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Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
Published on: May 10, 2017
Deep brain stimulation in trigeminal autonomic cephalalgias
Massimo Leone1, Angelo Franzini, Alberto Proietti Cecchini
1Headache Center, Neuromodulation Unit, Department of Neurology, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milan, Italy. leone@istituto-besta.it
Summary
Deep brain stimulation of the posterior hypothalamus effectively prevents pain attacks in approximately 60% of chronic cluster headache (CH) patients. This treatment also shows promise for SUNCT syndrome and paroxysmal hemicrania, with long-term safety established.
Area of Science:
- Neurology
- Neurosurgery
- Pain Medicine
Background:
- Trigeminal autonomic cephalalgias (TACs), including cluster headache (CH), paroxysmal hemicrania (PH), and SUNCT syndrome, involve short unilateral head pain with autonomic symptoms.
- Neuroimaging implicates posterior hypothalamic hyperactivity in TAC pathophysiology.
Purpose of the Study:
- To evaluate the efficacy and safety of posterior hypothalamic stimulation for intractable primary headaches.
- To investigate the long-term effects of hypothalamic stimulation on pain perception and autonomic function.
Main Methods:
- Surgical implantation of electrodes in the posterior hypothalamus for chronic stimulation.
- Clinical assessment of pain attack frequency and severity.
- Evaluation of sensory and pain thresholds, and orthostatic adaptation.
Main Results:
- Posterior hypothalamic stimulation prevented pain attacks in approximately 60% of 58 chronic drug-resistant CH patients.
- Positive outcomes were also observed in drug-resistant SUNCT and PH cases.
- Long-term stimulation demonstrated safety, with the primary noted change being nonsymptomatic impairment of orthostatic adaptation. Increased cold pain threshold observed ipsilaterally.
Conclusions:
- Posterior hypothalamic stimulation is an effective treatment for intractable cluster headache and shows potential for other TACs.
- The procedure is generally safe, with long-term stimulation well-tolerated and leading to beneficial sensory changes.
