Ventral tegmental area deep brain stimulation for refractory chronic cluster headache

Akram, Harith; Miller, Sarah; Lagrata, Susie; Hyam, Jonathan A.; Jahanshahi, Marjan; Hariz, Marwan; Matharu, Manjit; Zrinzo, Ludvic

doi:10.1212/wnl.0000000000002632

Cited by 86 publications

(105 citation statements)

References 35 publications

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“…We note that some of these studies were performed on medically refractory CH patients . 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.…”

Section: Resultsmentioning

confidence: 95%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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). Three studies used the European Quality of Life assessment – Visual Analog Scale (EuroQoL‐VAS) . The EuroQoL‐VAS is a generic instrument for describing and valuing health, and covers 5 domains (mobility, self‐care, usual activities, pain/discomfort, and depression/anxiety) that constitute a single composite score and also includes a visual analog scale addressing “current health state.” One study evaluated CH‐related QoL using a migraine‐specific questionnaire, the Migraine‐Specific Quality of Life (MSQ) .…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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Objective To summarize the available evidence on disability, quality of life (QoL), and economic burden on societies of cluster headache (CH), and to present which tools have been used to measure these domains with indications for future research. Background CH is a rare and severe primary headache. The focus of research on this disorder has historically been on understanding its complex pathophysiological mechanisms, whereas personal and global healthcare impact, disability, and QoL received little attention. Methods We reviewed the available literature published up to 2019, identifying primary research addressing QoL, disability, impact, or impairment in daily life due to episodic CH (ECH) or chronic CH (CCH), and its societal impact. Results CH produces a significant impact on sufferers QoL, disability, and work‐related aspects, with a stronger impact on CCH than ECH. The CH‐related disability appears to be greater than is seen in subjects with other primary headache disorders. Conclusions Information about patient‐reported outcomes is rarely collected in patients with CH. An effort to improve the amount of information on the lived experience of patients with CH is needed and CH‐specific disability and QoL measures require development.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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“…During the 2 months of crossover blind study they did not find significant differences between the 2 groups, but in the later open phase (10 months) 6 out of 11 patients had more than 50% improvement, including 3 patients who became pain free [22]. Akram et al [23] reported 60% improvement in headache frequency and 30% improvement in headache severity in an open label series of 21 patients. In our series, all of the patients improved in terms of the number and duration of pain attacks.…”

Section: Discussionmentioning

confidence: 94%

“…Fontaine et al [10] believe that the active contacts are located in a bridging zone between the hypothalamus and the mesencephalic gray matter, and Clelland et al [11] believe that they are located in the gray matter of the mesencephalic tegmentum. Akram et al [23] also place their target at the mesencephalic tegmentum, just anterior to the nucleus ruber. Most of the authors agree that the trigeminal autonomic reflex (TAR) plays an important role in the pathophysiology of CH [26].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Deep Brain Stimulation of the Mamillotegmental Fasciculus in Chronic Cluster Headache

Seijo-Fernández¹,

Sáiz

Santamarta

et al. 2018

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) and the proper target for chronic cluster headache (CCH) are still subjects of controversy. Objectives: We present our long-term results of analysis of the target and its structural connectivity. Methods: Fifteen patients with drug-resistant CCH underwent DBS in coordinates 4 mm lateral to the III ventricular wall and 2 mm behind and 5 mm below the intercommissural point. The clinical parameters recorded were the number of weekly attacks, pain intensity, and duration of the headache. Structural connectivity was studied using 3-T MR diffusion tensor imaging (DTI). Results: All of our patients improved from a mean of 39 attacks/week to 2; pain intensity decreased from 9 to 3 out of 10, and the mean cephalalgia duration decreased from 53 to 8 min. The mean stereotactic coordinates of the effective contact location were 6.1 mm lateral to the midcommissural point and 1.2 mm behind and 4.0 mm below the intercommissural point. DTI analysis showed that this target was connected to tracts and nuclei of the posterior mesencephalic tegmentum, specifically the dorsal longitudinal and mamillotegmental fasciculi. Conclusions: Our data showed DBS to be a safe and useful procedure for the treatment of drug-resistant CCH; the rate of improvement was higher than those found in other series. Although these are promising results, larger series targeting those fasciculi with a longer follow-up are needed.

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Deep Brain Stimulation for Chronic Cluster Headache: Meta‐Analysis of Individual Patient Data

Nowacki

Schöber

Nader

et al. 2020

Annals of Neurology

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Objective: Deep brain stimulation (DBS) is a treatment option for refractory chronic cluster headache (CCH). Despite several recent prospective case series reporting a good outcome, the effectiveness and the optimal stimulation target of DBS for CCH remain unclear. We aimed to obtain precise estimates and predictors of long-term pain relief in an individual patient data meta-analysis. Furthermore, we aimed to construct a probabilistic stimulation map of effective DBS. Methods: We invited investigators of published cohorts of patients undergoing DBS for CCH, identified by a systematic review of MEDLINE from inception to Febuary 15, 2019, to provide individual patient data on baseline covariates, pre-and postoperative headache scores at median (12-month) and long-term follow-up, in addition to individual imaging data to obtain individual electrode positions. We calculated a stimulation map using voxel-wise statistical analysis. We used multiple regression analysis to estimate predictors of pain relief. Results: Among 40 patients from four different cohorts representing 50% of all previously published cases, we found a significant 77% mean reduction in headache attack frequency over a mean follow-up of 44 months, with an overall response rate of 75%. Positive outcome was not associated with baseline covariates. We identified 2 hotspots of stimulation covering the midbrain ventral and retrorubral tegmentum. Interpretation: This study supports the hypothesis that DBS provides long-term pain relief for the majority of CCH patients. Our stimulation map of the region of influence of therapeutic DBS identified an optimal anatomical target site that can help surgeons to guide their surgical planning in the future.

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Ventral tegmental area deep brain stimulation for refractory chronic cluster headache

Abstract: This study provides Class IV evidence that VTA-DBS decreases headache frequency, severity, and headache load in patients with medically intractable chronic cluster headaches.

Cited by 86 publications

References 35 publications

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

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

Long-Term Results of Deep Brain Stimulation of the Mamillotegmental Fasciculus in Chronic Cluster Headache

Deep Brain Stimulation for Chronic Cluster Headache: Meta‐Analysis of Individual Patient Data

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