Long-term follow-up of bilateral hypothalamic stimulation for intractable cluster headache.
We provide a detailed case history of the first patient to receive bilateral hypothalamic stimulation to control severe bilateral chronic intractable cluster headaches initially occurring mostly on the left. These attacks were accompanied by life-threatening hypertensive crises and a grave deterioration in the patient's psychological state. Destructive surgery to the left trigeminal was absolutely contraindicated. Electrode implantation and continuous stimulation of the left posterior inferior hypothalamus resolved the left attacks. After four destructive operations on the right trigeminal, right side attacks recurred. Electrode implantation (with continuous stimulation) to the right resulted in immediate resolution of the right side pain and the hypertensive crises. On several occasions, both known and unknown to the patient, the stimulators were turned off: in all cases, crises reappeared and in all instances disappeared relatively quickly after turning stimulation back on. Pain crises have never reappeared when ipsilateral stimulation is ongoing. The only side effects were observed during long-term bilateral stimulation, consisting of transient vertigo and bradycardia. After 42 months (left) and 31 months (right) of follow-up, the patient remains crisis free without the need for pharmacological prophylaxis.
Istituto Nazionale Neurologico Carlo Besta, via Celoria 11, 20133 Milano Italy. leone@istituto-besta.it
M
M
Leone
A
A
Franzini
G
G
Broggi
A
A
May
G
G
Bussone
D000328:Adult; D003027:Cluster Headache / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D007031:Hypothalamus / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012008:Recurrence; D013238:Stereotaxic Techniques; D013997:Time Factors; D016896:Treatment Outcome