Ventral tegmental area deep brain stimulation for chronic cluster headache: Effects on cognition, mood, pain report behaviour and quality of life

Abstract

Background Deep brain stimulation in the ventral tegmental area (VTA-DBS) has provided remarkable therapeutic benefits in decreasing headache frequency and severity in patients with medically refractory chronic cluster headache (CH). However, to date the effects of VTA-DBS on cognition, mood and quality of life have not been examined in detail. Methods The aim of the present study was to do so in a case series of 18 consecutive patients with cluster headache who underwent implantation of deep brain stimulation electrodes in the ventral tegmental area. The patients were evaluated preoperatively and after a mean of 14 months of VTA-DBS on tests of global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis–Kaplan Executive Function System), and attention (Paced Auditory Serial Addition Test). Depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), and hopelessness (Beck Hopelessness Scale) were also assessed. Subjective pain experience (McGill Pain Questionnaire), behaviour (Pain Behaviour Checklist) and quality of life (Short Form-36) were also evaluated at the same time points. Results VTA-DBS resulted in significant improvement of headache frequency (from a mean of five to two attacks daily, p < .001) and severity (from mean Verbal Rating Scale [VRS] of 10 to 7, p < .001) which was associated with significant reduction of anxiety (from mean HADS-A of 11.94 to 8.00, p < .001) and help-seeking behaviours (from mean PBC of 4.00 to 2.61, p < .001). VTA-DBS did not produce any significant change to any tests of cognitive function and any other outcome measures (BDI, HADS-D, SAS, BHS, McGill Pain Questionnaire, Short Form-36). Conclusion We confirm the efficacy of VTA-DBS in the treatment of medically refractory chronic cluster headache. The reduction of headache frequency and severity was associated with a significant reduction of anxiety. Furthermore, the result suggests that VTA-DBS for chronic cluster headache improves pain-related help-seeking behaviours and does not produce any change in cognition.

Disability, Quality of Life, and Socioeconomic Burden of Cluster Headache: A Critical Review of Current Evidence and Future Perspectives

“…Seven studies have tested QoL in CH using the Medical Outcome Study Short Form, 36 and 12‐item version (SF‐36 and SF‐12) . The SF‐36 comprises 8 scales that can be summed up into 2 composite scores.…”

“…In the study by Ertsey and colleagues, ECH patients had lower, that is, poorer, scores in all the SF‐36 domains compared to controls and migraine patients, with a significant difference for SF‐36 domains evaluating bodily pain and social functioning. Cappon and colleagues evaluated patients with CCH before and after ventral tegmental area deep brain stimulation, reporting scores of the single 8 scales, but not the 2 composite scores (PCS and MCS) . The results showed an improvement in almost all scales (approximately by 24%), reaching statistical significance in social role functioning and emotional wellbeing.…”

“…Cappon and colleagues evaluated patients with CCH before and after ventral tegmental area deep brain stimulation, reporting scores of the single 8 scales, but not the 2 composite scores (PCS and MCS). 16 The results showed an improvement in almost all scales (approximately by 24%), reaching statistical significance in social role functioning and emotional wellbeing. With regard to the MSQ, patients reported the following scores: role-restriction (RR = 39.6), role-prevention (RP = 52.2), and emotional function (EF = 51.0).…”

“…Seven studies have tested QoL in CH using the Medical Outcome Study Short Form, 36 and 12-item version (SF-36 and SF-12). [10][11][12][13][14][15][16] The SF-36 17 comprises 8 scales that can be summed up into 2 composite scores. The first addresses physical health issues (eg, pain, general health, or ability to undertake physical activities), while the second addresses mental health issues (eg, vitality, emotional state and mental health).…”

Changes in Physiological and Pathological Behaviours Produced by Deep Microelectrode Implantation Surgery in Rats: A Temporal Analysis

“…Physiological behaviours such as the sleep-wake cycle and exploratory behaviours are important parameters in intact and sham-operated animals and are usually thought to be unaffected by experimental protocols in which neurosurgery is performed. However, there is insufficient evidence in the literature on the behavioural and cognitive effects observed after deep microelectrode implantation surgery in animal models of neurological diseases compared with studies carried out in patients with various brain pathologies [1,2]. In addition, most existing studies emphasize the morphological and molecular findings after surgery, such as inflammatory response, blood brain barrier disruption, or even fine motor deficit in control versus experimental animals without regard to physiological behaviours [3][4][5][6][7][8][9].…”