a multicenter ONS prospective registry. Efficacy was evaluated by frequency, intensity of pain attacks, quality of life (QoL) EuroQol 5 dimensions (EQ5D), functional (Headache Impact Test-6, Migraine Disability Assessment) and emotional (Hospital Anxiety Depression Scale [HAD]) impacts, and medication consumption. RESULTS: At last follow-up (mean 43.8 mo), attack frequency was reduced >50% in 69% of the patients. Mean weekly attack frequency decreased from 22.5 at baseline to 9.9 (P < .001) after ONS. Preventive and abortive medications were significantly decreased. Functional impact, anxiety, and QoL significantly improved after ONS. In excellent responders (59% of the patients), attack frequency decreased by 80% and QoL (EQ5D visual analog scale) dramatically improved from 37.8/100 to 73.2/100. When comparing baseline and 1-yr and last follow-up outcomes, efficacy was sustained over time. In multivariable analysis, low preoperative HAD-depression score was correlated to a higher risk of ONS failure. During the follow-up, 67 patients experienced at least one complication, 29 requiring an additional surgery: infection (6%), lead migration (12%) or fracture (4.5%), hardware dysfunction (8.2%), and local pain (20%). CONCLUSION: Our results showed that long-term efficacy of ONS in CCH was maintained over time. In responders, ONS induced a major reduction of functional and emotional headache-related impacts and a dramatic improvement of QoL. These results obtained in real-life conditions support its use and dissemination in rCCH patients.
Authors: Rafael Caiado Vencio; Paulo Eduardo Albuquerque Zito Raffa; André Costa Corral Ponce; Bruno Pricoli Malamud; César Cozar Pacheco; Paulo Roberto Franceschini; Roger Thomaz Rotta Medeiros; Paulo Henrique Pires de Aguiar Journal: Surg Neurol Int Date: 2021-04-26