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Occipital Stimulation for Chronic Migraine: Patient Selection and Complications

Published online by Cambridge University Press:  02 December 2014

Zelma H. T. Kiss  and
Werner J. Becker
Zelma H. T. Kiss*
Affiliation:
Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
Werner J. Becker
Affiliation:
Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
*
Room 1AC58, HRIC, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada. Email: zkiss@ucalgary.ca
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Abstract

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Background:

Chronic migraine is a significant cause of disability world-wide and occipital region stimulation (OS) has been proposed to treat it. While participating in an industry-sponsored pilot trial of OS, we aimed to collect data regarding our surgical complications and long term usage of OS in our chronic migraine patients.

Methods:

Ten patients (8 female, median age 46.5 years) were enrolled based on criteria established by the sponsoring company, screened in the headache clinic, and followed for a median of 33 months. We did not access data collected by industry for this report and instead collected our own data prospectively, including predominant location of headache, location of paresthesia evoked by OS, and complications.

Results:

Adverse events included three possible early infections requiring antibiotics but not hardware removal, one late implantable pulse generator erosion requiring removal, one generator malfunction requiring revision, and loss of paresthetic coverage requiring four revisions in four patients. Two patients experienced new symptoms requiring psychiatric intervention. Five patients had no benefit and have been explanted. Of those who remain using their device, the proportion of their pre-operative pain located in the occipital region was 0.62 ± 0.14, whereas in those patients who have been explanted, the proportion was 0.31 ± 0.18 (t = 3.15, p=0.01).

Conclusions:

Complication rates with OS are higher than those seen with other stimulation techniques, despite identical hardware and similar surgery. The location of migraine pain did predict outcome, and suggests that only those with primarily occipital region headache are candidates for this therapy.

Résumé

RÉSUMÉ Contexte:

La migraine chronique est une cause importante d'invalidité à l'échelle mondiale et la stimulation de la région occipitale (SO) a été proposée comme traitement de cette maladie. Lors de notre participation à un projet pilote sur la SO, commandité par l'industrie, nous avons recueilli des données sur les complications chirurgicales que nous avons observées et sur l'utilisation à long terme de la SO chez nos patients atteints de migraine chronique.

Méthode:

Dix patients dépistés à notre clinique de la céphalée, qui satisfaisaient aux critères de sélection déterminés par le commanditaire, ont été inclus dans l'étude dont 8 femmes et dont l'âge moyen était de 46,5 ans. La durée médiane du suivi a été de 33 mois. Nous n'avons pas eu recours aux données recueillies par le commanditaire pour effectuer cette étude. Nous avons plutôt recueilli nos propres données de façon prospective, dont la région prédominante de la céphalée, l'endroit des paresthésies provoquées par la SO et les complications de l'intervention.

Résultats:

Parmi les incidents thérapeutiques, nous avons noté 3 infections précoces ayant nécessité l'administration d'antibiotiques sans retrait de l'appareillage, une érosion tardive du neurostimulateur implantable ayant nécessité son retrait, un dysfonctionnement du neurostimulateur ayant nécessité une révision et la perte de la couverture paresthésique ayant nécessité 4 révisions chez 4 patients. Deux patients ont présenté de nouveaux symptômes qui ont nécessité une intervention psychiatrique. Cinq patients n'ont pas éprouvé de bénéfice et leur dispositif a été retiré. Chez ceux dont le dispositif est encore en place, la proportion de la douleur préopératoire localisée à la région occipitale était de 0,62 ± 0,14, alors que chez les patients explantés, la proportion était de 0,31 ± 0,18 (t = 3,15; p = 0,01).

Conclusions:

Les taux de complications de la SO sont plus élevés que ceux observés avec d'autres techniques de stimulation, malgré un appareillage et une chirurgie similaires. La localisation de la douleur migraineuse prédisait le résultat thérapeutique, ce qui suggère que seulement ceux qui ont une céphalée principalement occipitale sont des candidats à ce traitement.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 6 , November 2012 , pp. 807 - 812
Copyright
Copyright © The Canadian Journal of Neurological 2012

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