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        New Message Board Archives >> Medications, Treatments, Therapies 2002 >> CH as presented at the Am Academy of Neuro
        
(Message started by: dougW on May 29^th, 2002, 8:38pm)

Title: CH as presented at the Am Academy of Neuro
Post by dougW on May 29^th, 2002, 8:38pm

As presented at the 54th Annual Meeting of the American Academy of Neurology

April 13 - 20, 2002, Denver, Colorado

I've cut this from the presentation on Headaches and included the references. Dr. Leone is an OUCH member in Italy. He has conducted several studies on CH.

Enjoy
Doug Wright

Cluster Headache

Cluster headache is the most severe and debilitating of the primary headaches. It can have a chronic course and be unresponsive to medication. Positron emission tomography (PET) has shown that the inferior posterior hypothalamic gray matter homolateral to the pain is activated during cluster headache attacks.[4] A voxel-based morphometric magnetic resonance imaging (MRI) study also demonstrated changes in the same area in patients with cluster headache.[5] This suggests that the cluster headache generator is located in this region.
Leone and associates[6] reasoned that high-frequency electrical stimulation of this area might prevent activation during cluster headache and thus relieve intractable forms of the disorder. They previously reported success with 1 severely compromised patient.[7] At this meeting, they presented preliminary results and follow up of 4 patients with severe, intractable, chronic cluster headache. They implanted stereotactic electrodes into the hypothalami of 4 patient, for a total of 5 implants in 4 patients (3 men, 1 woman, mean age 51.2 years, range 39-63 years). All had International Headache Society (IHS) chronic cluster headache, with 1 being bilateral. MRI and angio-MRI ruled out secondary causes for their headaches. Mean illness duration was 7 years (range 3-9 years), with an average of 7 attacks per day.

All patients have been completely free of headache attacks after a mean of 7.8 months (range 1-16 months). Two patients (including 1 who received bilateral implants) required no add-on pharmacologic therapy; 1 patient required methysergide (3 mg/day); and the most recently operated patient is being tapered from dexamethasone.

The stimulator was switched off 3 times in 1 patient, and once in another patient. On 3 occasions, pain reappeared within 48 hours, but on the other, it reappeared after 23 days. When stimulation was restarted, the pain disappeared twice in less than 24 hours and twice after 10 days. All 4 patients have normal blood pressure, heart rate, electrolyte balance, hormone levels, and behavior. In this study, hypothalamic stimulation was well tolerated and may be a treatment option for intractable chronic cluster headache.

References:

4) May A, Bahra A, Buchel C, Frackowiak RS, Goadsby PJ. Hypothalamic activation in cluster headache attacks. Lancet. 1998;352:275-278.
5) May A, Ashburner J, Buchel C, et al. Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nature Med. 1999;5:836-838.
6) Leone M, Franzini A, Amico DD, et al. Preliminary results and followup of stereotactic electrode implant in posterior hypothalamic gray matter to relieve intractable chronic cluster headache. Neurology. 2002;58:A89-A90.
7) Leone M, Franzini A, D'Amico D, et al. Stereotactic electrode implant in inferior posterior hypothalamic gray matter to relieve intractable chronic cluster headache: the first reported case. Neurology. 2001;56:218.

Title: Re: CH as presented at the Am Academy of Neuro
Post by rick on May 30^th, 2002, 1:19am

Thanks Doug. I'm wondering if anyone could explain in further detail how the stereotactic electrodes are implanted? Just curious.

-Rick

Title: Re: CH as presented at the Am Academy of Neuro
Post by DrLisa on May 30^th, 2002, 1:23am

Doug -
My neurologist mentioned that Baclofen was brought up fot the first time at some meeting in April as an prophylactic CH med. Do you know whether that topic was at the same Denver meetings? And if so, do you have any info on what was said/discussed? I'd love to find out - thanks - DrLisa

Title: Re: CH as presented at the Am Academy of Neuro
Post by Karla on May 30^th, 2002, 6:36am

Doug would this be similar to the implants they now do for epilepsy? At least conceptually it sounds like it to me am I wrong? Who is performing these procedures now? When can we start getting them done? Any timeestimes? Thanks Karla

Title: Re: CH as presented at the Am Academy of Neuro
Post by Riccardo on May 30^th, 2002, 7:49am

Little update..... now the implants are six.
And all the patients are still pain free

Thanks Doug

And yes Karla, the implant was cloned from that for epylepsy.
It is an electrode implanted DEEPLY in your Hypothalamus, with a small (like pacemakers) battery.

Dr Leone suggest this treatment for the untractable chronics because you can run the same risks of an brain aneurism operation. (he do it with the "open" brain)

Dr Leone show me the pictures of the first patient, and I can assure you that I have NEVER seen a chronic in that "status"...... terrible. I didn't think that CH could do these horrible things to a man!
Now this man is in good shape, and he is returned to the "normality"

The 6 operations was done in Milan (Italy). But Dr Leone is planning to do some operations in New York, and probably in London.

Title: Re: CH as presented at the Am Academy of Neuro
Post by dougW on May 30^th, 2002, 11:00am

This part on CH was contained in a paper entitled "Headache" by Stephen D. Silberstein, MD, FACP

He presented the entire paper (based on headache classification) at the conference. (I only wish I had attended). The summary of articles is available on Medscape (free-susbscription).

Dr Lisa, I have seen nothing on Baclofen, but it may have been brought up during discussions. To date, only the presented paper are available. Comments and discussion should be available in a few months.

In the meantime, I'm looking for the copies of the entire articles.

Riccardo....got a copy??

Regards

Doug Wright

Title: Re: CH as presented at the Am Academy of Neuro
Post by Riccardo on May 30^th, 2002, 11:41am

Sorry Doug, but these articles are still under ... uhm... "copyright" ?!? (In the sense we still have to pay to have them)
I asked Dr Leone to give me them as soon as possible, when he can release them freely.

Sorry, and ciao for now