scholarly journals Occipital Nerve Stimulation for Chronic Migraine: A Randomized Trial

2012 ◽  
Vol 3;15 (3;5) ◽  
pp. 245-253 ◽  
Author(s):  
Dr. Gerardo Serra
Keyword(s):  
Quality Of Life ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Drug Intake ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Number Of Patients ◽  
One Year

Background: Chronic migraine (CM) and medication overuse headache (MOH) are disabling conditions that may be only partially managed with conservative treatments. Occipital nerve stimulation (ONS) is an innovative treatment for headache disorders. Objectives: To investigate the safety and efficacy of ONS for CM and MOH patients and to evaluate changes in disability, quality of life, and drug intake in implanted patients. Study Design: Prospective, randomized cross-over study. Methods: Eligible patients who responded to a stimulation trial underwent device implantation and were randomized to “Stimulation On” and “Stimulation Off” arms. Patients crossed over after one month, or when their headaches worsened. Stimulation was then switched On for all patients. Disability as measured by the Migraine Disability Assessment (MIDAS), quality of life (SF-36), and drug intake (patient’s diary) were assessed over a one-year follow-up. Results: Thirty-four patients (76% women, 34% men, mean age: 46 ± 11 years) were enrolled; 30 were randomized and 29 completed the study. Headache intensity and frequency were significantly lower in the On arm than in the Off arm (P < 0.05) and decreased from the baseline to each follow-up visit in all patients with Stimulation On (median MIDAS A and B scores: baseline = 70 and 8; one-year follow-up = 14 and 5, P < 0.001). Quality of life significantly improved (P < 0.05) during the study. Triptans and nonsteroidal anti-inflammatory drug use fell dramatically from the baseline (20 and 25.5 doses/month) to each follow-up visit (3 and 2 doses/month at one year, P < 0.001). A total of 5 adverse events occurred: 2 infections and 3 lead migrations. Limitations: Single-centre study, relatively small number of patients, absence of a control group. Conclusions: According to the results obtained, ONS appears to be a safe and effective treatment for carefully selected CM and MOH patients. Key words: Occipital nerve stimulation, chronic migraine, headache attacks, quality of life, cross-over

scholarly journals Occipital Nerve Stimulation for Refractory Chronic Migraine: Results of a Long-Term Prospective Study

2017 ◽  
Vol 1 (21;1) ◽  
pp. E151-E159 ◽  
Author(s):  
Dolores Rodrigo
Keyword(s):  
Surgical Technique ◽  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Occipital Nerve Stimulation ◽  
Open Label ◽  
Occipital Nerve ◽  
Refractory Chronic Migraine

Background: Refractory chronic migraine affects approximately 4% of the population worldwide and results in severe pain, lifestyle limitations, and decreased quality of life. Occipital nerve stimulation (ONS) refers to the electric stimulation of the distal branches of greater and lesser occipital nerves; the surgical technique has previously been described and has demonstrated efficacy in the treatment of a wide variety of headache disorders. Objectives: The aim of this study is to evaluate the long-term efficacy and tolerability of ONS for medically intractable chronic migraine. Study Design: Prospective, long-term, open-label, uncontrolled observational study. Setting: Single public university hospital. Methods: Patients who met the International Headache Society criteria for chronic migraine, all of them having been previously treated with other therapeutic alternatives, and who met all inclusion and exclusion criteria for neurostimulation, received the implantation of an ONS system after a positive psychological evaluation and a positive response to a preliminary occipital nerve blockage. The implantation was performed in 2 phases: a 10 day trial with implanted occipital leads connected to an external stimulator and, if more than 50% pain relief was obtained, permanent pulse generator implantation and connection to the previously implanted leads. After the surgery, the patients were thoroughly evaluated annually using different scales: pain Visual Analogue Scale (VAS), number of migraine attacks per month, sleep quality, functionality in social and labor activities, reduction in pain medication, patient satisfaction, tolerability, and reasons for termination. The average follow-up time was 9.4 ± 6.1 years, and 31 patients completed a 7-year follow-up period. Results: Thirty-seven patients were enrolled and classified according to the location and quality of their pain, accompanying symptoms, work status, and psychological effects. Substantial pain reduction was obtained in most patients, and the VAS decreased by 4.9 ± 2.0 points. These results remained stable over the followup period. Five of the 35 permanently implanted patients with migraine attacks at baseline were free from these attacks at their last visits, whereas the pain severity decreased 3.8 ± 2.5 (according to the VAS) in the remaining patients. Seven of the 35 permanent implanted devices were definitively removed: 2 devices because of treatment inefficacy, and 5 devices because the patients were asymptomatic and considered to be cured from their pain, even with the stimulation off. Systemic side effects were not observed. Limitations: Limitations of the current study include its uncontrolled and open-label design. Additionally, not all patients completed the 7-year follow-up period. Conclusions: We consider that the trigemino-cervical autonomous and cervical connection may explain why ONS might relieve chronic migraine pain, but this is just a theoretical explanation which should be demonstrated in future studies. The results achieved in this study suggest that ONS may provide longterm benefits for patients with medically intractable chronic migraine. These outcomes are slightly better than previous reports and were maintained over the 7-year follow-up. We believe that an accurate selection of patients, realization of diagnostic occipital nerve blocks, psychological evaluations, rigorous surgical technique, and appropriate parameter programming helped us achieve these outcomes. Key words: Refractory chronic migraine, headache, occipital nerve stimulatino, peripheral nerve stimulation, occipital nerve block

Combined occipital and supraorbital neurostimulation for the treatment of chronic migraine headaches: Initial experience

Cephalalgia ◽  
2009 ◽  
Vol 30 (3) ◽  
pp. 260-271 ◽  
Author(s):  
KL Reed ◽  
SB Black ◽  
CJ Banta ◽  
KR Will
Keyword(s):  
Chronic Migraine ◽  
Nerve Stimulation ◽  
Inadequate Response ◽  
Occipital Nerve Stimulation ◽  
Occipital Nerve ◽  
Supraorbital Nerve ◽  
Migraine Headaches ◽  
Novel Approach ◽  
Refractory Chronic Migraine

A novel approach to the treatment of chronic migraine headaches based on neurostimulation of both occipital and supraorbital nerves was developed and reduced to clinical practice in a series of patients with headaches unresponsive to currently available therapies. Following positive trials, seven patients with chronic migraine and refractory chronic migraine headaches had permanent combined occipital nerve–supraorbital nerve neurostimulation systems implanted. The relative responses to two stimulation programs were evaluated: one that stimulated only the occipital leads and one that stimulated both the occipital and supraorbital leads together. With follow-up ranging from 1 to 35 months all patients reported a full therapeutic response but only to combined supraorbital–occipital neurostimulation. Occipital nerve stimulation alone provided a markedly inferior and inadequate response. Combined occipital nerve–supraorbital nerve neurostimulation systems may provide effective treatment for patients with chronic migraine and refractory chronic migraine headaches. For patients with chronic migraine headaches the response to combined systems appears to be substantially better than occipital nerve stimulation alone.

Occipital nerve stimulation improves the quality of life in medically-intractable chronic cluster headache: Results of an observational prospective study

Cephalalgia ◽  
2016 ◽  
Vol 37 (12) ◽  
pp. 1173-1179 ◽  
Author(s):  
Denys Fontaine ◽  
Serge Blond ◽  
Christian Lucas ◽  
Jean Regis ◽  
Anne Donnet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cluster Headache ◽  
Nerve Stimulation ◽  
Health Related Quality ◽  
Occipital Nerve Stimulation ◽  
Attack Frequency ◽  
Related Quality ◽  
Health Related ◽  
One Year

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.

scholarly journals C-Arm Guided Percutaneous Radiofrequency Thoracic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis in Comparison with Local Botulinum Toxin Type A Injection, Randomized Trial

2019 ◽  
Vol 6 (22;6) ◽  
pp. 591-599
Author(s):  
Tarek A.H. Mostafa
Keyword(s):  
Quality Of Life ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Palmar Hyperhidrosis ◽  
Rf Ablation ◽  
Number Of Patients ◽  
Significant Difference ◽  
One Year

Background: Hyperhidrosis is a disorder associated with detrimental effects on patients’ quality of life, occupational activities, and social interactions. Objectives: This study compares C-arm guided percutaneous radiofrequency (RF) ablation of the second and third thoracic sympathetic ganglions and local intradermal botulinum toxin type A (BTX-A) injection for the treatment of primary palmar hyperhidrosis. It focuses on clinical effectiveness, patient satisfaction, quality of life, safety, and the time at which repetition of the procedure is needed over one-year follow-up. Study Design: This is a randomized single-blinded trial. Setting: This study took place in a single hospital. Methods: Eighty patients with primary palmar hyperhidrosis were randomly assigned to one of 2 interventions: local intradermal BTX-A injection (n = 40) or C-arm guided percutaneous RF ablation (n = 40). The Dermatology Life Quality Index (DLQI) questionnaire and the Hyperhidrosis Disease Severity Scale (HDSS) were used for assessment at one week, one month, and 2, 6, and 12 months after intervention. The number of patients who required repetition of the procedure later on and the time at which they needed it were recorded, and possible side effects were assessed. Results: HDSS scores in the RF group were statistically significantly lower than in the BTX-A group at one week, one month, and 2, 6, and 12 months of follow-up. DLQI scores in the RF group were statistically significantly lower than in the BTX-A group at 6- and 12-month follow-up, whereas at one week, one month, and 2 months of follow-up, there was no statistically significant difference between both groups. The number of patients who required that the procedure be repeated was statistically significantly lower in the RF group than in the BTX-A group. The time at which patients needed repetition of the procedure in the BTX-A group was about 3 to 7 months after the first intervention. All patients in this group showed an increase in HDSS scores within this one-year followup. In the RF group, however, only one patient complained of increased HDSS scores after 8 months. There was no statistically significant difference in side effects between both groups. Limitations: The first limitation of this study is that results were based on subjective scales. The second is the radiation exposure associated with the technique described. Conclusions: This study supports percutaneous C-arm guided RF ablation of the second and third thoracic sympathetic ganglions and local intradermal BTX-A injection as safe, effective options and rapid lines of treatment of primary palmar hyperhidrosis. However, percutaneous RF ablation proved to be more effective, with longer effectiveness time and better patient satisfaction, compared to local intradermal BTX-A injection.

scholarly journals Fear of Falling, Recurrence of Falls, and Quality of Life in Patients with a Low Energy Fracture—Part II of an Observational Study

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 584
Author(s):  
Puck C. R. van der Vet ◽  
Jip Q. Kusen ◽  
Manuela Rohner-Spengler ◽  
Björn-Christian Link ◽  
Roderick M. Houwert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Low Energy ◽  
Activity Levels ◽  
Activity Restriction ◽  
One Year ◽  
Falls In Elderly

Background and objective: Falls in elderly cause injury, mortality, and loss of independence, making Fear of Falling (FoF) a common health problem. FoF relates to activity restriction and increased fall risk. A voluntary intervention including fall risk assessment and prevention strategies was implemented to reduce falls in elderly patients with low energy fractures (LEF). The primary purpose of this study was to evaluate FoF and the number of subsequent falls in trauma patients one year after a LEF. The secondary aim was to examine how FoF affects patients’ lives in terms of Quality of Life (QoL), mobility, and activity levels. Finally, participation in the voluntary fall prevention program (FPP) was evaluated. Materials and Methods: Observational cohort study in one Swiss trauma center. LEF patients, treated between 2012 and 2015, were analyzed one year after injury. Primary outcomes were Falls-Efficacy Score-International (FES-I) and number of subsequent falls. Secondary outcomes were EuroQoL-5-Dimensions-3-Levels (EQ5D-3L), mobility, activity levels, and participation in the FPP. Subgroup analysis was performed for different age categories. Results: 411 patients were included for analysis. Mean age was 72 ± 9.3, mean FES-I was 21.1 ± 7.7. Forty percent experienced FoF. A significant negative correlation between FoF and QoL (R = 0.64; p < 0.001) was found. High FoF correlated with lower activity levels (R= −0.288; p < 0.001). Six percent visited the FPP. Conclusions: At follow-up, 40% suffered from FoF which seems to negatively affect patients’ QoL. Nevertheless, participation in the FPP was low. Simply informing patients about their susceptibility to falls and recommending participation in FPPs seems insufficient to motivate and recruit patients into FPPs. We suggest implementing repeated fall risk- and FoF screenings as standard procedures in the follow-up of LEF, especially in patients aged over 75 years.

scholarly journals Task-oriented exercises improve disability of working patients with surgically-treated proximal humeral fractures. A randomized controlled trial with one-year follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marco Monticone ◽  
Igor Portoghese ◽  
Daniele Cazzaniga ◽  
Valentina Liquori ◽  
Giuseppe Marongiu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Group Differences ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
One Year ◽  
Task Oriented

Abstract Background General physiotherapy is a common means of rehabilitation after surgery for proximal humeral fracture (PHF). Better-targeted exercises seem worthy of investigation and the aim of this study was to assess the efficacy of a rehabilitation program including task-oriented exercises in improving disability, pain, and quality of life in patients after a PHF. Methods By means of a randomized controlled trial with one-year follow-up, 70 working patients (mean age of 49 ± 11 years; 41 females), who were selected for open reduction and internal fixation with plates caused by PHF, were randomized to be included in an experimental (n = 35) or control group (n = 35). There was a permuted-block randomization plan, and a list of program codes was previously created; subsequently, an automatic assignment system was used to conceal the allocation. The first group underwent a supervised rehabilitation program of task-oriented exercises based on patients’ specific job activities, and occupational therapy. The second group underwent general physiotherapy, including supervised mobility, strengthening and stretching exercises. Both groups individually followed programs of 60-min session three times per week for 12 weeks in the outpatient setting. The Disability Arm Shoulder Hand questionnaire (DASH; scores range from 0 to 100; primary outcome), a Pain intensity Numerical Rating Scale (scores range 0 to 10; secondary outcomes), and the Short-Form Health Survey (scores range from 0 to 100; secondary outcomes) assessed the interventions. Participants were evaluated before surgery, before and after rehabilitation (primary endpoint), and at the one-year follow-up (secondary endpoint). A linear mixed model analysis for repeated measures was carried out for each outcome measure (p < 0.05). Results Time, group and time by group showed significant effects for all outcome measures in favour of the experimental group. The DASH and the DASH work achieved clinically important between-group differences of 16.0 points (95% confidence interval [C.I.] 7.3 to 24.7) and 19.7 (95% C.I. 9.0 to 30.5) at follow-up, respectively. The NRS achieved a between-group difference of 2.9 (95% C.I. 1.0 to 3.9) at follow-up. As for SF-36, there were between-group differences ranging from 17.9 to 37.0 at follow-up. Conclusions A rehabilitation program based on task-oriented exercises was useful in improving disability, pain, and quality of life in working patients after PHFs. Improvements lasted for at least 12 months. Trial registration On 16/12/2019, the trial was retrospectively registered in the ISRCTN registry with the ID number 17996552.

scholarly journals 357 Factors associated with changes in health-related quality of life in children with cystic fibrosis during one-year follow-up

2017 ◽  
Vol 16 ◽  
pp. S154
Author(s):  
M. Van Horck ◽  
B. Winkens ◽  
G. Wesseling ◽  
K. de Winter-de Groot ◽  
I. De Vreede ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Health Related Quality ◽  
Factors Associated ◽  
Related Quality ◽  
Health Related ◽  
One Year

Seurantatutkimus erikoissairaanhoidon kuntoutustutkimuspotilaiden työmarkkinatilanteesta, elämänlaadusta sekä koetusta työ- ja toimintakyvystä

Kuntoutus ◽  
2021 ◽  
Vol 44 (4) ◽  
pp. 5-17
Author(s):  
Minna Savinainen ◽  
Elina Lindgren ◽  
Hannu Heikkilä
Keyword(s):  
Quality Of Life ◽  
Labor Market ◽  
Work Ability ◽  
Market Situation ◽  
Perceived Work Ability ◽  
Professional Assessment ◽  
Sickness Benefits ◽  
One Year

Työurien pidentämisessä ja työhön osallistumisen lisäämisessä oleellista on tukea myös osatyökykyisten henkilöiden työhön kiinnittymistä ja työssä jatkamista. Tutkimuksen tavoitteena oli selvittää erikoissairaanhoidon kuntoutustutkimuspotilaiden (N = 238) työmarkkinatilanteen, sairausetuuksien käytön, elämänlaadun sekä työ- ja toimintakyvyn muutoksia vuoden kuluttua kuntoutustutkimuksesta. Kuntoutustutkimuksessa olleiden osallistuminen työmarkkinoille sekä ammatilliseen kuntoutukseen lisääntyi ja samalla sairausetuuksien käyttö väheni. Potilaiden elämänlaatu, koettu terveys ja työkyky sekä itsestä huolehtiminen paranivat. Vastaavasti kognitiivinen ja fyysinen toimintakyky sekä osallisuus heikkenivät. Systemaattisella ja moniammatillisella työ- ja toimintakyvyn arvioinnilla voidaan saavuttaa vaikuttavia suunnitelmia työllistymisen edistämiseksi. Abstract Follow-up study on the labor market situation, quality of life and perceived work ability and functioning of patients of a rehabilitation outpatient clinicIn order to prolong working careers and increase participation in work, it is also important to support the attachment and continuation of people with partial ability to work. The aim of the study was to find out the changes in the labor market situation, the use of sick leave, quality of life, and work ability and functioning of the outpatient clinic of the Department of Physical Medicine and Rehabilitation (N=238) during one-year follow-up. Participation in the labor market and vocational rehabilitation of those who participated in rehabilitation increased, and at the same time the use of sickness benefits decreased. Patients’ quality of life, perceived health and work ability, and self-care improved. Correspondingly, cognitive and physical functioning as well as inclusion were impaired. Systematic and multi-professional assessment of work ability and functioning can lead to effective plans to promote employment. Keywords: rehabilitation, employment status, quality of life, work ability, functioning

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