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Fortschr Neurol Psychiatr 2010; 78(12): 709-714
DOI: 10.1055/s-0029-1245599
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Beidseitige Nervus-occipitalis-Stimulation zur Behandlung des therapierefraktären chronischen Cluster-Kopfschmerzes: eigene Fallserie und Initiierung einer prospektiven Studie

Bilateral Occipital Nerve Stimulation for the Treatment of Chronic Cluster Headache: Case Series and Initiation of a Prospective StudyO. M. Müller1 [*] , C. Gaul2 [*] , Z. Katsarava2 , U. Sure1 , H.-C. Diener2 , T. Gasser1
  • 1Neurochirurgie, Universitätsklinikum Essen
  • 2Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen
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Publication Date:
06 December 2010 (online)

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Zusammenfassung

Hintergrund: Der chronische Cluster-Kopfschmerz (CCH) stellt für die Betroffenen eine enorme physische, psychische und soziale Belastung und für die behandelnden Ärzte eine therapeutische Herausforderung dar. Da ein Teil der Patienten durch ihre Medikation keine adäquate Schmerzlinderung und durch Prophylaxe keine ausreichende Attackenreduktion erfahren, muss nach Therapiealternativen gesucht werden. Methoden: In Essen wurden seit Dezember 2008 sieben Patienten mit CCH durch eine beidseitige Stimulation des Nervus occipitalis (NOS) behandelt. Die Implantation der Stimulationselektroden und Einstellung der Reizparameter erfolgte standardisiert. Das Follow-up beträgt bisher 6 – 12 Monate. Ergebnisse: Alle Patienten profitierten von der Operation. Die Attackenintensität reduzierte sich im Median um die Hälfte bei gleichzeitiger Reduktion der Akutmedikation um durchschnittlich 77 %. Die medikamentöse Dauertherapie wurde bei einem Teil der Patienten reduziert. Im SF-36 zeigten alle Patienten eine Verbesserung ihrer Lebensqualität. 6 Patienten würden die Operation uneingeschränkt weiterempfehlen. Schlussfolgerung: Die beidseitige Stimulation des Nervus occipitalis ist eine vielversprechende Therapieform für den CCH. Da der Wirkmechanismus sowie die optimalen Stimulationsparameter noch unklar sind, sind weitere Untersuchungen zur Optimierung des Verfahrens erforderlich. In Essen werden seit Oktober 2009 Patienten mit CCH zu diesem Zweck in eine prospektive Studie eingeschlossen.

Abstract

Background: The chronic cluster headache (CCH) is a disabling disorder for every patient. Treatment is a challenging situation for the physician. Some patients will not experience adaequate resolution of their cluster attacks by medication and the prophylaxis does not reduce the attacks sufficiently. Therefore, other treatment options have to be found. Methods: Since December 2008 seven patients with CCH have been treated by bilateral occipital nerve stimulation (ONS) at the University Hospital Essen. Implantation of the electrodes and stimulation paradigms were standardised. The maximum follow-up to date is 12 months. Results: ONS was successfully employed in all patients. The intensity of the attacks decreased by 50 %. The consumption of attack medication was reduced by 77 % on average. Some patients could reduce their medication prophylaxis. A tendency towards improved quality of life was seen in all patients by means of a standardised questionaire (SF-36). One generator had to be exchanged due to infection. Scar formations required reoperation and adhesiolysis of the thoracic connector in another patient. 6 out of 7 patients would fully recommend the operation. Conclusion: Bilateral ONS is a promising treatment for CCH, with a low risk profile in our experience. Further studies have to be conducted to clarify the mechanism of the stimulation and optimal parameters of ONS. For this particular reason, patients with CCH have been included in a prospective study since October 2009.

Schlüsselwörter

chronischer Cluster-Kopfschmerz - Nervus-occipitalis-Stimulation - Neuromodulation

Keywords

chronic cluster headache - occipital nerve stimulation - neuromodulation

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1 gleichberechtigte Autoren.

Dr. Oliver Marcus Müller

Neurochirurgie Universitätsklinikum Essen

Hufelandstr. 55

45147 Essen

Email: oliver.mueller@uk-essen.de