Abstracts

Head pain is common following insertion of intracranial subdural electrodes for continuous video EEG monitoring. The symptoms can be severe, poorly responsive to traditional analgesics, and they may adversely affect subdural electrode recordings. Acupuncture is an established treatment for many types of headache and it has shown benefit post-craniotomy in preliminary reports. We conducted a controlled, non-randomized, exploratory study to further delineate the potential benefit of accupuncture in this setting.
The accupuncture group consisted of 24 consecutive patients admitted to the epilepsy unit immediately following subdural electrode implantation. A licenced physiotherapist trained in acupuncture stimulated the Large Intestine [quot]4[quot] (LI4) point uni- or bilaterally at her discretion. Seirin disposable acupuncture needles, size #3 (0.2 x 40mm), were placed and stimulated manually for 20 minutes in each treatment. Using Visual Analogue Scales (VAS), patients[apos] pain scores were recorded pre- and post-acupuncture treatment. Serial treatments were often given, but only the data from each patient[apos]s first session are analyzed here. The control group consisted of 15 patients participating in the placebo arm of a separate randomized trial of pharmacological treatment of pain post-implantation of subdural electrodes. These patients assessed their pain level using VAS pre- and 4-hours post-treatment. Patients in both groups received analgesics and antiemetics as needed, following a standard postoperative pain-management protocol. Other outcome measures included nausea, analgesic requirement and fever.
Improvement in VAS pain scores from pre- to post-treatment was significantly higher in the acupuncture group as comapared to the control (non-acupuncture) group. The mean difference between groups was -3.475 [95% CI = -4.925, -2.0252]), in favor of acupuncture. This was highly statistically significant on independent T-test analyses (p [lt] 0.0001). Although baseline VAS scores were significantly different between the groups, there were no other differences in important factors such as clinical and demographic variables, and amount or type of analgesics administered.
In this prospective pilot study, patients treated with acupuncture had significantly greater improvements in their reported pain intensity when compared to non-randomized controls. This study suggests that acupuncture may have a role in the management of pain related to intracranial subdural EEG monitoring. However, a randomized, controlled study is required to formally assess its efficacy.