Tourette’s Syndrome cervical dystonia induced occipital neuralgia remedied by peripheral nerve stimulation: A case report
DOI:
https://doi.org/10.48208/HeadacheMed.2023.40Keywords:
Pain medicine, Acute pain, Chronic pain, Occipital neuralgia, Tourette’s syndrome, Peripheral nerve stimulationAbstract
Background
Dystonia is uncommon in Tourette’s syndrome, and occipital neuralgia secondary to Tourette's dystonia is more rare, affecting quality of life. Occipital peripheral nerve stimulation (PNS) is an excellent alternative by being adjustable and minimally invasive. Our case demonstrates occipital PNS as an effective option for refractory Tourette’s dystonia.
Case Presentation
A thirty-four-year-old male with poorly controlled Tourette’s cervical dystonia presented with severe occipital neuralgia. Various medications were prescribed including propranolol and amitriptyline, and bilateral third-occipital nerve rhizotomies and occipital nerve blocks were trialed. Distal nerve blocks at the occipital protuberance were most effective. Therefore, an occipital PNS trial was done, and a PNS was implanted with no complications. Upon follow-up, the patient reported drastic pain reduction.
Conclusion
Our case illustrates neuromodulation benefits for a rare presentation of refractory occipital neuralgia secondary to Tourette’s-related dystonia. Occipital PNS should be considered for refractory cases because it is safe, easy to implant, and effective.
Downloads
References
.Jankovic J and Kurlan R. Tourette syndrome: Evolving concepts. Movement Disorders 2011;26(6):1149-1156 Doi: 10.1002/mds.23618 DOI: https://doi.org/10.1002/mds.23618
.Stone LA and Jankovic J. The Coexistence of Tics and Dystonia. Archives of Neurology 1991;48(8):862-865 Doi: 10.1001/archneur.1991.00530200104028 DOI: https://doi.org/10.1001/archneur.1991.00530200104028
.Pringsheim T, Freeman R and Lang A. Tourette syndrome and dystonia. Journal of Neurology, Neurosurgery & Psychiatry 2006;78(5):544-544 Doi: 10.1136/jnnp.2006.0102442 DOI: https://doi.org/10.1136/jnnp.2006.0102442
.Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38(1):1-211 Doi: 10.1177/0333102417738202 DOI: https://doi.org/10.1177/0333102417738202
.Choi I and Jeon SR. Neuralgias of the Head: Occipital Neuralgia. Journal of Korean Medical Science 2016;31(4):Doi: 10.3346/jkms.2016.31.4.479 DOI: https://doi.org/10.3346/jkms.2016.31.4.479
.Finiels PJ and Batifol D. The treatment of occipital neuralgia: Review of 111 cases. Neurochirurgie 2016;62(5):233-240 Doi: 10.1016/j.neuchi.2016.04.004 DOI: https://doi.org/10.1016/j.neuchi.2016.04.004
.Harsh V, Mishra P, Gond PK and Kumar A. Peripheral nerve stimulation: black, white and shades of grey. British Journal of Neurosurgery 2019;33(3):332-336 Doi: 10.1080/02688697.2018.1538479 DOI: https://doi.org/10.1080/02688697.2018.1538479
.Weiner RL and Reed KL. Peripheral Neurostimulation for Control of Intractable Occipital Neuralgia. Neuromodulation: Technology at the Neural Interface 1999;2(3):217-221 Doi: 10.1046/j.1525-1403.1999.00217.x DOI: https://doi.org/10.1046/j.1525-1403.1999.00217.x
.Oh MY, Ortega J, Bellotte JB, Whiting DM and Aló K. Peripheral Nerve Stimulation for the Treatment of Occipital Neuralgia and Transformed Migraine Using a C1-2-3 Subcutaneous Paddle Style Electrode: A Technical Report. Neuromodulation: Technology at the Neural Interface 2004;7(2):103-112 Doi: 10.1111/j.1094-7159.2004.04014.x DOI: https://doi.org/10.1111/j.1094-7159.2004.04014.x
.Knight T, Steeves T, Day L, Lowerison M, Jette N and Pringsheim T. Prevalence of Tic Disorders: A Systematic Review and Meta-Analysis. Pediatric Neurology 2012;47(2):77-90 Doi: 10.1016/j.pediatrneurol.2012.05.002 DOI: https://doi.org/10.1016/j.pediatrneurol.2012.05.002
.Ducic I, Felder JM, Khan N and Youn S. Greater Occipital Nerve Excision for Occipital Neuralgia Refractory to Nerve Decompression. Annals of Plastic Surgery 2014;72(2):184-187 Doi: 10.1097/SAP.0b013e3182898736 DOI: https://doi.org/10.1097/SAP.0b013e3182898736
.Jose A, Nagori SA, Chattopadhyay PK and Roychoudhury A. Greater Occipital Nerve Decompression for Occipital Neuralgia. Journal of Craniofacial Surgery 2018;29(5):e518-e521 Doi: 10.1097/scs.0000000000004549 DOI: https://doi.org/10.1097/SCS.0000000000004549
.Salmasi V, Olatoye OO, Terkawi AS, Hah JM, Ottestad E and Pingree M. Peripheral Nerve Stimulation for Occipital Neuralgia. Pain Medicine 2020;21(Supplement_1):S13-S17 Doi: 10.1093/pm/pnaa083 DOI: https://doi.org/10.1093/pm/pnaa083
.Urits I, Schwartz RH, Patel P, Zeien J, Connor D, Hasoon J, . . . Viswanath O. A Review of the Recent Findings in Minimally Invasive Treatment Options for the Management of Occipital Neuralgia. Neurology and Therapy 2020;9(2):229-241 Doi: 10.1007/s40120-020-00197-1 DOI: https://doi.org/10.1007/s40120-020-00197-1
.Keifer OP, Diaz A, Campbell M, Bezchlibnyk YB and Boulis NM. Occipital Nerve Stimulation for the Treatment of Refractory Occipital Neuralgia: A Case Series. World Neurosurgery 2017;105:599-604 Doi: 10.1016/j.wneu.2017.06.064 DOI: https://doi.org/10.1016/j.wneu.2017.06.064
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Crystal Joseph, Anishinder Parkash, John Gallagher, Ahish Chitneni, Hirsh Kaveeshvar (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
