Supraorbital Occipital Circumferential Stimulation (SOCS) for the Treatment of Refractory Chronic Primary Headache: A Case Series.

Supraorbital Occipital Circumferential Stimulation (SOCS) for the Treatment of Refractory Chronic Primary Headache: A Case Series.

World Neurosurg. 2019 Jan 02;:

Authors: Jiang JF, Diaz AN, Campbell M, Boulis NM, Keifer OP

Abstract
BACKGROUND: Patients with refractory chronic primary headache disorders have extremely debilitating symptoms, severe comorbidities (e.g. anxiety, depression), and a significant reduction in quality of life. The headaches are extremely difficult to treat, as they are often refractory to pharmacologic and procedural interventions. Neuromodulation with stimulation of the occipital and supraorbital nerves has been proposed as a viable treatment for these refractory headaches.
OBJECTIVE: We retrospectively review the long-term (33.5 ± 20 months) results of supraorbital occipital nerve circumferential stimulation (SOCS) in patients with chronic primary headache disorders.
METHODS: A retrospective review of 25 patients that were evaluated for SOCS for chronic primary headache disorders from 2010 to 2017 at a single institution with a single neurosurgeon.
RESULTS: Of these 25 patients, 14 saw benefit to their trial stage of stimulation and underwent full implantation. A total 3 patients were excluded from further analysis due to having <2 months of follow-up or discordant data. Of the 11 patients analyzed, there was an overall response rate (>=50% pain reduction) of 82%. The average preoperative 10-point pain score dropped from 7.1 ±1.6 to a postoperative score of 3.3 ±2.1. However, there was a high rate of complications including infection, erosion, and loss of effect.
CONCLUSION: The results (82% response) suggest that SOCS may be an effective treatment and should be studied more extensively. Occipital nerve stimulation alone has shown 40-50% response rate in published studies. However, the relatively high complication rate highlights an obstacle for the approach for the treatment of refractory headache disorders and room for device optimization.

PMID: 30610973 [PubMed - as supplied by publisher]

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