Neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking: A safe procedure resulting in medium-term remission in five of seven horses

作者：Roberts V L H^*; Patel N K; Tremaine W H

来源：Equine Veterinary Journal, 2016, 48(2): 201-204.

DOI：10.1111/evj.12394

• horse
• headshaking
• trigeminal-mediated
• neuromodulation
• percutaneous electrical nerve stimulation PENS

Reasons for performing studyThere are no consistently safe and effective methods for the treatment of trigeminal-mediated headshaking in horses. In affected horses, the trigeminal nerve is sensitised, appearing to result in neuropathic pain. Percutaneous electrical nerve stimulation (PENS) therapy is a minimally invasive neuromodulatory treatment used in people to manage neuropathic pain.
ObjectivesTo determine whether PENS therapy is safe, tolerated and effective for the management of trigeminal-mediated headshaking in horses.
Study designDescriptive case series.
MethodsSeven horses diagnosed with trigeminal-mediated headshaking and currently showing clinical signs were studied. All procedures were carried out in sedated horses with a needle-prick sized area of skin desensitised with local anaesthetic to facilitate probe insertion. A disposable PENS probe was advanced subcutaneously adjacent to the nerve, rostral to the infraorbital foramen under ultrasonographic guidance. The nerve was stimulated for 25min following a protocol of alternating frequencies and a perception threshold based on human clinical data. The probe was removed and the procedure repeated on the contralateral side. The protocol used comprised a series of 3 or 4 treatments, with treatments being repeated when signs of headshaking recurred.
ResultsAll horses tolerated the procedure well. Three horses developed a haematoma at the site on one occasion and 2 had increased clinical signs for up to 3 days following first treatment. Six horses demonstrated a positive response to their first treatment, returning to ridden work at the same level as prior to onset of headshaking, with 5 continuing to respond. Median remission time for first treatment was 3.8 days (range 0-8 days, n = 7), second treatment 2.5 weeks (0-8 weeks, n = 7), third treatment 15.5 weeks (0-24 weeks, n = 5) and fourth treatment 20 weeks (12-28 weeks ongoing, n = 2).
ConclusionsPercutaneous electrical nerve stimulation therapy is a safe, well tolerated, minimally invasive, repeatable management option for trigeminal-mediated headshaking, with encouraging efficacy for amelioration of clinical signs in the short- to medium term.

• 出版日期2016-3