Deep brain stimulation in craniofacial pain: seven years' experience
Cluster headache (CH) is a primary headache with excruciatingly painful attacks that are strictly unilateral. About 10% of cases experience no significant remission, and about 15% of these do not respond to medication, so surgery is considered. Neuroimaging studies show that the posterior inferior hypothalamus is activated during CH attacks and is plausibly the CH generator. We report on 16chronic CH patients, with headaches refractory to all medication, who received long-term hypothalamic stimulation following electrode implant to the posterior inferior hypothalamus. After a mean follow-up of 23 months, a persistent pain-free to almost pain-free state was achieved in 13716 patients (15/18 implants; 83.3%) a mean of 42 days (range 1-86 days) after monopolar stimulation initiation. Ten patients (11 implants) are completely pain-free. A common side effect was transient diplopia, which limited stimulation amplitude. In one patient, a small non-symptomatic haemorrhage into the 3rd ventricle occurred following implant, but regressed 24h later. Persistent side effects are absent except in one patient with bialteral stimulation, in whom stimulation was stopped to resolve vertigo and worsened bradycardia, but was resumed later without further problems. Hypothalamic stimulation is an effective safe and well tolerated treatment for chronic drug-refracory CH. It appears as a valid alternative to destructive surgical modalities, and has the additionalm advantageof being reversible.
Autori: G. Bussone, A. franzini, A. Proietti cecchini, E. Mea, M. Curone, V. tullo, G. Broggi, G. Casucci, V. Bonavita, M. Leone
Neurol Sci (2007) 28 (Suppl 2):S232-S234