Abstract
Improvement in the biomedical and biotechnological research fields have allowed refinement of the neuromodulation approach in the treatment of a subgroup of medical disorders otherwise refractory to pharmacological treatment, such as chronic primary headaches. Chronic pain conditions imply central sensitisations and functional reorganisation that cannot be quickly or easily reversed. It appears evident that conventional treatment can sometimes be unsuccessful or only partially successful, and that relapse is common. Cluster headache (CH) is the most frequent trigeminal autonomic cephalalgia (TAC) and the most representative of this spectrum of disorders characterised by the association of headache and loco-regional signs and symptoms of facial parasympathetic activation. The striking features of circadian rhythmicity of attacks and circannual periodicity of cluster period, together with the neuroendocrine abnormalities, are suggestive of a neurochronobiological disorder with a central-diencephalic pathogenetic involvement, confirmed by direct evidence in functional neuroimaging studies of ipsilateral posterior hypothalamic activation during cluster attack. In 2000 these findings prompted a functional neurosurgery approach, with the first case of deep brain hypothalamic stimulation (DBS) in a severely disabled chronic CH patient. Since then, 18 implants in our centre and many others in different countries have been performed. Although the outcomes are encouraging, the invasive nature of the technique and the occurrence of rare but major adverse events have suggested a safer peripheral approach with occipital nerve stimulation (ONS).
| Original language | English |
|---|---|
| Journal | Neurological Sciences |
| Volume | 29 |
| Issue number | SUPPL. 1 |
| DOIs | |
| Publication status | Published - May 2008 |
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Keywords
- Cluster headache
- DBS
- Neurostimulation
- Occipital nerve
- ONS
- SUNCT
- TACs
ASJC Scopus subject areas
- Neuroscience(all)
- Clinical Neurology
Cite this
Long-term experience of neuromodulation in TACs. / Proietti Cecchini, Alberto; Mea, Eliana; Tullo, Vincenzo; Peccarisi, Cesare; Bussone, Gennaro; Leone, Massimo.
In: Neurological Sciences, Vol. 29, No. SUPPL. 1, 05.2008.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Long-term experience of neuromodulation in TACs
AU - Proietti Cecchini, Alberto
AU - Mea, Eliana
AU - Tullo, Vincenzo
AU - Peccarisi, Cesare
AU - Bussone, Gennaro
AU - Leone, Massimo
PY - 2008/5
Y1 - 2008/5
N2 - Improvement in the biomedical and biotechnological research fields have allowed refinement of the neuromodulation approach in the treatment of a subgroup of medical disorders otherwise refractory to pharmacological treatment, such as chronic primary headaches. Chronic pain conditions imply central sensitisations and functional reorganisation that cannot be quickly or easily reversed. It appears evident that conventional treatment can sometimes be unsuccessful or only partially successful, and that relapse is common. Cluster headache (CH) is the most frequent trigeminal autonomic cephalalgia (TAC) and the most representative of this spectrum of disorders characterised by the association of headache and loco-regional signs and symptoms of facial parasympathetic activation. The striking features of circadian rhythmicity of attacks and circannual periodicity of cluster period, together with the neuroendocrine abnormalities, are suggestive of a neurochronobiological disorder with a central-diencephalic pathogenetic involvement, confirmed by direct evidence in functional neuroimaging studies of ipsilateral posterior hypothalamic activation during cluster attack. In 2000 these findings prompted a functional neurosurgery approach, with the first case of deep brain hypothalamic stimulation (DBS) in a severely disabled chronic CH patient. Since then, 18 implants in our centre and many others in different countries have been performed. Although the outcomes are encouraging, the invasive nature of the technique and the occurrence of rare but major adverse events have suggested a safer peripheral approach with occipital nerve stimulation (ONS).
AB - Improvement in the biomedical and biotechnological research fields have allowed refinement of the neuromodulation approach in the treatment of a subgroup of medical disorders otherwise refractory to pharmacological treatment, such as chronic primary headaches. Chronic pain conditions imply central sensitisations and functional reorganisation that cannot be quickly or easily reversed. It appears evident that conventional treatment can sometimes be unsuccessful or only partially successful, and that relapse is common. Cluster headache (CH) is the most frequent trigeminal autonomic cephalalgia (TAC) and the most representative of this spectrum of disorders characterised by the association of headache and loco-regional signs and symptoms of facial parasympathetic activation. The striking features of circadian rhythmicity of attacks and circannual periodicity of cluster period, together with the neuroendocrine abnormalities, are suggestive of a neurochronobiological disorder with a central-diencephalic pathogenetic involvement, confirmed by direct evidence in functional neuroimaging studies of ipsilateral posterior hypothalamic activation during cluster attack. In 2000 these findings prompted a functional neurosurgery approach, with the first case of deep brain hypothalamic stimulation (DBS) in a severely disabled chronic CH patient. Since then, 18 implants in our centre and many others in different countries have been performed. Although the outcomes are encouraging, the invasive nature of the technique and the occurrence of rare but major adverse events have suggested a safer peripheral approach with occipital nerve stimulation (ONS).
KW - Cluster headache
KW - DBS
KW - Neurostimulation
KW - Occipital nerve
KW - ONS
KW - SUNCT
KW - TACs
UR - http://www.scopus.com/inward/record.url?scp=45249095604&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=45249095604&partnerID=8YFLogxK
U2 - 10.1007/s10072-008-0890-9
DO - 10.1007/s10072-008-0890-9
M3 - Article
C2 - 18545900
AN - SCOPUS:45249095604
VL - 29
JO - Neurological Sciences
JF - Neurological Sciences
SN - 1590-1874
IS - SUPPL. 1
ER -