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Topic: Chronic CH--recent treatment development (Read 285 times) |
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Bob_Johnson
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Chronic CH--recent treatment development
« on: Jul 9th, 2003, 7:07am » |
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From: www.medscape.com
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Deep Brain Stimulation May Benefit Refractory Cluster Headache, OCD
Laurie Barclay, MD
April 28, 2003 — The benefits of deep brain stimulation (DBS) may be extended to two more conditions that are not adequately treated medically, according to two oral presentations at the American Association of Neurological Surgeons annual meeting in San Diego, California.
Stimulating the inferior posterior hypothalamic gray matter offered complete relief from the pain of cluster headaches in a group of patients who were refractory to medical therapy. Preliminary results of a second trial suggest that bilateral DBS of the anterior limb of the internal capsule may be promising in obsessive-compulsive disorder (OCD).
"The management of cluster headache should be primarily medical and nonsurgical," presenter Giovanni Broggi, MD, says in a news release. "Since the results of surgery for the treatment of medically intractable cluster headache remain, to this day, very disappointing, alternative strategies for this devastating problem are needed."
Ten patients with intractable, chronic cluster headache as defined by the International Headache Society had nine electrodes surgically implanted in the posterior hypothalamus. Conservative management consisted of single or combination therapy with corticosteroids, lithium, methysergide, ergotamine, calcium channel blockers, beta-blocking agents, tricyclic antidepressants, melatonin, or nonsteroidal anti-inflammatory drugs.
During long-term high-frequency hypothalamic stimulation, all of the patients experienced complete pain relief that continued during the study and through the follow-up evaluation. Over an average period of more than four weeks, there was a progressive reduction in the number of daily attacks until the symptoms completely disappeared.
All of the patients were pain-free at follow-up intervals of two to 26 months, and most were able to discontinue or to decrease medications significantly. Typical attacks recurred when the stimulator was switched off and resolved when it was switched on again.
There were no adverse effects reported from chronic high-frequency hypothalamic stimulation and no complications from the implantation procedure.
"The hypothalamic stimulation treatment is a safe and effective alternative for treatment of drug-resistant chronic cluster headaches," says second author Angelo Franzini, MD. "The procedure does not cause any of the unwanted side effects associated with surgical procedures."
A second presentation revealed preliminary results from a multicenter prospective trial of bilateral DBS in 15 severely disabled patients with OCD refractory to prolonged medication and behavioral therapy. Average age of onset of OCD was 14 years, and average age of DBS implantation in the anterior limb of the internal capsule was 36 years.
Overall, patients experienced an improved quality of life during DBS, but not all effects were positive. Some patients reported mood elevation, acute depression, hypomania, anxiety reduction, decreased OCD symptoms, increased alertness and energy, memory flashbacks, irritability, muscle contractions, epigastric and olfactory sensations, nausea, vomiting, visual changes, facial paresthesias, and tachycardia.
"DBS has the advantage of being reversible and adjustable and is now routinely used for the treatment of refractory movement disorders," says lead author Ali R. Rezai, MD, from the Cleveland Clinic Foundation in Ohio. "This treatment holds promise for the ongoing treatment of intractable obsessive compulsive disorder."
AANS Annual Meeting: Abstract 731, presented April 28, 2003; abstract 761, presented April 29, 2003.
Reviewed by Gary D. Vogin, MD
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Bob Johnson
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BobG
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Re: Chronic CH--recent treatment development
« Reply #1 on: Jul 9th, 2003, 12:18pm » |
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Thanks for the info Bob. Very interesting.
Note to the newer people here that may not know about Bob Johnson. He's been here a long time and has done more "digging" and searching for information on clusters than probably anyone here.
Click on this from the archives:
http://www.clusterheadaches.com/wwwboard/messages2/117016.html
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Stay stressed. Never relax. Never sleep. Ever.
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firebrix
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Re: Chronic CH--recent treatment development
« Reply #2 on: Jul 9th, 2003, 11:14pm » |
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Thank you Bob_Johnson for this encouraging info.
It is news like this that chronics really need.
That light at the end of the tunnel, which is NOT the train allows a little hope.
Thank you
firebrix
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"All that it takes for the triumph of evil is for good men to do nothing."
Edmund Burke
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