RESUMO
We prospectively followed a cohort of 26 subjects for an average period of 41 months who benefited from occipital nerve stimulation (ONS) in the context of chronic refractory headaches. In 17 patients treated, the frequency of headache decreased, and quality of life scores improved significantly. Among these patients, the "very good" response rate was 34 %. In this cohort, treatment-related adverse events are relatively common (42 %) but not severe. While it is difficult to anticipate the risk factors for non-response to treatment, we estimate that the risk of failure may not be related to the duration of the disease, but rather to the number of different preventives attempted prior to ONS.
Nous avons suivi prospectivement durant une période d'en moyenne 41 mois une cohorte de 26 patients romands qui ont bénéficié d'une stimulation du nerf occipital (ONS) dans le cadre de céphalées chroniques réfractaires. Chez 17 patients non explantés, la fréquence des céphalées a diminué et les scores de qualité de vie se sont améliorés de façon significative. Parmi ces patients, le taux de « très bonne ¼ réponse est de 34 %. On constate dans cette cohorte que les effets indésirables liés au traitement sont relativement courants (42 %) mais non sévères. Même s'il est difficile d'anticiper les facteurs de risque de non-réponse au traitement, nous estimons que la probabilité d'échec ne serait pas corrélée à la durée de la maladie mais plutôt au nombre de traitements préventifs tentés avant l'ONS.
Assuntos
Terapia por Estimulação Elétrica , Transtornos da Cefaleia , Cefaleia/terapia , Transtornos da Cefaleia/terapia , Humanos , Qualidade de Vida , Resultado do TratamentoRESUMO
Background Occipital nerve stimulation (ONS) has been proposed to treat chronic medically-intractable cluster headache (iCCH) in small series of cases without evaluation of its functional and emotional impacts. Methods We report the multidimensional outcome of a large observational study of iCCH patients, treated by ONS within a nationwide multidisciplinary network ( https://clinicaltrials.gov NCT01842763), with a one-year follow-up. Prospective evaluation was performed before surgery, then three and 12 months after. Results One year after ONS, the attack frequency per week was decreased >30% in 64% and >50% in 59% of the 44 patients. Mean (Standard Deviation) weekly attack frequency decreased from 21.5 (16.3) to 10.7 (13.8) ( p = 0.0002). About 70% of the patients responded to ONS, 47.8% being excellent responders. Prophylactic treatments could be decreased in 40% of patients. Functional (HIT-6 and MIDAS scales) and emotional (HAD scale) impacts were significantly improved, as well as the health-related quality of life (EQ-5D). The mean (SD) EQ-5D visual analogic scale score increased from 35.2 (23.6) to 51.9 (25.7) ( p = 0.0037). Surgical minor complications were observed in 33% of the patients. Conclusion ONS significantly reduced the attack frequency per week, as well as the functional and emotional headache impacts in iCCH patients, and dramatically improved the health-related quality of life of responders.