Article
Chronic deep brain stimulation in the treatment of cluster headache: clinical results and neurophysiological findings
Die tiefe Hirnstimulation in der Behandlung von Cluster-Kopfschmerzen: Klinische Ergebnisse und neurophysiologische Befunde
Search Medline for
Authors
Published: | April 11, 2007 |
---|
Outline
Text
Objective: The conservative treatment of cluster headache is often frustrating and may fail to alleviate the suffering of patients. Recently, deep brain stimulation of the posterior hypothalamus has been shown to be effective in cluster headache refractory to medical treatment. Thus far, however, there is very little published data available.
Methods: Two men (24 and 42 years old) suffered from severe cluster headache with several attacks daily. Conservative treatment including lithium, corticosteroids, calcium antagonists and inhalation of 100% oxygen, had no lasting benefit on the intensity and frequency of the attacks. Therefore, both patients were scheduled for deep brain stimulation of the ipsilateral posterior hypothalamus. After routine preoperative diagnostic evaluation we performed CT-stereotactic implantation of an ipsilateral DBS electrode (Medtronic, 3389) in the posterior hypothalmus with microelectrode guidance.
Results: There were no surgical complications. Microelectrode recording demonstrated unique firing patterns with neurons firing at 10-20 Hz in the posterior hypothalamus. Postoperatively, test stimulation was performed for 6 and 10 days with the electrode being externalized. In both patients, both intensity and frequency of the attacks were reduced (frequency reduced by 80%, intensity reduced up to 80% measured by the VAS). Therefore, the DBS electrode was internalized and connected to an IPG (Medtronic, Soletra). Stimulation parameters for chronic stimulation were as follows: Patient 1 1.2 V, 130 Hz, 60 µs; Patient 2 4.0 V, 130 Hz, 60 µs; bipolar stimulation. Both patients show prolonged benefit up to half a year.
Conclusions: Our experience underlines the beneficial role of chronic DBS of the posterior hypothalamus in patients with intractable cluster headache as a promising treatment option if conservative treatment fails. Microelectrode recording may be helpful in identifying the target region.