Mumbai, Oct 17: City doctors have conducted a
novel procedure by stimulation of the Greater Occipital Nerve
(GON) in the brain to control the type of migraine which is
uncontrollable with medicines.
The procedure was conducted by eminent neurosurgeon Dr
Paresh Doshi along with headache specialist Dr K Ravishankar
on a 42-year-old man who suffered from migraine for the 11
years which became "intracable" (untreatable by medicines) for
the last five years.
"Although this procedure has been done on 40 patients
all across the world, this is the first time in India we have
carried out this procedure where we identified Tilak Lodaya as
a qualified patient," Doshi of Jaslok hospital told media
today.
Doshi said, "as Lodaya`s work (running a transport
business) was affected by his disease condition, he agreed to
undergo the Occipital Nerve (ON) stimulation procedure last
week.
"We have implanted two eight-contact-point electrodes in
this patient overlying the GON," Doshi said adding, "They have
been connected to a pacemaker implanted on the chest wall. The
pacemaker delivers current to stimulate the GON through the
electrodes."
The procedure is done when the patient will be fully
awake so that he can interact with the doctors, the doctors
said. Whenever the patient gets a migraine attack, he can
switch on the pacemaker and control migraine.
The ON arises at the back of the head and supplies
sensation to the back of the head. There are two GONs, right
and left and these nerves have connections in the brain with
an area called trigeminovascular (TVS) complex, which is
involved in pain generation felt in migraine.
Ravishankar said the patients can be selected for this
procedure only by specialists as per the International
Headache Society guidelines and criteria to undergo this
treatment.
The cost of the pacemaker is about Rs 2.5 to 3.5 lakh
while the total procedure costs about Rs four lakh, Doshi
said.
However, the efficacy of the procedure all over the
world is still being studied. The first procedure was done
only three years back.
Only after five years of experience with the makers in
the cases abroad can give us more insight into the efficacy of
this novel procedure which totally cuts off the medicines for
a patient with severe cases migraine, Ravishanakr said.
The patient Lodaya said for the last one week he was on
any medicine and switched on the pacemaker (which is placed
under the skin below the shoulder) couple of times when he had
the attack after the procedure.
Migraine is a form of chronic debilitating malady
characterised by recurrent throbbing headache, lasting
anywhere from 4 to 24 hours, associated with photophobia and
phonophobia, occurs in 70 per cent of patients suffering from
chronic headaches, Ravishankar said.
In the general population, the incidence of this varies
from 15 to 18 per cent in women, six per cent in men and 4 to
6 per cent in children, he said.
Most of these headaches respond to conservative
treatment, however, some of them can not be controlled
(approximately four per cent) with all the available options,
he said adding that these are labelled as "intractable"
migraineurs.
Bureau Report
