Hypothalamic deep brain stimulation for cluster headache: Experience from a new multicase series

T. Bartsch*, M. O. Pinsker, D. Rasche, T. Kinfe, F. Hertel, H. C. Diener, V. Tronnier, H. M. Mehdorn, J. Volkmann, G. Deuschl, J. K. Krauss

*Korrespondierende/r Autor/-in für diese Arbeit
128 Zitate (Scopus)

Abstract

Deep brain stimulation (DBS) of the posterior hypothalamus was found to be effective in the treatment of drug-resistant chronic cluster headache. We report the results of a multicentre case series of six patients with chronic cluster headache in whom a DBS in the posterior hypothalamus was performed. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to published coordinates 2 mm lateral, 3 mm posterior and 5 mm inferior referenced to the mid-AC-PC line. Microelectrode recordings at the target revealed single unit activity with a mean discharge rate of 17 Hz (range 13-35 Hz, n = 4). Out of six patients, four showed a profound decrease of their attack frequency and pain intensity on the visual analogue scale during the first 6 months. Of these, one patient was attack free for 6 months under neurostimulation before returning to the baseline which led to abortion of the DBS. Two patients had experienced only a marginal, non-significant decrease within the first weeks under neurostimulation before returning to their former attack frequency. After a mean follow-up of 17 months, three patients are almost completely attack free, whereas three patients can be considered as treatment failures. The stimulation was well tolerated and stimulation-related side-effects were not observed on long term. DBS of the posterior inferior hypothalamus is an effective therapeutic option in a subset of patients. Future controlled multicentre trials will need to confirm this open-label experience and should help to better define predictive factors for non-responders.

OriginalspracheEnglisch
ZeitschriftCephalalgia
Jahrgang28
Ausgabenummer3
Seiten (von - bis)285-295
Seitenumfang11
ISSN0333-1024
DOIs
PublikationsstatusVeröffentlicht - 03.2008

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