Occipital Nerve Stimulation Decreases Attack Frequency Of In
A study was conducted by a group of researchers from the Netherlands, to demonstrate if occipital nerve stimulation could prove to be an efficient treatment for patients with medically intractable chronic cluster headache.

The researchers conducted a controlled clinical trial at a total of six hospitals, four hospitals in the Netherlands, one hospital in Belgium, one in Germany, and one in Hungary. After 12 weeks' baseline observation, a total of 150 patients were enrolled with a history of being non-responsive to at least three standard preventive drugs between October 12, 2010, to December 3, 2017.

They were randomly allocated to treatment 131 (87%) to treatment for 24 weeks; out of which 65 (50%) patients were assigned to 100% Occipital nerve stimulation and 66 (50%) were assigned to 30% Occipital nerve stimulation. One of the 66 patients assigned to 30% ONS was not implanted and was therefore excluded from the intention-to-treat analysis. As occipital nerve stimulation causes paraesthesia, preventing masked comparison versus placebo, they compared high-intensity versus low-intensity occipital nerve stimulation, which is hypothesized to cause similar paraesthesia, but with different efficacy.

The primary outcome was the weekly mean attack frequency in weeks 21-24 compared with baseline across all patients and if a decrease was shown, to show a group-wise difference. The findings of the study are as follows:

· Median weekly mean attack frequencies in the total population decreased from baseline to 7·38) in 21-24 weeks, with a median change of -5·21 attacks per week.

· In the 100% occipital nerve stimulation group, mean attack frequency decreased from 17·58 at baseline to 9·50 at 21-24 weeks.

· While in the 30% occipital nerve stimulation group, mean attack frequency decreased from 15·00 to 6·75.

· The difference in median weekly mean attack the frequency between groups at the end of the masked phase in weeks 21-24 was -2·42.

· In the masked study phase, adverse events occurred more in the 100% occipital nerve stimulation group (n=129) as compared to 30% occipital nerve stimulation group (n=95).

· The most common adverse events were local pain, impaired wound healing, neck stiffness, and hardware damage.

· All the adverse events were expected but 17 with 100% occipital nerve stimulation group and 8 with 30% occipital nerve stimulation group were labeled as serious, as they required hospitalization.

Thus, the researchers concluded that both 100% and 30% occipital nerve stimulation substantially reduced attack frequency and were safe as well as well-tolerated. Hence, future studies should focus on optimizing stimulation protocols and disentangling the underlying mechanism of action.

Source:
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(21)00101-0/fulltext
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