Hypothalamic Deep Brain Stimulation for Cluster Headache: Experience From a New Multicase Series

• Published in: Cephalalgia 2008-03, Vol.28 (3), p.285-295
• Main Authors: Bartsch, T, Pinsker, MO, Rasche, D, Kinfe, T, Hertel, F, Diener, HC, Tronnier, V, Mehdorn, HM, Volkmann, J, Deuschl, G, Krauss, JK
• Format: Article
• Language: English
• Subjects: Adult; Cluster headache; Cluster Headache - physiopathology; Cluster Headache - therapy; deep brain stimulation; Deep Brain Stimulation - methods; Deep Brain Stimulation - trends; Female; Follow-Up Studies; Humans; Hypothalamus; Hypothalamus, Posterior - physiology; Male; Middle Aged; pain modulation
• ISSN: 0333-1024; 1468-2982
• DOI: 10.1111/j.1468-2982.2007.01531.x

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 multi-centre trials will need to confirm this open-label experience and should help to better define predictive factors for non-responders.