Miller, S;
Akram, H;
Lagrata, S;
Hariz, M;
Zrinzo, L;
Matharu, M;
(2016)
Ventral tegmental area deep brain stimulation in refractory short-lasting unilateral neuralgiform headache attacks.
Brain
, 139
pp. 2631-2640.
10.1093/brain/aww204.
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Abstract
Short-lasting unilateral neuralgiform headache attacks are primary headache disorders characterized by short-lasting attacks of unilateral pain accompanied by autonomic features. A small minority are refractory to medical treatment. Neuroimaging studies have suggested a role of the posterior hypothalamic region in their pathogenesis. Previous case reports on deep brain stimulation of this region, now understood to be the ventral tegmental area, for this disorder are limited to a total of three patients. We present a case series of 11 new patients treated with ventral tegmental area deep brain stimulation in an uncontrolled, open-label prospective observational study. Eleven patients with refractory short-lasting unilateral neuralgiform headache attacks underwent ipsilateral ventral tegmental area deep brain stimulation in a specialist unit. All patients had failed, or been denied access to, occipital nerve stimulation within the UK’s National Health Service. Primary endpoint was change in mean daily attack frequency at final follow-up. Secondary outcomes included attack severity, attack duration, headache load (a composite score of attack frequency, severity and duration), quality of life measures, disability and affective scores. Information was also collected on adverse events. Eleven patients (six male) with a median age of 50 years (range 26–67) were implanted between 2009 and 2014. Median follow-up was 29 months (range 7–63). At final follow-up the median improvement in daily attack frequency was 78% (interquartile range 33%). Response rate (defined as at least a 50% improvement in daily attack frequency) was 82% and four patients were rendered pain-free for prolonged periods of time. Headache load improved by 99% (interquartile range 52%). Improvements were observed in a number of quality of life, disability and affect measures. Adverse events included mild incision site pain, subcutaneous displacement of the implantable pulse generator, transient oscillopsia and minor wound infection. One patient required removal of the system due to wound infection. Ventral tegmental area deep brain stimulation may be an effective treatment option for refractory short-lasting unilateral neuralgiform headache attack patients who have failed other therapies.
Type: | Article |
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Title: | Ventral tegmental area deep brain stimulation in refractory short-lasting unilateral neuralgiform headache attacks |
Open access status: | An open access version is available from UCL Discovery |
DOI: | 10.1093/brain/aww204 |
Publisher version: | http://dx.doi.org/10.1093/brain/aww204 |
Additional information: | This is a pre-copyedited, author-produced PDF of an article accepted for publication in Brain following peer review. The version of record Miller, S; Akram, H; Lagrata, S; Hariz, M; Zrinzo, L; Matharu, M; (2016) Ventral tegmental area deep brain stimulation in refractory short-lasting unilateral neuralgiform headache attacks. Brain, 139 pp. 2631-2640 is available online at: http://dx.doi.org/10.1093/brain/aww204. |
Keywords: | Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Neurosciences, Neurosciences & Neurology, SUNCT, SUNA, trigeminal autonomic cephalalgia, neuromodulation, deep brain stimulation |
UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases |
URI: | https://discovery.ucl.ac.uk/id/eprint/1508383 |
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