Deep brain stimulation to relieve drug‐resistant SUNCT

Leone, Massimo; Franzini, Angelo; D’Andrea, Giovanni; Broggi, Giovanni; Casucci, Gerardo; Bussone, Gennaro

doi:10.1002/ana.20507

Cited by 153 publications

(96 citation statements)

References 19 publications

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“…The outcome of the three patients was promising, with a significant and sustained decrease in attack frequency, respectively, at 18-month [37], 12-month [38] and 15-month follow-up [39].…”

Section: Deep Brain Stimulation Of the Posterior Hypothalamic Regionmentioning

confidence: 88%

SUNCT and SUNA: medical and surgical treatments

Lambru

Matharu

2013

Neurol Sci

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Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are rare and often disabling primary headache disorders. Their management can be challenging. The abortive therapies are not generally useful as the attacks are relatively short lasting. A myriad of pharmacological preventive treatments have been tried in single case reports or small series in an openlabel fashion. Lamotrigine, as an oral preventive treatment, and lidocaine, as an intravenous transitional treatment, seem to be the most effective therapies. For medically intractable chronic forms of SUNCT and SUNA, several surgical approaches have been tried. These include ablative procedures involving the trigeminal nerve or the Gasserian ganglion, microvascular decompression of the trigeminal nerve, and neurostimulation techniques. This review provides an overview of the current pharmacological and surgical options for SUNCT and SUNA syndromes.

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“…The outcome of the three patients was promising, with a significant and sustained decrease in attack frequency, respectively, at 18-month [37], 12-month [38] and 15-month follow-up [39].…”

Section: Deep Brain Stimulation Of the Posterior Hypothalamic Regionmentioning

confidence: 88%

SUNCT and SUNA: medical and surgical treatments

Lambru

Matharu

2013

Neurol Sci

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“…64 When the stimulator was turned off, without the patient's knowledge, the crises reappeared but gradually disappeared after it was turned back on. 64 Another drug-resistant SUNCT patient received ipsilateral hypothalamic implantation: the patient experienced an immediate 63% decrease in the mean number of attacks per day, and a progressive decline in attack frequency; at 12 months after implantation, daily attack frequency had stably reduced by 80%, relative to preoperative frequency. 65 Paroxysmal hemicrania is a rare trigeminal autonomic cephalalgia characterized by severe, unilateral, orbitalsupraorbital, or temporal pain attacks lasting 2-30 minutes and accompanied by ipsilateral craniofacial autonomic manifestations.…”

Section: Sunct Syndrome and Paroxysmal Hemicraniamentioning

confidence: 99%

Deep Brain Stimulation in Trigeminal Autonomic Cephalalgias

et al. 2010

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Summary:Cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome) are primary headaches grouped together as trigeminal autonomic cephalalgias (TACs). All are characterized by short-lived unilateral head pain attacks associated with oculofacial autonomic phenomena. Neuroimaging studies have demonstrated that the posterior hypothalamus is activated during attacks, implicating hypothalamic hyperactivity in TAC pathophysiology and suggesting stimulation of the ipsilateral posterior hypothalamus as a means of preventing intractable CH. After almost 10 years of experience, hypothalamic stimulation has proved successful in preventing pain attacks in approximately 60% of the 58 documented chronic drug-resistant CH patients implanted at various centers. Positive results have also been reported in drug-resistant SUNCT and PH. Microrecording studies on hypothalamic neurons are increasingly being performed and promise to make it possible to more precisely identify the target site. The implantation procedure has generally proved safe, although it carries a small risk of brain hemorrhage. Long-term stimulation is proving to be safe: studies on patients under continuous hypothalamic stimulation have identified nonsymptomatic impairment of orthostatic adaptation as the only noteworthy change. Studies on pain threshold in chronically stimulated patients show increased threshold for cold pain in the distribution of the first trigeminal branch ipsilateral to stimulation. When the stimulator is switched off, changes in sensory and pain thresholds do not occur immediately, indicating that long-term hypothalamic stimulation is necessary to produce sensory and nociceptive changes, as also indicated by clinical experience that CH attacks are brought under control only after weeks of stimulation. Infection, transient loss of consciousness, and micturition syncope have been reported, but treatment interruption usually is not required.

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“…An average reduction in seizure frequency of 67% (range 44-94%), was noted during the sham interval. Once the stimulators were turned on, a 49% (range 35-76%) reduction in seizure frequency was noted over the subsequent follow-up period (mean 43.8 months, range [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. In 1 patient the stimulator was inadvertently turned off during months 7-12, during which period the seizure frequency increased compared to baseline.…”

Section: Stimulation Of the Antmentioning

confidence: 99%

“…26,47,48 Although DBS of targets such as the thalamus, cerebellum, and locus ceruleus has been performed in patients with psychiatric disorders or spasticity who also had seizures, technical limitations have prevented it from becoming an appropriate treatment option for patients with epilepsy alone. 15,21,74,89 A resurgence of interest in DBS for epilepsy has arisen as a result of its successful use in movement disorders, as well as the technological improvements in the equipment.…”

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confidence: 99%

Deep brain stimulation for medically refractory epilepsy

Ellis¹,

Stevens²

2008

FOC

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Epilepsy is a chronic neurological disorder that affects 0.5–1% of the population. Up to one-third of patients will have incompletely controlled seizures or debilitating side effects of anticonvulsant medications. Although some of these patients may be candidates for resection, many are not. The desire to find alternative treatments for epilepsy has led to a resurgence of interest in the use of deep brain stimulation (DBS), which has been used quite successfully in movement disorders. Small pilot studies and open-label trials have yielded results that may support the use of DBS in selected patients with refractory seizures. Because of the diversity of regions involved with seizure initiation and propagation, a variety of targets for stimulation have been examined. Moreover, stimulation parameters such as amplitude, frequency, pulse duration, and continuous versus intermittent on vary from one study to the next. More studies are necessary to determine if there is an appropriate population of seizure patients for DBS, the optimal target, and the most efficacious stimulation parameters.

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Deep brain stimulation to relieve drug‐resistant SUNCT

Cited by 153 publications

References 19 publications

SUNCT and SUNA: medical and surgical treatments

SUNCT and SUNA: medical and surgical treatments

Deep Brain Stimulation in Trigeminal Autonomic Cephalalgias

Deep brain stimulation for medically refractory epilepsy

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