Díaz-de-Terán Javier, Membrilla Javier A, Paz-Solís José, de Lorenzo Iñigo, Roa Javier, Lara-Lara Manuel, Gil-Martínez Alfonso, Díez-Tejedor Exuperio
Neurology Department, University Hospital La Paz, 28046 Madrid, Spain.
CranioSPain Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle (UAM), La Salle Campus Madrid, 28023 Madrid, Spain.
Brain Sci. 2021 Feb 13;11(2):236. doi: 10.3390/brainsci11020236.
Occipital nerve stimulation (ONS) is a surgical treatment proposed for drug-resistant chronic cluster headache (drCCH). Long-term series assessing its efficacy are scarce. We designed a retrospective observational study with consecutive sampling, evaluating the follow-up of 17 drCCH patients who underwent ONS. Our main endpoint was the reduction the rate of attacks per week. We also evaluated the pain intensity through the Visual Analogue Scale (VAS), patient overall perceived improvement and decrease in oral medication intake. After a median follow-up of 6.0 years (4.5-9.0), patients decreased from a median of 30 weekly attacks to 22.5 (5.6-37.5, = 0.012), 7.5 at 1 year ( = 0.006) and 15.0 at the end of follow-up ( = 0.041). The VAS decreased from a median of 10.0 to 8.0 ( = 0.011) at three months, to 7.0 ( = 0.008) at twelve months and 7.0 ( = 0.003) at the end of the follow-up. A total of 23.5% had an overall perceived improvement of ≥70% at 3 months, 41.2% at 1 year and 27.8% at the end of follow-up. Reducing prophylactic oral medication was possible in 76.5% and it was stopped in 17.7%. Triptan use decreased in all the responder patients and 17.7% stopped its intake. A total of 41.2% presented mild adverse events. In conclusion, our long-term experience suggests that ONS could be an interesting option for drCCH-selected patients, as it is a beneficial and minimally invasive procedure with no serious adverse events.
枕神经刺激术（ONS）是一种针对药物难治性慢性丛集性头痛（drCCH）提出的外科治疗方法。评估其疗效的长期研究系列较少。我们设计了一项连续抽样的回顾性观察性研究，评估了17例接受ONS的drCCH患者的随访情况。我们的主要终点是每周发作次数的减少率。我们还通过视觉模拟量表（VAS）评估疼痛强度、患者总体感知改善情况以及口服药物摄入量的减少情况。在中位随访6.0年（4.5 - 9.0年）后，患者每周发作次数从中位30次降至22.5次（5.6 - 37.5次，P = 0.012），1年后为7.5次（P = 0.006），随访结束时为15.0次（P = 0.041）。VAS评分在3个月时从中位10.0降至8.0（P = 0.011），12个月时降至7.0（P = 0.008），随访结束时降至7.0（P = 0.003）。共有23.5%的患者在3个月时总体感知改善≥70%，1年时为41.2%，随访结束时为27.8%。76.5%的患者能够减少预防性口服药物用量，17.7%的患者停用了该药物。所有有反应的患者曲坦类药物使用量均减少，17.7%的患者停止服用。共有41.2%的患者出现轻度不良事件。总之，我们的长期经验表明，对于选定的drCCH患者，ONS可能是一个不错的选择，因为它是一种有益且微创的手术，没有严重不良事件。
