1 Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
5 Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Cephalalgia. 2019 Aug;39(9):1099-1110. doi: 10.1177/0333102419839957. Epub 2019 Mar 21.
Deep brain stimulation in the ventral tegmental area (VTA-DBS) has provided remarkable therapeutic benefits in decreasing headache frequency and severity in patients with medically refractory chronic cluster headache (CH). However, to date the effects of VTA-DBS on cognition, mood and quality of life have not been examined in detail.
The aim of the present study was to do so in a case series of 18 consecutive patients with cluster headache who underwent implantation of deep brain stimulation electrodes in the ventral tegmental area. The patients were evaluated preoperatively and after a mean of 14 months of VTA-DBS on tests of global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis-Kaplan Executive Function System), and attention (Paced Auditory Serial Addition Test). Depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), and hopelessness (Beck Hopelessness Scale) were also assessed. Subjective pain experience (McGill Pain Questionnaire), behaviour (Pain Behaviour Checklist) and quality of life (Short Form-36) were also evaluated at the same time points.
VTA-DBS resulted in significant improvement of headache frequency (from a mean of five to two attacks daily, < .001) and severity (from mean Verbal Rating Scale [VRS] of 10 to 7, p < .001) which was associated with significant reduction of anxiety (from mean HADS-A of 11.94 to 8.00, < .001) and help-seeking behaviours (from mean PBC of 4.00 to 2.61, < .001). VTA-DBS did not produce any significant change to any tests of cognitive function and any other outcome measures (BDI, HADS-D, SAS, BHS, McGill Pain Questionnaire, Short Form-36).
We confirm the efficacy of VTA-DBS in the treatment of medically refractory chronic cluster headache. The reduction of headache frequency and severity was associated with a significant reduction of anxiety. Furthermore, the result suggests that VTA-DBS for chronic cluster headache improves pain-related help-seeking behaviours and does not produce any change in cognition.
腹侧被盖区（VTA）深部脑刺激在降低药物难治性慢性丛集性头痛（CH）患者头痛频率和严重程度方面提供了显著的治疗益处。然而，迄今为止，VTA-DBS 对认知、情绪和生活质量的影响尚未得到详细研究。
本研究的目的是对 18 例连续接受 VTA 深部脑刺激电极植入的丛集性头痛患者进行研究。在 VTA-DBS 治疗后 14 个月，患者接受了全球认知（简易精神状态检查）、智力（韦氏简明智力量表）、言语记忆（加利福尼亚言语学习测验-II）、执行功能（Delis-Kaplan 执行功能系统）和注意力（听觉连续加法测试）的测试。同时还评估了抑郁（贝克抑郁量表和医院焦虑抑郁量表-D）、焦虑（医院焦虑抑郁量表-A）、冷漠（斯塔克斯坦冷漠量表）和绝望（贝克绝望量表）。还评估了主观疼痛体验（麦吉尔疼痛问卷）、行为（疼痛行为检查表）和生活质量（SF-36）。
VTA-DBS 可显著改善头痛频率（从平均每日 5 次减少至 2 次， < 0.001）和严重程度（从平均言语评定量表[VRS]的 10 减少至 7，p < 0.001），同时显著降低焦虑（从平均 HADS-A 的 11.94 减少至 8.00， < 0.001）和求助行为（从平均 PBC 的 4.00 减少至 2.61， < 0.001）。VTA-DBS 对认知功能和其他任何测试结果（BDI、HADS-D、SAS、BHS、麦吉尔疼痛问卷、SF-36）均无显著变化。
我们证实了 VTA-DBS 在治疗药物难治性慢性丛集性头痛方面的疗效。头痛频率和严重程度的降低与焦虑的显著降低有关。此外，结果表明 VTA-DBS 治疗慢性丛集性头痛可改善与疼痛相关的求助行为，而不会对认知产生任何影响。
