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Published on: December 31, 2013
Occipital neurostimulation-induced muscle spasms: implications for lead placement
Salim M Hayek1, Joseph F Jasper, Timothy R Deer
1Division of Pain Medicine, Department of Anesthesiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA. Salim.hayek@UHhospitals.org
Pain Physician
|September 30, 2009
Summary
Occipital peripheral nerve stimulation (ONS) can cause painful spasms. Placing ONS leads higher, at the nuchal line, effectively eliminates these spasms while maintaining therapeutic paresthesia for headache relief.
Area of Science:
- Neuromodulation
- Pain Management
- Neurosurgery
Background:
- Occipital peripheral nerve stimulation (ONS) offers relief for chronic headaches.
- A rare complication of ONS is painful muscle spasms, often linked to lead placement at the C1-2 level.
- Anatomical variations in the greater occipital nerve (GON) can influence lead placement outcomes.
Observation:
- This study reports on five cases where ONS leads were revised due to intractable muscle spasms.
- Physicians adjusted lead placement to a higher position at the nuchal line.
- The goal was to mitigate ONS-induced neck and occipital muscle spasms.
Findings:
- Placing ONS leads at or above the nuchal line successfully provided paresthesia.
- This higher lead placement avoided the occurrence of neck muscle spasms in all reported cases.
- The effectiveness was independent of stimulation parameters, suggesting lead position is key.
Implications:
- A modified lead placement technique for ONS at the nuchal line can prevent debilitating muscle spasms.
- This variation offers a viable alternative for patients experiencing spasms with traditional C1-2 lead placement.
- Optimizing lead position is crucial for successful and comfortable ONS therapy in headache management.
