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Success, failure, and putative mechanisms in hypothalamic stimulation for drug-resistant chronic cluster headache.
MedLine Citation:
PMID:  23103434     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Drug-resistant chronic cluster headache (CH) is an unremitting illness with excruciatingly severe headaches that occur several times daily. Starting in 2000, a total of 19 patients with long-lasting chronic CH, with multiple daily attacks unresponsive to all known prophylactics, received stimulation of the posterior inferior hypothalamic area ipsilateral to the pain as treatment. We report long-term follow-up (median 8.7years, range 6-12years) in 17 patients. Long-lasting improvement occurred in 70% (12 of 17): 6 are persistently almost pain-free; another 6 no longer experience daily attacks but rather episodic CH interspersed with long-lasting remissions. In 5 of 6 almost pain-free patients, the stimulators have been off for a median of 3years (range 3-4years). Five patients did not improve: 4 had bilateral CH, and 3 developed tolerance after experiencing relief for 1-2years. Adverse events are electrode displacement (n=2), infection (electrode n=3; generator n=1), electrode malpositioning (n=1), transient nonsymptomatic third ventricle hemorrhage (n=1), persistent slight muscle weakness on one side (n=1), and seizure (n=1). This exceptionally long follow-up shows that hypothalamic stimulation for intractable chronic CH produces long-lasting improvement in many patients. Previous experience was limited to a median of 16months. Important new findings are as follows: stimulation is well tolerated for many years after implantation; after several years during which stimulation was necessary for relief, a persistent almost pain-free condition can be maintained when stimulation is off, suggesting that hypothalamic stimulation can change disease course; tolerance can occur after marked long-lasting improvement; and bilateral chronic CH seems to predict poor response to hypothalamic stimulation.
Authors:
Massimo Leone; Angelo Franzini; Alberto Proietti Cecchini; Gennaro Bussone
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-29
Journal Detail:
Title:  Pain     Volume:  -     ISSN:  1872-6623     ISO Abbreviation:  Pain     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-10-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7508686     Medline TA:  Pain     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Affiliation:
Department of Neurology, Headache Centre and Pain Neuromodulation Unit, Fondazione Istituto Nazionale Neurologico Carlo Besta, Milano, Italy. Electronic address: leone@istituto-besta.it.
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