Cyberonics reneged on its "Lifetime Reimbursement Guarantee". Click on the image to learn how you can help...
Showing posts with label migraine. Show all posts
Showing posts with label migraine. Show all posts

Friday, March 14, 2014

Effect of noninvasive vagus nerve stimulation on acute migraine: An open-label pilot study.

Cephalalgia. 2014 Mar 7. [Epub ahead of print]

Effect of noninvasive vagus nerve stimulation on acute migraine: An open-label pilot study.

Goadsby P1, Grosberg B, Mauskop A, Cady R, Simmons K.

Author information
Abstract
BACKGROUND:

We sought to assess a novel, noninvasive, portable vagal nerve stimulator (nVNS) for acute treatment of migraine.

METHODS:

Participants with migraine with or without aura were eligible for an open-label, single-arm, multiple-attack study. Up to four migraine attacks were treated with two 90-second doses, at 15-minute intervals delivered to the right cervical branch of the vagus nerve within a six-week time period. Subjects were asked to self-treat at moderate or severe pain, or after 20 minutes of mild pain.

RESULTS:

Of 30 enrolled patients (25 females, five males, median age 39), two treated no attacks, and one treated aura only, leaving a Full Analysis Set of 27 treating 80 attacks with pain. An adverse event was reported in 13 patients, notably: neck twitching ( N  = 1), raspy voice ( N  = 1) and redness at the device site ( N  = 1). No unanticipated, serious or severe adverse events were reported. The pain-free rate at two hours was four of 19 (21%) for the first treated attack with a moderate or severe headache at baseline. For all moderate or severe attacks at baseline, the pain-free rate was 12/54 (22%).

CONCLUSIONS:

nVNS may be an effective and well-tolerated acute treatment for migraine in certain patients.

KEYWORDS:

Migraine, acute treatment, neuromodulation, vagus nerve

PMID:
24607501
[PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/24607501

Thursday, March 13, 2014

Clinical study in international headache journal finds electroCore’s non invasive vagus nerve stimulation effective in treating migraine

Clinical study in international headache journal finds electroCore’s non invasive vagus nerve stimulation effective in treating migraine

 

BusinessWire · Mar. 13, 2014 | Last Updated: Mar. 13, 2014 10:54 AM ET

A study reported (13TH March 2014) in the International Headache Society’s official journal Cephalalgia found that the use of electroCore’s non invasive vagus nerve stimulation therapy (nVNS) may be an effective and well tolerated treatment for migraine in certain patients.

The open label study, which was led by Professor Goadsby, was carried out by the University of California, San Francisco and at four other sites in the US involving 30 patients.

Of the 30 enrolled patients 27 used the nVNS therapy to treat a total of 80 migraine attacks. Patients with moderate or severe headache attacks reported pain freedom or relief in, twenty-three out of fifty-four attacks (43 %). This included twelve out of fifty-four attacks where the patients reported being pain free at two hours after treatment (22 %). Additionally, in ten of twenty-six attacks when the patient treated while the pain was mild the patients reported being pain free at two hours (38 %). No unanticipated, serious or severe adverse events were reported and the paper stated that nVNS seems much better tolerated than the more potent triptans and does not have comparable cardiovascular or cerebrovascular concerns.

The study also found that certain patients responded positively on a consistent basis. Of eighteen patients who treated at least three attacks six were pain free on 2/3 occasions (33 %).

JP Errico CEO and founder of electroCore commented. “We are delighted to see that this easy to use treatment was found to be effective in a substantial number of patients for this debilitating and painful condition. The authors of this report noted the need for further placebo controlled trials and we are presently carrying out four double blind randomized controlled studies in the US and Europe which will read out in the second half of this year”

ElectroCore's proprietary, non invasive electrical stimulation therapy works by activating specific fibers in the vagus nerve bundle. This activation causes the release of inhibitory neurotransmitters within the central nervous system, and reduces the over expression of the excitatory neurotransmitter glutamate, which has been implicated in a number of different disorders.

Patients self treat by holding the device on their neck over the vagus nerve for two minutes. All patients are trained in the use of the device to ensure they place it correctly and they use the appropriate setting.

The great benefit of this therapy is that it is very safe. Surgically implanted VNS has been in use for more than 20 years in over a 100,000 patients without any side effects. It can also be used in conjunction with other medications as the chemicals it produces are endogenous and contained within the central nervous system.

Authors; J. Goadsby, B. M. Grosberg, A. Mauskop, R. Cadyand K.A. Simmons

Contacts

Vane Percy & Roberts for ElectroCore
Simon Vane Percy
+44-(0)-1737-821890
simon@vanepercy.com

http://www.nationalpost.com/markets/news/Clinical+study+international+headache+journal+finds+electroCore+invasive/9613205/story.html

Friday, December 20, 2013

Cerena TMS gets FDA Clearance for Migraine Treatment

Cerena TMS gets FDA Clearance for Migraine Treatment

Contract Manufacturing, Industry News, Design, Components, Devices

FDA allows marketing of the first device to relieve migraine headache pain.

December 19, 2013

The U.S. Food and Drug Administration has allowed marketing of the Cerena Transcranial Magnetic Stimulator (TMS), by eNeura Therapeutics, the first device to relieve pain caused by migraine headaches that are preceded by an aura: a visual, sensory or motor disturbance immediately preceding the onset of a migraine attack.

Migraine headaches are characterized by intense pulsing or throbbing pain in one area of the head accompanied by nausea and/or vomiting and sensitivity to light and sound. A migraine can last anywhere between 4 hours and 72 hours when untreated. These debilitating headaches affect approximately 10% of people worldwide and are three times more common in women than in men. About one third of people with migraines experience an aura.

“Millions of people suffer from migraines and this new device represents a new treatment option for some patients,” said Christy Foreman, director of the Office of Device Evaluation in the FDA’s Center for Devices and Radiological Health.

The Cerena TMS is a prescription device used after the onset of pain associated with migraine headaches preceded by an aura. Using both hands to hold the device against the back of the head, the user presses a button to release a pulse of magnetic energy to stimulate the occipital cortex in the brain, which may stop or lessen the pain associated with migraine headaches preceded by an aura.

The FDA reviewed the data for the Cerena TMS through the de novo premarket review pathway, a regulatory pathway for some low- to moderate-risk medical devices that are not substantially equivalent to an already legally marketed device.

The FDA reviewed a randomized control clinical trial of 201 patients who had mostly moderate to strong migraine headaches and who had auras preceding at least 30% of their migraines. Of the study subjects, 113 recorded treating a migraine at least once when pain was present. Analysis of these 113 subjects was used to support marketing authorization of the Cerena TMS for the acute treatment of pain associated with migraine headache with aura.

The study showed that nearly 38% of subjects who used the Cerena TMS when they had migraine pain were pain-free two hours after using the device compared to about 17% of patients in the control group. After 24 hours, nearly 34% of the Cerena TMS users were pain-free compared to 10% in the control group.

The study did not show that the Cerena TMS is effective in relieving the associated symptoms of migraine, such as sensitivity to light, sensitivity to sound, and nausea. The device is for use in people 18 years of age and older. The study did not evaluate the device’s performance when treating types of headaches other than migraine headaches preceded by an aura.

Adverse events reported during the study were rare for both the device and the control groups but included single reports of sinusitis, aphasia (inability to speak or understand language) and vertigo (sensation of spinning). Dizziness may be associated with the use of the device.

Patients must not use the Cerena TMS device if they have metals in the head, neck, or upper body that are attracted by a magnet, or if they have an active implanted medical device such as a pacemaker or deep brain stimulator. The Cerena TMS device should not be used in patients with suspected or diagnosed epilepsy or a personal or family history of seizures. The recommended daily usage of the device is not to exceed one treatment in 24 hours.

http://www.onlinetmd.com/cerena-transcranial-magnetic-stimulator-medical-device-121913.aspx

Wednesday, July 10, 2013

[Vagus nerve stimulation in patients with migraine].

Rev Neurol. 2013 Jul 16;57(2):57-63.

[Vagus nerve stimulation in patients with migraine].

[Article in Spanish]

Mosqueira AJ, Lopez-Manzanares L, Canneti B, Barroso A, Garcia-Navarrete E, Valdivia A, Vivancos J.

Source

Hospital Universitario de la Princesa, 28006 Madrid, Espana.

Abstract

in English

INTRODUCTION. Vagus nerve stimulation (VNS) has been approved for the treatment of refractory epilepsy when resective surgery is not possible, and has proved to be highly effective. Series published in the literature suggest a beneficial effect of VNS in the treatment of migraine. AIMS. To determine the degree to which headaches improve in patients with migraine after the placement of VNS to treat refractory epilepsy, and to evaluate what variables are associated with an increased chance of success with this measure. PATIENTS AND METHODS. An observation-based retrospective study was conducted from 1st January 1999 until 31st December 2010. Patients with VNS for refractory epilepsy were contacted by telephone, after selecting those who fulfilled International Headache Society criteria for migraine. Data collected included age, gender, year of placement, age at onset of epilepsy and migraine, improvement of seizures and migraine, presence of migraine with aura and coexistence of anxious-depressive syndrome. Ninety-four patients with VNS were contacted and 13 patients with migraine were selected. RESULTS. Following placement of the VNS, the number of episodes of migraine was seen to decrease by at least 50% in nine patients (69%) (p = 0.004) and there was a drop in the number of episodes of migraine in those patients who had also reduced their epileptic seizures (p = 0.012). No statistically significant associations were observed as regards sex, age, length of disease history, existence of migraine with aura or coexistence of anxious-depressive syndrome. CONCLUSIONS. VNS could have beneficial effects for patients with migraine, especially in cases that are difficult to control. Due to the type of study, these conclusions must be taken with caution. Prospective clinical studies are needed before introducing the technique into daily clinical practice.

PMID:
23836335
[PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/23836335

Related citations in PubMed

See reviews...See all...

Monday, July 8, 2013

Inside the incredible mind of a savant

Inside the incredible mind of a savant

Date
July 8, 2013
 
Melissa Davey
Melissa Davey
Health Reporter
Orlando Serrell.

Orlando Serrell.

When a baseball smashed into the side of Orlando Serrell's head as he made a frantic dash to first base, the then 10-year-old fell to the ground and stayed there, for several minutes.

Once he slipped out of his daze, he climbed to his feet and, with a splitting headache, continued to play the game. He did not tell his parents about the accident, so did not receive medical treatment, despite a headache that would persist for months.

Serrell had become what the scientific and medical worlds refer to as an acquired savant: someone who is perfectly ordinary until an injury to the brain, after which they possess a remarkable ability.

Serrell, from the US, was an ordinary child before he received that blow to the head on a Virginia baseball field in 1979. But one year later, when the headaches had cleared, it dawned on Serrell that he had been left with an uncanny side effect, one that has stayed with him. He could perform complex calendrical calculations in his head with dizzying speed and complete accuracy. The number of days between two dates, the number of times January 6 has fallen on a Saturday - Serrell could answer questions such as these in his head, and in an instant.

Professor Allan Snyder, Director Centre for the Mind.

Professor Allan Snyder, Director Centre for the Mind. Photo: Steve Baccon

Since the accident, he remembers things in minute detail - the outfit a friend wore on a certain day years ago, the number plate of each car that has crossed his path, his every meal.

Advertisement

Serrell had become what the scientific and medical worlds refer to as an acquired savant: someone who is perfectly ordinary until an injury to the brain, after which they possess a remarkable ability, such as a photographic memory, a talent for a musical instrument despite no prior training, a sudden propensity for complex mathematical equations, the ability to sculpt or draw scale replicas of objects they've only glimpsed. Brain damage, usually to the left hemisphere, unlocks something in their brains as the right hemisphere compensates for the injury. The result is, very rarely, great skill, unfathomable to the ordinary person.

Not all savants acquire their skill - some are born with these abilities and are known as ''classical savants''. They usually fall somewhere on the autism spectrum and their skills tend to appear in early childhood. Classical savants may have great difficulty carrying out seemingly ordinary tasks such as social interaction or tying shoelaces, but despite this, possess remarkable talent in a specific area.

But what if these skills could be unlocked in ordinary people without having to inflict damage to the brain? Founder of the Centre for the Mind at the University of Sydney, Dr Allan Snyder, a neuropsychologist, is working to unlock extraordinary potential in ordinary minds. It is an area he has been investigating since the early 1990s.

''I had a radical idea that these skills must be latent within everyone,'' Snyder says. ''It's just that unlike savants, we don't have access to them.

''I thought maybe I could release it myself by decreasing the influence of the left brain hemisphere and enhancing the right.''

Savants are exceedingly rare, and Snyder says he is unaware of any acquired savants living in Australia. While estimates vary, it is thought about 10 per cent of the autistic population possess savant abilities, compared with less than 1 per cent of the rest of the population. Male savants outnumber females by about 6:1. Savants have a range of abilities. Some can speak dozens of languages, learning them at a rapid pace. Others are exceptional painters, sculptors and drawers. Many have memory skills that allow them to memorise telephone books. Their skills seem so remarkable because they would take years to learn, or seem impossible, for an ordinary person.

''I was inspired by the fact that music, art, mathematics and even memory are taken by many to be an exceptional ability in humans requiring laborious hours of study and training,'' Snyder says.

''And yet here, we have a group of people without a bigger or better brain than we do, just a different one, able to do these things.''

Snyder's first attempts to bring out the latent savant skills in his subjects were ''not so successful''. He and his researchers used magnetic pulses on participants' brains to temporarily make the area underneath the pulses less inhibited; in other words, simulating a lesion or damage.

''That was our first experiment,'' Snyder says. ''The results were good, but not brilliant. They were constant, but not enormous, people didn't suddenly show any enormous savant skills.''

Then, he turned to transcranial direct-current stimulation, where non-invasive and weak electrical currents are applied to the brain. It is considered safe, and is used as a treatment for conditions such as migraines and depression. Using this method, Snyder can make the networks of neurons near the surface of the brain less likely to fire. An electrode is placed on each side of the heads, over the anterior temporal lobes just above the ears.

A weak electric current then passes between the electrodes. The dose given, Snyder says, changes the behaviour of the underlying neurons in participants for about an hour. His experiments have shown during that 60-minute window that people are able to solve arithmetic problems that would ordinarily stump them.

During one experiment, 33 participants were asked to solve the notoriously difficult nine-dots problem, the goal being to connect all nine dots in a square formation using four straight lines, without lifting pen from paper. In the laboratory, Dr Snyder says, about 5 per cent of participants manage to solve it, even with hints and added time. In his experiment group, no participant could solve it. After receiving the stimulation, however, 14 of them cracked it. Snyder and his researchers calculated that the probability they had gone on to solve it by chance was less than one in a billion. The results were published in the journal Neuroscience Letters last year.

''We go through a rigorous scientific protocol to separate placebo affects from real affects,'' Snyder says. ''I'm really very confident there's no way this ability could be due to any other affects other than the stimulation.''

What had stopped participants from solving the problem initially was that people have rigid mindsets, researchers suspect, which make them less receptive and even resistant to novel interpretations and ideas. In a piece he wrote for Scientific American last November, Snyder describes prior learning and experience as shaping the way we see the world and allowing for mental short cuts. While these mental filters mean our minds are more conceptual, the savant mind, Snyder says, is more literal, their mental filters less powerful. As an example, he describes a savant who, when asked about the ending of a book, recited the last page word for word.

''We look at the world through filters, through our mindsets, which are carefully evolved to be able to manoeuvre rapidly in our world,'' Snyder says.

''We see the forest, not the trees. Savants see the trees, not the forest. It's why savants do very badly in tests where you ask them things like, 'What does it mean by the grass is always greener on the other side?' They want to interpret it literally.''

Genius is a word that gets used a lot when describing savants. To acquire an injury one day and be able to play the piano, or draw scale replicas of buildings seen only once the next is, in fact, extraordinary. But Snyder wonders if the word genius is quite right to describe these skills.

''Our brains are deliberately designed not to have access to peculiar skills, which in some instances are advantageous but mostly are bizarre,'' he says.

''The classical image of a savant, to me, is a person who has an ability to mimic things extraordinarily quickly and with detail. But a memory for licence plates, or knowing what dates a Saturday falls on - what kind of memory is that? It is a memory without meaning.

''We have the same memory power as savants do, their brains aren't bigger or better than ours. It's just more of our memory is devoted to conceptual detail, and more of theirs is devoted to literal details.''

So what would be the point of bringing these latent skills out in ordinary people, and finding a way of doing so that doesn't injure, but merely suppresses, neurons in the left hemisphere of the brain? Snyder refers to the nine-dots problem again. It was only when participants had their pre-existing prejudices dampened that they were able to solve the difficult task by coming at it in a different way. Imagine the seemingly impossible problems that could be solved and the different ways of seeing the world there could be, Snyder says, if we could break down these prejudices in everyone. Even just temporarily.

''Opening the doors of perception to be able to look at the world without prejudice, just for a moment, would be of enormous value,'' Snyder says. ''This technology we have, and the interaction between technology and the mind - if this could be perfected, then perhaps problems like nine dots are just the tip of the iceberg.''

The uniqueness of savants is what makes them so fascinating, and Snyder hopes that someday anyone will have access to the kind of technology he is experimenting with.

But if savant-like skills become something that could be induced in anyone, would it be unfair? Would it take the intrigue away from skills once seen as unique and unfathomable?

On this point, Snyder is focused firmly on the greater good. ''If I gave you a pill to increase intellectual ability, would you think it was cheating if you got a Nobel prize for curing cancer as a result of taking that pill?''

Beautiful minds

Alonzo Clemons

Colorado, US

A brain injury when he was a child left Clemons with an IQ of between 40 and 50. But he was also left with the ability to sculp animals out of clay to incredible detail and at great speed, only needing to see an animal briefly to create a replica. He has shown his work at galleries and some have sold for tens of thousands of dollars.

Daniel Tammet

London, England

Tammet (below) is unique in that he is a high-functioning savant. While many autistic savants lack the ability to describe how they think, Tammet has documented the workings of his mind through a series of books, including the autobiographical Born on a Blue Day. He can learn a language in one week and performs calculations to 100 decimal places in his head.

Leslie Lemke

Wisconsin, US

Lemke was born with brain damage and glaucoma, which left him blind. He was 15 before he learnt to walk. But at the age of 16, his adoptive mother found him playing Tchaikovsky's Piano Concerto No.1 after he had heard the piece once on television. Lemke can play all musical styles and is considered a musical prodigy, able to play a song after hearing it once, as well as composing his own pieces.

Gilles Trehin

Nice, France

Trehin is an autistic savant who has created hundreds of maps and drawings of an imaginary French city, which he calls Urville. He has devoted his life to documenting Urville through maps and drawings of the city, which he says has a population of 12 million and is the capital of a large island province. He has published books devoted to it.

http://www.dailylife.com.au/lifestyle/inside-the-incredible-mind-of-a-savant-20130709-2pmzg.html

Wednesday, June 26, 2013

Positive Pilot Study of Noninvasive Vagus Nerve Stimulation for Acute Treatment of Migraine

Nonpharmacologic Therapy   ISSUE: JUNE 2013 | VOLUME: 11  

Positive Pilot Study of Noninvasive Vagus Nerve Stimulation for Acute Treatment of Migraine

  image

 An open-label, multicenter, pilot study suggests that noninvasive vagus nerve stimulation (nVNS) can be effective for acute treatment of migraine.   

An analysis of 25 women and two men treated with nVNS for migraine with or without aura showed that patients were pain-free two hours after treatment in 38% of mild migraine attacks and 22% of moderate or severe attacks. Twelve of the patients had adverse events, but all were mild or moderate, according to a presentation of the results by Peter Goadsby, MD, PhD, at the American Academy of Neurology’s 2013 annual meeting, held recently in San Diego.

 “Noninvasive or transcutaneous VNS is well tolerated and seems to be effective in acute migraine,” concluded Dr. Goadsby, professor of neurology at the University of California, San Francisco. “This points to the importance of getting on with controlled trials—and indeed there are two studies each in Europe and the U.S. under way already.”   

Ana Recober, MD, assistant professor of neurology at the University of Iowa, University Heights, chaired the session at which Dr. Goadsby presented the data. She praised the results as being “exciting” and warranting “follow-up with a larger randomized, double-blinded, sham-controlled clinical trial.”   

“The headache community is looking for new, innovative acute-migraine treatments, and non-medicinal therapies with minimal side effects are very attractive,” said Todd Rozen, MD, director, Geisinger Headache Center, Geisinger Health System, Wilkes-Barre, Pa. “The two-hour data for pain freedom and pain relief in the study are promising, but the investigators didn’t indicate whether the pain returns within 24 hours, or even within four hours for that matter. Also, no data were presented on what happened to migrainous-associated symptoms—such as nausea and vomiting—with treatment.”   

He agreed that results from the controlled trials would be useful.    Dr. Goadsby said data on migraine symptoms up to 24 hours post-treatment would be included in a paper that is being prepared for submission to a medical journal.   

The pilot study was paid for by ElectroCore, which makes the gammaCore device that was used in the study. The goal was to build on several published case series on use of nVNS that showed it relieved some patients’ migraine symptoms (see, e.g., Cephalalgia 2005;25:82-86).   

The participants had a median age of 39 years. Each was treated with nVNS for four consecutive migraine attacks, either with immediate treatment for moderate or severe attacks, or after 20 minutes of mild pain. Each treatment consisted of one 90-second dose followed by another dose 15 minutes later.   

The initial study population included 30 individuals but three did not have any attacks treated; thus, the intent-to-treat group comprised 27 subjects. In that group, there were 84 attacks, 55 of which were moderate or severe. In 10 of the mild attacks (38%) and in 12 of the moderate or severe attacks (22%), the patients were pain-free after two hours.   

Three patients experienced neck twitching at the location of the treatment; one had neck redness; and another reported a raspy voice. The adverse effects all were only present during the stimulation time and resolved spontaneously.

 —Rosemary Frei, MSc

   Dr. Goadsby is a consultant with ElectroCore. Drs. Recober and Rozen did not disclose any relevant conflicts of interest.   

 http://www.painmedicinenews.com/ViewArticle.aspx?d=Nonpharmacologic%2BTherapy&d_id=84&i=June+2013&i_id=963&a_id=23359

Friday, June 1, 2012

“Nerve Pacemaker” Helps Chronic Migraine Sufferers Acheive Freedom From Pain

“Nerve Pacemaker” Helps Chronic Migraine Sufferers Acheive Freedom From Pain


Dr. Brian Snyder of Neurological Surgery, P.C. Uses Occipital Nerve Stimulation When Medications Fail

Rockville Centre, NY (PRWEB) June 01, 2012
A relatively new treatment known as occipital nerve stimulation significantly decreases the severity and frequency of headaches in patients suffering from debilitating chronic migraines. The treatment is used by Brian J. Snyder, M.D., attending neurosurgeon with Neurological Surgery, P.C., when medical therapies fail to provide relief.

“Many suffer daily with severe migraines, without relief,” says Dr. Snyder. “Occipital nerve stimulation has been studied extensively, and can provide significant relief to patients whose migraines do not respond to medication.”

Occipital nerve stimulation involves delivering a small electrical charge over the region of the occipital nerves through an implanted device. The device resembles a cardiac pacemaker, except that it is used to stimulate nerves overlying the skull rather than the heart. It is implanted in the chest wall like a cardiac pacemaker and controlled via a remote control device. The doctor uses a programmer to set up the stimulation programs.

The device is first tried using temporary leads. Adjustments are then made, and if the device works well for the patient, permanent leads are implanted a week later. Recuperation time is brief.

There is one greater occipital nerve on each side of the head. Emerging from between bones of the spine in the upper neck, the two occipital nerves make their way through muscles at the back of the head and into the scalp. Although the pain relief mechanism is not entirely understood, occipital nerve stimulation may influence centers deep in the brain that are responsible for pain modulation.
One patient of Dr. Snyder’s who was recently helped by this device is E.W. of Long Island. E.W. suffered from daily migraines so debilitating they left her unable to work or care for her family. She was bedridden much of the time and required multiple hospitalizations, in which she received intravenous medications. Her migraines could last 10-15 days, and there was nothing that would stop them.

Just weeks after her second procedure, E.W. is now pain free. “Dr. Snyder was a lifesaver,” she says.
There are currently three large-scale randomized, placebo-controlled trials of occipital nerve stimulation, the largest being the Occipital Nerve Stimulation for the Treatment of Intractable Migraine (ONSTIM) study, sponsored by Medtronic. Preliminary findings from ONSTIM were published in 2010, showing significant migraine relief for severely debilitated patients who regularly experienced headaches for 15 days or more a month and were not responsive to medical therapies.
A number of nerve stimulators, known as “neurostimulation” or “neuromodulation” devices, are currently on the market. These devices are FDA approved for various neurostimulation uses, but are not yet cleared for occipital nerve stimulation. The government allows their use “off-label” if the physician feels it is in the patient’s best interest and they are approved for other uses. Occipital nerve stimulation has been in use since the 1990s, and has been studied extensively.

“Many patients with chronic migraines and other types of pain who are not responsive to non-surgical treatment may benefit from neurostimulation devices,” says Dr. Snyder. “This is an important new treatment option.”

According to the American Migraine Foundation, 36 million Americans suffer from migraines. Migraines are three times more common in women than in men, and nearly a third of women experience migraine in their lifetimes. The World Health Organization places migraine as one of the top 20 disabling conditions on the planet, and chronic migraine is even more disabling. Chronic migraine, which affects 3.2 million Americans, is a severely debilitating headache that occurs 15 or more days a month for at least six consecutive months.

Brian J. Snyder, M.D. is a neurosurgeon who specializes in treating chronic pain, seizure disorders and epilepsy, as well as movement disorders such as Parkinson’s disease, tremor and dystonia. He is a leading practitioner of deep brain stimulation (DBS), having trained under Dr. Andres Lozano, perhaps the world’s foremost DBS authority. He also has extensive expertise in vagal nerve stimulation and procedures for mapping, recording and identifying seizure foci in the brain, and in the surgical resection of these foci. Dr. Snyder uses a number of types of neuromodulation techniques and devices for chronic pain, including spinal cord stimulation, peripheral nerve stimulation (including occipital nerve stimulation), deep brain stimulation and implantable drug pumps. He is certified in both Gamma Knife® and CyberKnife® radiosurgery.

About Neurological Surgery, P.C.
Neurological Surgery, P.C. is one of the New York City area’s premier neurosurgical groups, offering patients the most advanced treatments of brain and spine disorders. These include minimally invasive procedures such as stereotactic radiosurgery (Gamma Knife® and CyberKnife®), aneurysm coiling, neuro-endoscopy, spinal stimulators, carotid stents, interventional pain management, microdiscectomy, kyphoplasty, and X-STOP®. The practice’s physicians represent a range of surgical and nonsurgical specialties, combining compassionate care with highly specialized training. They are leaders in the region’s medical community, with appointments as chiefs of neurosurgery in some of Long Island’s best hospitals. NSPC offers nine convenient locations in Queens, Nassau and Suffolk Counties. For more information, call 1-800-775-7784 or visit http://www.NSPC.com.

http://www.prweb.com/releases/2012/6/prweb9564653.htm

Tuesday, October 26, 2010

Therapeutic neuromodulation in primary headaches

Nervenarzt. 2010 Oct 24. [Epub ahead of print]

[Therapeutic neuromodulation in primary headaches.]

[Article in German]
Institut für Systemische Neurowissenschaften und Kopfschmerzambulanz der Neurologischen Klinik, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland, a.may@uke.uni-hamburg.de.

Abstract

Neuromodulatory techniques have developed rapidly in the therapeutic management of refractory headaches. Invasive procedures comprise peripheral nerve stimulation (particularly occipital nerve stimulation), vagus nerve stimulation, cervical spinal cord stimulation and hypothalamic deep brain stimulation. Transcutaneous electrical nerve stimulation, repetitive transcranial magnetic stimulation and transcranial direct current stimulation are noninvasive variants. Based on current neuroimaging, neurophysiological and clinical studies occipital nerve stimulation and hypothalamic deep brain stimulation are recommended for patients with chronic cluster headache. Less convincing evidence can be found for their use in other refractory headaches such as chronic migraine. No clear recommendation can be given for the other neuromodulatory techniques. The emerging concept of intermittent stimulation of the sphenopalatine ganglion is nonetheless promising. Robust randomized and sham-controlled multicenter studies are needed before these therapeutic approaches are widely implemented. Due to the experimental nature all patients should be treated in clinical studies.It is essential to confirm the correct headache diagnosis and the refractory nature before an invasive approach is considered. Patients should generally be referred to specialized interdisciplinary outpatient departments which closely collaborate with neurosurgeons who are experienced in the implantation of neuromodulatory devices. It is crucial to ensure a competent postoperative follow-up with optimization of stimulation parameters and adjustment of medication.
PMID: 20972665 [PubMed - as supplied by publisher