Hypothalamic deep brain stimulation for cluster headache: experience from a new multicase series.
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.
Bartsch
T
T
Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany. t.bartsch@neurologie.uni-kiel.de
Pinsker
M O
MO
Rasche
D
D
Kinfe
T
T
Hertel
F
F
Diener
H C
HC
Tronnier
V
V
Mehdorn
H M
HM
Volkmann
J
J
Deuschl
G
G
Krauss
J K
JK
D000328:Adult; D003027:Cluster Headache / Q000503:physiopathology / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007034:Hypothalamus, Posterior / Q000502:physiology*; D008297:Male; D008875:Middle Aged