2023-05-08 01:51:58
The Hospital Clnic de Barcelona demonstrates the usefulness of this technique in this indication, which is already used to treat epilepsy or symptoms associated with prkinson’s
A patient with cluster headache refractory to the usual treatments has undergone for the first time in Spain a deep brain stimulation. The results of the intervention, which has been carried out with an innovative technique, have been very good. Thus, after therapy, the patient has gone from presenting five episodes of intense headache a day to presenting none and no longer requiring medication.
The procedure, a pioneer in our country, has been carried out at the Hospital Clínic de Barcelona, which has extensive experience in the use of deep brain stimulation in other pathologies, such as prkinson’s disease or epilepsy. Every year he performs more than 50 interventions of this type.
Cluster headache is a very rare disease. Its prevalence is estimated to be one case per thousand inhabitants. However, it can be very disabling for those who suffer from it. Especially in those cases in which it becomes chronic, which happens in around 10% of all patients. This was the case of the 58-year-old patient who was treated at the Clínic with deep brain stimulation and who had not responded to any treatment for 10 years.
“Thanks to the research that has been done on this disease, we know that the hypothalamus is in some way the generator that sets off the crises. This led us to consider that inhibiting neural networks near the hypothalamus we could manage to control the activity of the hypothalamus and control the seizures”, explains Víctor Obach, neurologist of the multidisciplinary group of Celfalea and Facial Algia of the Clínic Institute of Neurosciences, who together with the neurologist Santiago Fernández and the neurosurgeon Pedro Roldán co-directed the neurostimulation of the hypothalamus. patient as compassionate treatment.
Inhibit the engine of crises
The use of deep brain stimulation is already well documented in other pathologies. In prkinson manages to control tremors and spasms involuntary that it causes and in epilepsy it serves to control the areas that trigger the seizures. Its effectiveness has also been seen in some neuropsychiatric disorders, such as affective bipolar.
“In the case of cluster headache, we saw that the area that caused the seizures was close to the hypothalamus, in the ventral tegmental area, specifically the mammillotegmental bundle, and we considered that if this circuit could be blocked, they could be blocked.” control crises“, aade Obach.
For this, a novel technique was used in which implanted the electrodes using computer-guided catheterswhile the patient underwent a scanner and an intraoperative resonance so that the surgeon who carried out the intervention could control the intervention at all times.
“Just in case, being the first time we performed this intervention In a patient with these characteristics, after placing the electrodes, we waited a month before starting the stimulation to allow the inflammation caused by the catheters to reduce, and we already saw that the crises decreased”, comments Víctor Obach, who points out that after starting with stimulation, these disappeared completely and the patient has been able to recover all his quality of life and that persists in these four months since the intervention.
The battery life problem
After brain stimulation, the patient has not resubmitted any episode and has not required rescue medication. He has reconciled his sleep, recovering the desire to do personal and social activities that he had abandoned, such as becoming a biker again. On the other hand, the implanted electrodes have begun to record his brain activity and it is hoped that relevant data will be able to be obtained that will make it possible to anticipate possible episodes in the near future. “This is also something new and it will allow us to obtain a lot of information about the mechanisms behind cluster headache crises,” adds the neurologist.
In this way, it is intended that brain stimulation may be discontinuous and that is carried out only when the possible crisis is detected. Likewise, possible side effects on the brain and its connections may be reduced, and the life of the implanted generator battery may be extended.
“Right now the battery, being in continuous operation, has a life of about five to. If we can get it to activate only when the crisis is about to occur, we hope that this duration can be doubled,” adds Obach, who points out that replacing the batteries is not a problem anyway, since they are placed accordingly. subcutaneously and its replacement does not require intervention in the brain.
Evidences for its implantation
The results achieved in this first patient are spectacular, achieving complete control of the seizures. In the Hospital Clnic they have also wanted to try what happens when the electrodes are disconnected. “This past Monday we did a first test after five months with the patient fully controlled. In the evening he began to present some of the symptoms that are related to the seizures, he had trouble falling asleep at night and the next morning he already had a major attack, which was repeated shortly after,” explains Obach, who adds that after resuming stimulation in just twelve hours, the crises disappeared.
This test demonstrates how brain stimulation truly controls cluster headache. Authorization has now been requested from the Catalan Health Service (CatSalut) to be able to carry out two annual interventions of this type. “We now have seven patients who could be candidates for this brain stimulation and who could benefit. I believe that brain stimulation should not be applied in any case to all patients with cluster headaches, but especially to those patients who are beginning to be chronic “, comments the expert, who adds that if they receive early treatment they could lead a completely normal life.
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