Ventral tegmental area deep brain stimulation for refractory chronic cluster headache
Ventral tegmental area deep brain stimulation for refractory chronic cluster headache
复制标题
DOI：
10.1212/wnl.0000000000002632
复制
发表时间：
2016-05-03
期刊：
影响因子：
9.9
通讯作者：
Zrinzo, Ludvic
中科院分区：
文献类型：
--
作者：
Akram, Harith;Miller, Sarah;Zrinzo, Ludvic
目的：介绍一组难治性慢性丛集性头痛（CCH）患者接受腹侧被盖区（VTA）脑深部电刺激（DBS）治疗的结局：在一项非对照开放标签前瞻性研究中，21例难治性CCH患者（17例男性;平均年龄52岁）由包括头痛神经科医生和功能神经外科医生在内的多学科专家团队选择进行同侧VTA-DBS。在英国国家卫生服务体系内，患者也未能或被拒绝接受枕神经刺激。主要终点是头痛频率的改善。次要结果包括其他头痛评分（严重程度，持续时间，头痛负荷），药物使用，残疾和情感评分，生活质量（QoL）的措施，和adverse events.Results：中位数随访18个月（范围4-60个月）。在最终随访时，头痛频率改善60%（p = 0.007），头痛严重程度改善30%（p = 0.001）。头痛负荷（包括发作频率、严重程度和持续时间的综合评分）改善了68%（p = 0.002）。治疗后，该组每月总曲坦摄入量下降了57%。在许多生活质量、残疾和情绪量表中观察到显著改善。副作用包括复视，2例患者在刺激调整后复视消退，1例患者持续存在同侧滑车神经麻痹病史。有没有其他严重的不良事件。结论：这项研究支持，VTA-DBS可能是一种安全有效的治疗难治性CCH患者谁failedconventional treatments.Classification的证据：这项研究提供了IV级证据，VTA-DBS降低头痛的频率，严重程度和头痛负荷的患者在医学上顽固性慢性丛集性头痛。
Objective: To present outcomes in a cohort of medically intractable chronic cluster headache (CCH) patients treated with ventral tegmental area (VTA) deep brain stimulation (DBS).Methods: In an uncontrolled open-label prospective study, 21 patients (17 male; mean age 52 years) with medically refractory CCH were selected for ipsilateral VTA-DBS by a specialist multidisciplinary team including a headache neurologist and functional neurosurgeon. Patients had also failed or were denied access to occipital nerve stimulation within the UK National Health Service. The primary endpoint was improvement in the headache frequency. Secondary outcomes included other headache scores (severity, duration, headache load), medication use, disability and affective scores, quality of life (QoL) measures, and adverse events.Results: Median follow-up was 18 months (range 4-60 months). At the final follow-up point, there was 60% improvement in headache frequency (p = 0.007) and 30% improvement in headache severity (p = 0.001). The headache load (a composite score encompassing frequency, severity, and duration of attacks) improved by 68% (p = 0.002). Total monthly triptan intake of the group dropped by 57% posttreatment. Significant improvement was observed in a number of QoL, disability, and mood scales. Side effects included diplopia, which resolved in 2 patients following stimulation adjustment, and persisted in 1 patient with a history of ipsilateral trochlear nerve palsy. There were no other serious adverse events.Conclusions: This study supports that VTA-DBS may be a safe and effective therapy for refractory CCH patients who failed conventional treatments.Classification of evidence: This study provides Class IV evidence that VTA-DBS decreases headache frequency, severity, and headache load in patients with medically intractable chronic cluster headaches.