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DOI: 10.1055/s-0038-1630023
Voraussetzungen für die hypothalamische Tiefenhirnstimulation bei Patienten mit chronischen Clusterkopfschmerzen
Hypothalamus deep-brain stimulation at patients with chronic cluster headachePublication History
Publication Date:
30 January 2018 (online)
Zusammenfassung
Clusterkopfschmerzen zeichnen sich durch eine stereotype Symptomatik aus und gehören zu den schwersten primären Schmerzsyndromen. Bildgebungsstudien haben funktionelle und strukturelle Veränderungen im ipsilateral zum Schmerz gelegenen inferior-posterioren Hypothalamus nachgewiesen. Diese Veränderungen sind sehr spezifisch für das Syndrom und legen nahe, dass diese anatomische Region als Auslöser oder Generator der akuten Attacken und/oder der akuten Schmerzperioden fungiert. Diese Befunde führten dazu, dass einige nicht oder nur sehr schwer therapierbare Patienten einer hypothalamischen Tiefenhirnstimulation unterzogen wurden. Bislang wurden 19 Patienten erfolgreich behandelt, resultierend in zum Teil lang anhaltenden schmerzfreien Perioden, ohne dass wesentliche Nebenwirkungen auftraten. Vor kurzem wurde allerdings auch über einen Patienten berichtet, der auf Grund eines Blutdruckanstieges und nachfolgender Ruptur eines zuvor nicht diagnostizierten Aneurysmas, nach der Operation verstarb. Der folgende Artikel bietet eine zusammenfassende Übersetzung kürzlich publizierter Kriterien einer internationalen Konsensusgruppe (1), die neben einem positiven Ethikvotum erfüllt sein sollten, bevor eine Stimulation des Hypothalamus bei solchen Patienten erwogen wird.
Summary
Cluster headaches show a stereotypic pathology and belong to the most severe primary pain syndromes. Imaging studies have proven functional and structural changes in the inferior-posterior hypothalamus. These changes are very specific for this syndrome and demonstrate that this anatomical region triggers and generates acute attacks and/or acute periods of pain. These results lead to deepbrain treatment of the hypothalamus region of patients, who were not treated or were difficult to treat. Until now, 19 patients have been treated successfully without any significant side effects. Recently, the case of a patient, who died following an operation because of increased blood pressure and rupture due to an undiagnosed aneurysm was reported. The following article gives an overview of recently published criteria of an international consensus group (1), which should be fulfilled, before a deep-brain stimulation can be considered in these patients.
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Literatur
- 1 Leone M. et al. Deep brain stimulation for intractable chronic cluster headache: proposals for patient selection. Cephalalgia 2004; 24: 934-7.
- 2 Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 2nd edition. Cephalalgia 2004; 24: 1-160.
- 3 Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias, SUNCT syndrome and other shortlasting headaches with autonomic feature, including new cases. Brain 1997; 120: 193-209.
- 4 May A, Evers S, Straube A, Pfaffenrath V, Diener H. Therapie und Prophylaxe von Clusterkopfschmerzen und anderen Trigemino-Autonomen Kopfschmerzen. Überarbeitete Empfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft. Nervenheilkunde 2004; 23: 478-90.
- 5 May A, Evers S, Limmroth V, Straube A. DGNLeitlinien. http://www.uni-duesseldorf.de/WWW/AWMF/awmf-frs.htm access December 2004
- 6 Dodick D, Rozen T, Goadsby P, Silberstein S. Cluster headache. Cephalalgia 2000; 20: 787-803.
- 7 May A, Leone M. Update on cluster headache. Curr Opin Neurol 2003; 16: 333-40.
- 8 Black D, Dodick DW. Two cases of medically and surgically intractable SUNCT: a reason for caution and an argument for a central mechanism. Cephalalgia 2002; 22: 201-4.
- 9 O’Brien M, Kirpatrick P, MacCabe J. Trigeminal nerve section for chronic migraine neuralgia. In: Cluster Headache and Related Conditions. Olesen J, Goadsby P. (eds.) Oxford: Oxford University Press; 1999: 291-5.
- 10 Matharu MS, Goadsby PJ. Persistence of attacks of cluster headache after trigeminal nerve root section. Brain 2002; 125: 976-84.
- 11 Donnet A, Valade D, Regis J. Gamma knife treatment for refractory cluster headache: prospective open trial. J Neurol Neurosurg Psychiatry 2005; 76: 218-21.
- 12 Sjaastad O. (ed.) Cluster Headache Syndrome. London: W B Saunders Company Ltd; 1992
- 13 Leone M, Bussone G. A review of hormonal findings in cluster headache. Evidence for hypothalamic involvement. Cephalalgia 1993; 13: 309-17.
- 14 Goadsby PJ, Bahra A, May A. Mechanisms of cluster headache. Cephalalgia 1999; 19 Suppl 23: 19-21
- 15 May A, Bahra A, Büchel C, Frackowiak RSJ, Goadsby PJ. Hypothalamic activation in cluster headache attacks. Lancet 1998; 352: 275-8.
- 16 May A, Ashburner J, Buchel C, McGonigle DJ, Friston KJ, Frackowiak RS, Goadsby PJ. Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med 1999; 5: 836-8.
- 17 Benabid AL, Pollak P, Gao D, Hoffmann D, Limousin P, Gay E, Payen I, Benazzouz A. Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg 1996; 84: 203-14.
- 18 Obeso JA, Rodriguez MC, Gorospe A, Guridi J, Alvarez L, Macias R. Surgical treatment of Parkinson’s disease. Baillieres Clin Neurol 1997; 6: 125-45.
- 19 Loher TJ, Hasdemir MG, Burgunder JM, Krauss JK. Long-term follow-up study of chronic globus pallidus internus stimulation for posttraumatic hemidystonia. J Neurosurg 2000; 92: 457-60.
- 20 Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med 2001; 345: 956-63.
- 21 Vesper J, Chabardes S, Fraix V, Sunde N, Ostergaard K. Dual channel deep brain stimulation system (Kinetra) for Parkinson’s disease and essential tremor: a prospective multicentre open label clinical study. J Neurol Neurosurg Psychiatry 2002; 73: 275-80.
- 22 Vesper J, Klostermann F, Wille C, Funk T, Brock M. Long-term suppression of extrapyramidal motor symptoms with deep brain stimulation (DBS). Zentralbl Neurochir 2004; 65: 117-22.
- 23 Nikkhah G, Prokop T, Hellwig B, Lucking CH, Ostertag CB. Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions. Report of two cases. J Neurosurg 2004; 100: 1079-83.
- 24 Leone M, Franzini A, Broggi G, May A, Bussone G. Long-term follow-up of bilateral hypothalamic stimulation for intractable cluster headache. Brain 2004; 127: 2259-64.
- 25 Schoenen J. et al. Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action. Brain 2005; 128: 940-7.
- 26 Tfelt-Hansen P. Prophylactic pharmacotherapy of cluster headache. In: Cluster Headache and related conditions. vol 9 Olesen J, Goadsby P. (eds.) Oxford, New York: Oxford University Press; 1999: 257-63.
- 27 Dodick D, Campbell K. Cluster Headache. Diagnosis, Management, and Treatment. In: Wolff’s Headache. Silberstein S, Lipton R, Dalessio D. (eds.) New York, Oxford: Oxford University Press; 2001: 283-309.
- 28 Dodick DW, Capobianco DJ. Treatment and management of cluster headache. Curr Pain Headache Rep 2001; 5: 83-91.
- 29 Leone M, D’Amico D, Frediani F, Moschiano F, Grazzi L, Attanasio A, Bussone G. Verapamil in the prophylaxis of episodic cluster headache: a double-blind study versus placebo. Neurology 2000; 54: 1382-5.
- 30 Gabai IJ, Spierings EL. Prophylactic treatment of cluster headache with verapamil. Headache 1989; 29: 167-8.
- 31 Leone M, Franzini A, Bussone G. Stereotactic stimulation of posterior hypothalamic gray matter in a patient with intractable cluster headache. N Engl J Med 2001; 345: 1428-9.