Vetrugno Roberto, Pierangeli Giulia, Leone Massimo, Bussone Gennaro, Franzini Angelo, Brogli Giovanni, D'Angelo Roberto, Cortelli Pietro, Montagna Pasquale
Department of Neurological Sciences, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy.
Headache. 2007 Jul-Aug;47(7):1085-90. doi: 10.1111/j.1526-4610.2007.00864.x.
To evaluate the structure and quality of sleep and the circadian rhythm of body core temperature (BcT degrees ) in patients with drug-resistant chronic cluster headache (CH) before and during deep brain stimulation (DBS) of the posterior hypothalamus.
Chronic CH is a severe primary headache and frequently associated with disturbances in sleep. Posterior hypothalamus DBS is performed as an effective treatment of drug-resistant chronic CH. The effects of posterior hypothalamus DBS on sleep and the circadian rhythm of BcT degrees are unknown.
Three male patients with chronic drug-resistant CH underwent 48-hour consecutive polysomnography (PSG) by means of the VITAPORT system with determination of BcT degrees by means of a rectal probe. Recordings were done before electrode implantation in the posterior hypothalamus and after optimized DBS of posterior hypothalamus.
Before electrode implantation PSG showed nocturnal CH attacks, reduced sleep efficiency, fragmented sleep and increased periodic limb movements in sleep (PLMS). During DBS nocturnal CH attacks were abolished and sleep efficiency and PLMS improved. BcT degrees circadian rhythm was normal both before and during DBS.
Our data show that DBS of posterior hypothalamus in drug-resistant chronic CH is effective in curtailing nocturnal CH attacks, and is associated with improved sleep structure and quality. Chronic CH displays a normal circadian rhythm of BcT degrees, unchanged during hypothalamic DBS.
评估药物难治性慢性丛集性头痛（CH）患者在下丘脑后深部脑刺激（DBS）之前及期间的睡眠结构、睡眠质量以及体核温度（BcT度）的昼夜节律。
慢性丛集性头痛是一种严重的原发性头痛，常伴有睡眠障碍。下丘脑后深部脑刺激是治疗药物难治性慢性丛集性头痛的一种有效方法。下丘脑后深部脑刺激对睡眠及BcT度昼夜节律的影响尚不清楚。
三名药物难治性慢性丛集性头痛男性患者通过VITAPORT系统连续进行48小时多导睡眠图（PSG）监测，并通过直肠探头测定BcT度。记录在下丘脑后植入电极前以及下丘脑后优化深部脑刺激后进行。
电极植入前，多导睡眠图显示夜间丛集性头痛发作、睡眠效率降低、睡眠碎片化以及睡眠中周期性肢体运动（PLMS）增加。在深部脑刺激期间，夜间丛集性头痛发作消失，睡眠效率和PLMS得到改善。深部脑刺激前后BcT度昼夜节律均正常。
我们的数据表明，药物难治性慢性丛集性头痛患者下丘脑后深部脑刺激在减少夜间丛集性头痛发作方面有效，且与睡眠结构和质量改善相关。慢性丛集性头痛显示BcT度昼夜节律正常，在下丘脑深部脑刺激期间无变化。
