Deep Brain Stimulation for Chronic Cluster Headache: Meta-Analysis of Individual Patient Data.

Nowacki, Andreas; Schober, Martin; Nader, Lydia; Saryyeva, Assel; Nguyen, Thuy-Anh Khoa; Green, Alexander L; Pollo, Claudio; Krauss, Joachim K; Fontaine, Denys; Aziz, Tipu Z (2020). Deep Brain Stimulation for Chronic Cluster Headache: Meta-Analysis of Individual Patient Data. Annals of neurology, 88(5), pp. 956-969. Wiley-Blackwell 10.1002/ana.25887

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OBJECTIVE

Deep brain stimulation (DBS) is a treatment option for refractory chronic cluster headache (CCH). Despite several recent prospective case series reporting a good outcome, the effectiveness and the optimal stimulation target of DBS for CCH remain unclear. We aimed to obtain precise estimates and predictors of long-term pain relief in an individual patient data meta-analysis. Furthermore, we aimed to construct a probabilistic stimulation map of effective DBS.

METHODS

We invited investigators of published cohorts of patients undergoing DBS for CCH, identified by a systematic review of MEDLINE from inception to Febuary 15, 2019, to provide individual patient data on baseline covariates, pre- and postoperative headache scores at median (12-month) and long-term follow-up, in addition to individual imaging data to obtain individual electrode positions. We calculated a stimulation map using voxel-wise statistical analysis. We used multiple regression analysis to estimate predictors of pain relief.

RESULTS

Among 40 patients from four different cohorts representing ~50% of all previously published cases, we found a significant 77% mean reduction in headache attack frequency over a mean follow-up of 44 months, with an overall response rate of 75%. Positive outcome was not associated with baseline covariates. We identified 2 hotspots of stimulation covering the midbrain ventral and retrorubral tegmentum.

INTERPRETATION

This study supports the hypothesis that DBS provides long-term pain relief for the majority of CCH patients. Our stimulation map of the region of influence of therapeutic DBS identified an optimal anatomical target site that can help surgeons to guide their surgical planning in the future. ANN NEUROL 2020.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Nowacki, Andreas; Nguyen, Thuy Anh Khoa and Pollo, Claudio

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0364-5134

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Nicole Söll

Date Deposited:

09 Oct 2020 15:08

Last Modified:

24 Oct 2020 01:36

Publisher DOI:

10.1002/ana.25887

PubMed ID:

32827225

BORIS DOI:

10.7892/boris.146899

URI:

https://boris.unibe.ch/id/eprint/146899

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