Neurostimulation is used in neurology for the treatment of diseases
It is a neurostimulator surgically installed which, by electrical impulses, will oppose the transmission of pain. This technology has recently been adapted to stimulate Arnold's greater occipital nerve. An electrode is implanted under the skin at the back of the head, at the base of the occiput. This is connected to a small box implanted in the abdomen, which permanently stimulates the greater occipital nerve.
Reduction of headaches
In 60% of patients, this treatment leads to a clear reduction in the number of seizures and a significant improvement in quality of life (Reed 2012; Stanak et al. 2020). The neurostimulation of the greater occipital nerve in refractory chronic daily headaches has made it possible to make a great advance at the therapeutic level. This neurostimulation is called internal, because it requires a surgical act to implant the electrode. It is intended only for patients who do not respond to any drug treatment. In addition, no reimbursement by Social Security has been coded in France.
Following this discovery and the first positive results, several models of external neurostimulation, in which the electrodes are affixed directly to the skin, have been developed (Lanteri-Minet 2018).To ease the pain
In 2017, the GammaCore® neurostimulator obtained Marketing Authorization (MA) for cluster headache and in January 2018, US health authorities validated for widespread use in relieving migraine pain in adults. . More recently, the Belgian company Cefaly Technology also received approval from the Food and Drug Administration (FDA). In this device, the electrodes are located at the level of the temples and stimulate the trigeminal nerve. The device costs the patient approximately 400 to 600 euros (Stanak et al. 2020). If the French authorities have not yet validated these medical devices which seem promising, it is because there is still a dark side to their effectiveness .
Beware of false promises
First, the few clinical studies sponsored by the manufacturing laboratories compare the effectiveness of the product to a placebo group and not to drug treatments.
Secondly, and this is the fundamental point, the consequences of prolonged long-term neurostimulation are not known and the benefit-risk ratio cannot be accurately assessed (Géraud et al. 2015).
References
Lanteri-Minet, M. 2018. “Neuromodulation in the treatment of primary headaches”. Neurological Practice - FMC , JNLF 2018, 9 (2): 111-21. https://doi.org/10.1016/j.praneu.2018.02.002.
Reed, Ken L. 2012. “Peripheral Neuromodulation and Headaches: History, Clinical Approach, and Considerations on Underlying Mechanisms”. Current Pain and Headache Reports 17 (1): 305. https://doi.org/10.1007/s11916-012-0305-8.
Stanak, Michal, Sarah Wolf, Harald Jagoš, and Karin Zebenholzer. 2020. “The Impact of External Trigeminal Nerve Stimulator (e-TNS) on Prevention and Acute Treatment of Episodic and Chronic Migraine: A Systematic Review.” Journal of the Neurological Sciences 412 (May): 116725. https://doi.org/10.1016/j.jns.2020.116725.
