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Hypothalamische Tiefenhirnstimulation bei Patienten mit chronischen Cluster-Kopfschmerzen

Vorschläge zur Patientenselektion

Hypothalamic deep brain stimulation in patients with chronic cluster headaches

Suggestions for patient selection

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Zusammenfassung

Cluster-Kopfschmerzen zeichnen sich durch eine stereotype Symptomatik aus und gehören zu den schwersten primären Schmerzsyndromen. Bildgebungsstudien haben funktionelle und strukturelle Veränderungen im ipsilateral zum Schmerz gelegenen inferior-posterioren Hypothalamus nachgewiesen. Diese Veränderungen sind sehr spezifisch für das Syndrom und legen nahe, dass diese anatomische Region als Auslöser oder Generator der akuten Attacken und/oder der akuten Schmerzperioden fungiert. Diese Befunde führten dazu, dass einige nicht oder nur sehr schwer therapierbare Patienten einer hypothalamischen Tiefenhirnstimulation unterzogen wurden. Bislang wurden 19 Patienten erfolgreich behandelt, resultierend in z. T. lang anhaltenden schmerzfreien Perioden, ohne dass wesentliche Nebenwirkungen auftraten. Vor kurzem wurde allerdings auch über einen Patienten berichtet, der aufgrund eines Blutdruckanstiegs und nachfolgender Ruptur eines zuvor nicht diagnostizierten Aneurysmas nach der Operation verstarb. Der vorliegende Artikel bietet eine zusammenfassende Übersetzung kürzlich publizierter Kriterien einer internationalen Konsensusgruppe, die neben einem positiven Ethikvotum erfüllt sein sollten, bevor eine Tiefenhirnstimulation des Hypothalamus bei solchen Patienten erwogen wird.

Abstract

Cluster headaches involve a stereotypic symptomatic and belong to the most severe primary pain syndromes. Imaging studies have demonstrated functional and structural changes in the inferior-posterior hypothalamus ipsilateral to the pain. These changes are highly specific to the syndrome, strongly suggesting that this anatomical region is the trigger or generator of the acute attacks and/or determine the duration of the acute pain. These findings have led to the successful therapy of 19 not or difficult to treat patients with hypothalamic deep brain stimulation, resulting in long-term periods without pain and without significant side effects. Recently, however, a patient was reported who died after the operation due to increased blood pressure leading to the rupture of a previously non-diagnosed aneurysm. This article offers a translated summary of the recently published criteria of an international consensus group, which, in addition to a positive ethics vote, should be fulfilled before such deep brain stimulation of the hypothalamus is carried out in such patients.

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Authors and Affiliations

  1. Neurologische Universitätsklinik Hamburg Eppendorf (UKE)

    A. May

  2. Abteilung Stereotaktische Neurochirurgie Freiburg

    J. Vesper & G. Nikkhah

  3. Neurologische Universitätsklinik Hamburg Eppendorf (UKE)

    W. Hamel & M. Westphal

  4. Neurologische Universitätsklinik Freiburg

    C. Weiller

  5. Institut für systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg

    A. May

Authors
  1. A. May
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  2. J. Vesper
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  3. W. Hamel
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  4. M. Westphal
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  5. C. Weiller
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  6. G. Nikkhah
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Correspondence to A. May.

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May, A., Vesper, J., Hamel, W. et al. Hypothalamische Tiefenhirnstimulation bei Patienten mit chronischen Cluster-Kopfschmerzen. Schmerz 19, 544–548 (2005). https://doi.org/10.1007/s00482-005-0443-6

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  • DOI: https://doi.org/10.1007/s00482-005-0443-6

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