Reference : Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and m...
Scientific journals : Article
Social & behavioral sciences, psychology : Neurosciences & behavior
Human health sciences : Neurology
http://hdl.handle.net/2268/106745
Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action
English
SCHOENEN, Jean mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurologie CHR >]
Di Clemente, L. [> > > >]
Vandenheede, Michel [> >]
Fumal, Arnaud mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurologie CHR >]
De Pasqua, Victor [Centre Hospitalier Universitaire de Liège - CHU > > Neurologie CHR >]
Mouchamps, Micheline [> > > >]
Remacle, J. M. [> > > >]
MAERTENS DE NOORDHOUT, Alain mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurologie CHR >]
Apr-2005
Brain
Oxford Univ Press
128
Pt 4
940-947
Yes (verified by ORBi)
International
0006-8950
1460-2156
Oxford
[en] hypothalamus ; neurostimulation ; cluster headache ; algometry ; nitroglycerin
[en] We enrolled six patients suffering from refractory chronic cluster headache in a pilot trial of neurostimulation of the ipsilateral ventroposterior hypothalamus using the stereotactic coordinates published previously. After the varying durations needed to determine optimal stimulation parameters and a mean follow-up of 14.5 months, the clinical outcome is excellent in three patients (two are pain-free; one has fewer than three attacks per month), but unsatisfactory in one patient, who only has had transient remissions. Mean voltage is 3.28 V, diplopia being the major factor limiting its increase. When the stimulator was switched off in one pain-free patient, attacks resumed after 3 months until it was turned on again. In one patient the implantation procedure had to be interrupted because of a panic attack with autonomic disturbances. Another patient died from an intracerebral haemorrhage that developed along the lead tract several hours after surgery; there were no other vascular changes on post-mortem examination. After 1 month, the hypothalamic stimulation induced resistance against the attack-triggering agent nitroglycerin and tended to increase pain thresholds at extracephalic, but not at cephalic, sites. It had no detectable effect on neurohypophyseal hormones or melatonin excretion. We conclude that hypothalamic stimulation has remarkable efficacy in most, but not all, patients with treatment-resistant chronic cluster headache. Its efficacy is not due to a simple analgesic effect or to hormonal changes. Intracerebral haemorrhage cannot be neglected in the risk evaluation of the procedure. Whether it might be more prevalent than in deep-brain stimulation for movement disorders remains to be determined.
http://hdl.handle.net/2268/106745
10.1093/brain/awh411

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