Anodal transcranial direct stimulation (tDCS) targeting the anterior cingulate gyrus for the preventive treatment of chronic cluster headache: a proof of concept trial.
MAGIS, Delphine ; D'Ostilio, Kevin ; et al
Poster (2016, April)
Background There is a need for better treatments in chronic cluster headache (CCH). In responders to percutaneous occipital nerve stimulation, the subgenual anterior cingulate gyrus (sACG) was found ... [more ▼]
Background There is a need for better treatments in chronic cluster headache (CCH). In responders to percutaneous occipital nerve stimulation, the subgenual anterior cingulate gyrus (sACG) was found hypermetabolic (Magis et al. 2011). We reasoned that activation of this area by transcranial neurostimulation could be effective in CCH. Aim To explore the preventive effect of anodal (i.e. activating) transcranial direct current stimulation (tDCS) targeting the anterior cingulate gyrus in CCH patients. Method & subjects Difficult-to-treat CCH patients with a stable preventive drug regimen applied tDCS (2mA) interictally in 20-minute daily sessions for 4 weeks with the anode positioned over the forehead (FpZ), the cathode over the C7 spinous process. Therapeutic effects were monitored with paper diaries. Results Nineteen patients were enrolled up to now. In 13 patients who completed the trial, mean weekly attack frequency decreased by 38% after 4 weeks of daily stimulation (W-test: p = 0.002). The 50% responder rate was 54%. Patients (n=12) reported an improvement in headache impact, as shown by 5-point decrease in the mean HIT-6 score (from 67 to 62, p = 0.02). In 10 patients who were followed up after the treatment period, the benefit remained stable up to 4 weeks after the last stimulation. The first 3 enrolled patients had superficial skin burns under the adhesive cathode electrode. Sponge electrodes were therefore used in all subsequent patients without any adverse effect. Conclusion Anodal tDCS targeting the anterior cingulate gyrus seems promising for the preventive treatment of chronic cluster headache as suggested by this ongoing proof-of-concept trial. Use of adhesive electrodes is not recommended. [less ▲]Detailed reference viewed: 29 (2 ULg)
Non-invasive vagus nerve stimulation with the gammaCore® in healthy subjects: is there electrophysiological evidence for activation of vagal afferents ?
Schoenen, Jean ; NONIS, Romain ; D'Ostilio, Kevin et al
Poster (2016, April)
Abstract: Background Non-invasive vagus nerve stimulation (nVNS) with the gammaCore® improves migraine and cluster headache. Animal experiments suggest that nVNS acts via stimulation of vagal afferents ... [more ▼]
Abstract: Background Non-invasive vagus nerve stimulation (nVNS) with the gammaCore® improves migraine and cluster headache. Animal experiments suggest that nVNS acts via stimulation of vagal afferents, but proof in humans is lacking. Vagal somatosensory evoked potentials (vSEP) are identified after invasive VNS or transcutaneous stimulation of auricular vagal branches, but late components could be muscle artifacts. Objective To search in healthy volunteers for reliable vSEP during nVNS with the gammaCore® Methods In 12 healthy subjects (7males) evoked potentials were recorded at A1/A2 (ref Cz) and C3/C4 (ref F3/F4) during 2-minute stimulation over left/right cervical vagus nerve with the gammaCore® (25Hz, 6-24V) and during stimulation over the inner tragus with a monopolar stimulator (2Hz, 50 stimuli, mean intensity 8mA). Results We identified 3 reproducible peaks P1, N1, P2 in 10 patients on the side of the gammaCore® stimulation at mean latencies of 2.05ms, 5.20ms and 9.13ms. P1-N1 amplitude increased significantly (p<0.01) with increasing voltage from 0.04μV to 0.52μV (C3/C4) and from 0.13µV to 2.04μV (A1/A2) respectively at 10V and 30V. Inner tragus stimulation elicited P1, N1, P2 peaks with shorter mean latencies (2.21ms, 3.72ms, 5.71ms) and a mean P1-N1 amplitude (A1/A2) of 5.0µV. When the gammaCore® was placed over the sternocleidomastoid muscle, there were no reproducible evoked potentials. Conclusion Non-invasive transcutaneous stimulation of the cervical vagus nerve with the gammaCore® elicits evoked potentials similar to those found with implanted electrodes or stimulation of Arnold’s nerve in the outer ear. The gammaCore®-evoked potentials increase in amplitude with stimulation intensity and disappear when the stimulator is positioned over neck muscles, suggesting that they are not muscle artifacts. Their short latency is compatible with their generation at the level of the foramen jugulare. The therapeutic effects reported with the gammaCore® in primary headaches can thus be mediated by genuine activation of vagus nerve afferents. [less ▲]Detailed reference viewed: 49 (1 ULg)
Transcranial direct current stimulation and transcutaneous occipital nerve stimulation in chronic migraine: a pilot-comparison of therapeutic and electrophysiological effects.
Schoenen, Jean ; D'Ostilio, Kevin ; et al
Poster (2016)Detailed reference viewed: 25 (1 ULg)
Cerebral FDG uptake changes with supraorbital transcutaneous electrical stimulation for episodic migraine prevention
D'Ostilio, Kevin ; Thibaut, Aurore ; Laureys, Steven et al
Conference (2015, May)
Background: A recent multicentre RCT has shown that supraorbital transcutaneous stimulation (STS) targeting branches of the ophtalmic nerve with the Cefaly® device is effective as a preventive therapy for ... [more ▼]
Background: A recent multicentre RCT has shown that supraorbital transcutaneous stimulation (STS) targeting branches of the ophtalmic nerve with the Cefaly® device is effective as a preventive therapy for migraine (Schoenen et al., Neurology 2013). However, the mechanisms of action in the central nervous system remain unknown. Here, we conducted voxel-based analyses of FDG-PET to evaluate metabolic changes immediately after the first STS session and after 3 months of treatment in patients with migraine. Methods: Twenty-eight subjects participated in the experiment: 14 patients with episodic migraine (ICHD3 beta criteria) and 14 age-matched controls. Healthy volunteers underwent only one FDG-PET scan whereas patients were scanned at baseline, directly after a first session of STS and after 3 months of daily treatment. Results: Compliant patients showed a significant decrease in the number of attacks (p = 0.03). When compared to controls, patients (n = 14) at baseline were hypometabolic in the fronto-temporal regions (p < 0.001), especially in the orbitofrontal (OFC) and perigenual anterior cingulate cortex. OFC hypometabolism was not correlated with medication intake. In compliant patients, daily STS for 3 months was followed by a normalization of the fronto-temporal hypometabolism (p< 0.001; OFC: pFWE<0.01). Conclusion: Our study suggests that the OFC is hypoactive in episodic migraine. STS with the Cefaly° device is able to normalize this hypoactivity. This indicates that STS exerts its beneficial effect via slow neuromodulatory mechanisms, as also previously shown for percutaneous occipital nerve stimulation in refractory cluster headache (Magis et al., BMC Neurology 2011). [less ▲]Detailed reference viewed: 138 (5 ULg)
Safety and patients' satisfaction of transcutaneous supraorbital neurostimulation (tSNS) with the Cefaly® device in headache treatment: a survey of 2,313 headache sufferers in the general population.
MAGIS, Delphine ; SAVA, Simona Liliana ; et al
in Journal of Headache & Pain (2013), 14
BACKGROUND: Transcutaneous supraorbital nerve stimulation (tSNS) with the Cefaly® device was recently found superior to sham stimulation for episodic migraine prevention in a randomized trial. Its safety ... [more ▼]
BACKGROUND: Transcutaneous supraorbital nerve stimulation (tSNS) with the Cefaly® device was recently found superior to sham stimulation for episodic migraine prevention in a randomized trial. Its safety and efficiency in larger cohorts of headache sufferers in the general population remain to be determined.The objective of this study was to assess the satisfaction with the Cefaly® device in 2,313 headache sufferers who rented the device for a 40-day trial period via Internet. METHODS: Only subjects using specific anti-migraine drugs, and thus most likely suffering from migraine, were included in the survey. Adverse events (AEs) and willingness to continue tSNS were monitored via phone interviews after the trial period. A built-in software allowed monitoring the total duration of use and hence compliance in subjects who returned the device to the manufacturer after the trial period. RESULTS: After a testing period of 58.2 days on average, 46.6% of the 2,313 renters were not satisfied and returned the device, but the compliance check showed that they used it only for 48.6% of the recommended time. The remaining 54.4% of subjects were satisfied with the tSNS treatment and willing to purchase the device. Ninety-nine subjects out of the 2,313 (4.3%) reported one or more AEs, but none of them was serious. The most frequent AEs were local pain/intolerance to paresthesia (47 subjects, i.e. 2.03%), arousal changes (mostly sleepiness/fatigue, sometimes insomnia, 19 subjects, i.e. 0.82%), headache after the stimulation (12 subjects, i.e. 0.52%). A transient local skin allergy was seen in 2 subjects, i.e. 0.09%. CONCLUSIONS: This survey of 2,313 headache sufferers in the general population confirms that tSNS with is a safe and well-tolerated treatment for migraine headaches that provides satisfaction to a majority of patients who tested it for 40 days. Only 4.3% of subjects reported AEs, all of them were minor and fully reversible. [less ▲]Detailed reference viewed: 82 (0 ULg)
Pearls and pitfalls: Electrophysiology for primary headaches
MAGIS, Delphine ; ; SAVA, Simona Liliana et al
in Cephalalgia : An International Journal of Headache (2013)Detailed reference viewed: 68 (6 ULg)
Transcranial Direct Current Stimulation (tDCS) of the visual cortex: a proof-of-concept study based on interictal electrophysiological abnormalities in migraine
; ; SAVA, Simona Liliana et al
in Journal of Headache & Pain (2013), 14(23),Detailed reference viewed: 59 (4 ULg)
Quadripulse Repetitive Transcranial Magnetic Stimulation on Visual Cortex for Chronic Migraine Prevention: A Pilot-Trial
; ; et al
in Cephalalgia : An International Journal of Headache (2013), 33(8), 49Detailed reference viewed: 59 (1 ULg)
Anodal transcranial direct current stimulation over the visual cortex as a preventive treatment of migraine: a proof-of-concept study.
; ; SAVA, Simona Liliana et al
in Frontiers in Human Neuroscience (2012, September)Detailed reference viewed: 44 (2 ULg)
Theta burst and quadripulse repetitive Transcranial Magnetic Stimulation (rTMS) may have therapeutic potentials in migraine prevention: a proof-of-concept study in healthy volunteers and a pilot-trial in migraine patients.
; ; SAVA, Simona Liliana et al
in Frontiers in Human Neuroscience (2012, September)Detailed reference viewed: 57 (2 ULg)
Supraorbital transcutaneous neurostimulation has sedative effects in healthy subjects.
; ; SAVA, Simona Liliana et al
in BMC Neurology (2011), 11
BACKGROUND: Transcutaneous neurostimulation (TNS) at extracephalic sites is a well known treatment of pain. Thanks to recent technical progress, the Cefaly(R) device now also allows supraorbital TNS ... [more ▼]
BACKGROUND: Transcutaneous neurostimulation (TNS) at extracephalic sites is a well known treatment of pain. Thanks to recent technical progress, the Cefaly(R) device now also allows supraorbital TNS. During observational clinical studies, several patients reported decreased vigilance or even sleepiness during a session of supraorbital TNS. We decided therefore to explore in more detail the potential sedative effect of supraorbital TNS, using standardized psychophysical tests in healthy volunteers. METHODS: We performed a double-blind cross-over sham-controlled study on 30 healthy subjects. They underwent a series of 4 vigilance tests (Psychomotor Vigilance Task, Critical Flicker Fusion Frequency, Fatigue Visual Numeric Scale, d2 test). Each subject was tested under 4 different experimental conditions: without the neurostimulation device, with sham supraorbital TNS, with low frequency supraorbital TNS and with high frequency supraorbital TNS. RESULTS: As judged by the results of three tests (Psychomotor Vigilance Task, Critical Flicker Fusion Frequency, Fatigue Visual Numeric Scale) there was a statistically significant (p < 0.001) decrease in vigilance and attention during high frequency TNS, while there were no changes during the other experimental conditions. Similarly, performance on the d2 test was impaired during high frequency TNS, but this change was not statistically significant. CONCLUSION: Supraorbital high frequency TNS applied with the Cefaly(R) device decreases vigilance in healthy volunteers. Additional studies are needed to determine the duration of this effect, the underlying mechanisms and the possible relation with the stimulation parameters. Meanwhile, this effect opens interesting perspectives for the treatment of hyperarousal states and, possibly, insomnia. [less ▲]Detailed reference viewed: 28 (2 ULg)