Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf (UKE), Martinistrasse 52, Hamburg, Germany.
Cephalalgia. 2011 Jan;31(1):112-5. doi: 10.1177/0333102410373157. Epub 2010 May 17.
This case study concerns a patient with primary chronic cluster headache, who was unresponsive to all treatments and consecutively underwent hypothalamic deep brain stimulation (DBS). DBS had no effect on the cluster attacks, but cured an existing polydipsia as well as restlessness. However, hypothalamic DBS produced a constant, dull headache without concomitant symptoms and a high-frequent tremor. All of these effects were repeated when the stimulation was stopped and than started again. DBS had no effect on a pathological weight gain from 70 kg to 150 kg due to bulimia at night, usually during headache attacks. This case illustrates that cluster headache is, in some patients, only one symptom of a complex hypothalamic syndrome. This case also underlines that the stimulation parameters and anatomical target area for hypothalamic DBS may be too unspecific to do justice to the clinical variety of patients and concomitant symptoms. Hypothalamic DBS is an exquisite and potentially life-saving treatment method in otherwise intractable patients, but needs to be better characterised and should only be considered when other stimulation methods, such as stimulation of the greater occipital nerve, are unsuccessful.
本病例研究涉及一位原发性慢性丛集性头痛患者，该患者对所有治疗均无反应，随后连续接受了下丘脑深部脑刺激（DBS）治疗。DBS 对丛集性头痛发作没有影响，但治愈了现有的多饮症以及不安。然而，下丘脑 DBS 产生了持续的、钝痛的头痛，没有伴随症状和高频震颤。当刺激停止并再次开始时，所有这些影响都会重复出现。DBS 对由于夜间贪食症导致的病理性体重增加（从 70 公斤增加到 150 公斤）没有影响，通常在头痛发作期间。该病例说明，在某些患者中，丛集性头痛仅是复杂下丘脑综合征的一种症状。该病例还强调，下丘脑 DBS 的刺激参数和解剖目标区域可能过于不明确，无法充分体现患者的临床多样性和伴随症状。下丘脑 DBS 是一种精细且潜在的救命治疗方法，适用于其他治疗方法无效的顽固性患者，但需要进一步明确，并且只有在刺激其他方法（如枕大神经刺激）失败时才应考虑使用。
