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| 50th Annual Meeting of the American Headache Society |
Boston, Massachusetts June 26-29, 2008 |
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Deep Brain Stimulation for Chronic Headache
Patients |
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BY MAURY M. BREECHER
Contributing Writer |
BOSTON — The long-term efficacy of hypothalamic
neuromodulation, also known as “Deep Brain Stimulation,”
is greater than 60% in a group of drug-resistant chronic
headache patients, reported Dr. Massimo Leone on June 27
at the 50th Annual Meeting of the American Headache
Society.
“We have learned a lot in the past year about this
pathology,” said Dr. Leone of the National Neurologic
Institute and the Carol Basta Foundation in Milano,
Italy. He and his colleagues are known as pioneers of
Deep Brain Stimulation (DBS) for intractable cluster
headache.
“We are dealing with peripheral secrets involving the
brain stem,” said Dr. Leone. “The involvement of the
biological clock has been hypothesized as being due to
hypothalamic involvement. This hypothalamic involvement
has been, for the first time shown, by neuroimaging.”
In discussing the beginnings of DBS, Dr. Leone told of
his well-reported case involving the first bilateral
case of hypothalamic stimulation. (Brain 2004;
127:2259-2264).
“We learned that unilateral stimulation on one side of
the brain is not able to prevent attacks on the other
side,” he pointed out.
In Dr. Leone’s most famous case, right-sided attacks
reappeared after the electrode on the right side was
moved from the original position. The electrode was put
into the target again, and the attacks disappeared.
“Each time we switched off the stimulator, the attacks
reappeared,” he said. “That’s how we learned that we
need to put electrodes on both sides to control cluster
headaches.”
The next step, according to Dr. Leone, was determining
patient selection criteria for DBS. Patients must have
chronic, drug-resistant unilateral chronic headache with
a psychological stable profile (Cephalalgia
2004;24:934-937).
He pointed out that cluster headache is defined as at
least five attacks fulfilling criteria of at least
“severe, or very severe, unilateral, orbital,
supraorbital and/or temporal pain lasting 15–180 minutes
if untreated.” These headaches have a frequency from
one-half day to 8 days, are not attributed to another
disorder, and are accompanied by symptoms including,
nasal congestion, forehead and facial sweating, and a
sense of restlessness or agitation. Dr. Leone added that
cluster headaches have a Circadian daily occurrence and
a seasonal recurrence of cluster periods.
Dr. Leone added that the improvement in the frequency of
attacks is not instantaneous.
“It takes time,” he noted. “The median time for
improvement is about two months.”
DBS is not effective in aborting ongoing cluster
attacks, Dr. Leone added, and although the treatment is
safe, it’s not completely without risk. In Dr. Leon’s
series of patients (a total of 23 implantations), some
side effects were related to the to implantation of the
impulse generator (N=1), a skin lesion (N=1),
malfunction of the generator (N=2), displacement of the
cerebral electrodes (N=1), and infection (N=3). |
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