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Article Dans Une Revue Neurosurgery Année : 2021

Long-Term Efficacy of Occipital Nerve Stimulation for Medically Intractable Cluster Headache

Nadia Buisset
  • Fonction : Auteur
Bechir Jarraya
  • Fonction : Auteur
Sophie Colnat-Coulbois
François Caire
  • Fonction : Auteur
Philippe Rigoard
  • Fonction : Auteur
Laurie Tran
  • Fonction : Auteur
Coralie Cruzel
  • Fonction : Auteur
Michel Lantéri-Minet
  • Fonction : Auteur

Résumé

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.

Dates et versions

hal-04491837 , version 1 (06-03-2024)

Identifiants

Citer

Aurélie Leplus, Denys Fontaine, Anne Donnet, Jean Regis, Christian Lucas, et al.. Long-Term Efficacy of Occipital Nerve Stimulation for Medically Intractable Cluster Headache. Neurosurgery, 2021, 88 (2), pp.375-383. ⟨10.1093/neuros/nyaa373⟩. ⟨hal-04491837⟩
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