探索脑深部刺激治疗丛集性头痛的潜力:一项系统综述。

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY
Olivier Uwishema, Sanobar Shariff, Judy Ahmad El Chakik, Lydia Daniel Bisetegn, Omar Alomari, Magda Wojtara
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引用次数: 0

摘要

背景:丛集性头痛(CH)的衰弱性特点是强烈的、反复的头痛症,由于其严重程度,通常被称为“自杀头痛”。个体可能对治疗干预没有适当的反应,尽管有各种现成的替代方案。这就需要对进一步的管理办法进行调查。脑深部电刺激(deep brain stimulation, DBS)是治疗CH的一种很有前景的方法,它专门针对下丘脑后部。目的:本系统综述旨在总结目前关于DBS治疗ch的安全性和有效性的文献。方法和材料:综合文献检索确定了15项相关研究,包括临床试验、病例报告和观察性研究,这些研究来自Embase、Web of Science、PubMed/MEDLINE、Scopus和Cochrane图书馆,使用系统评价和荟萃分析(PRISMA) 2020标准的首选报告项目。结果:该系统综述阐明了DBS,重点是下丘脑后部,促进了与CH相关的脑病“发作”的频率、严重程度和持续时间的显著降低。虽然个体反应各不相同,但DBS通常耐受性良好,最常见的是包括局灶性神经功能缺损(即复视)在内的短暂和可逆的不良反应。重要的是,在大量人群中观察到长期效益,提高了他们的整体生活质量。此外,DBS的效果超越了局部下丘脑刺激,有证据表明疼痛处理网络的调节。此外,DBS在不破坏昼夜节律的情况下减轻了夜间CH发作。这些发现表明,DBS有望成为CH的治疗选择,特别是对其他治疗难治性的个体。结论:现有研究表明,DBS,特别是针对下丘脑后部的DBS,可以显著降低CH“发作”的频率、严重程度和持续时间。进一步的研究应该集中在患者选择标准和对DBS机制的深入了解上,以优化其在治疗这种致残性头痛方面的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Exploring the potential of deep brain stimulation in managing cluster headache: a systematic review.

Exploring the potential of deep brain stimulation in managing cluster headache: a systematic review.

Exploring the potential of deep brain stimulation in managing cluster headache: a systematic review.

Background: The debilitating nature of cluster headache (CH) is typified by intense, repeated cephalgia that are often referred to as "suicide headaches" owing to their severity. Individuals may not respond appropriately to therapeutic interventions despite various alternatives being readily available. This warrants an investigation into further management options. One of the promising solutions for CH has been identified as deep brain stimulation (DBS), which specifically targets the posterior hypothalamus.

Aim: This systematic review aims to summarize the current literature on the safety and efficacy of DBS in the management of CH.

Method and materials: A comprehensive literature search identified 15 relevant studies comprising clinical trials, case reports, and observational studies from Embase, Web of Science, PubMed/MEDLINE, Scopus, and the Cochrane Library using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 standards.

Results: The systematic review elucidated that DBS, with a focus on the posterior hypothalamus, facilitated significant reductions in the frequency, severity, and duration of cephalgic 'attacks' associated with CH observed. While individual responses varied, DBS was generally well-tolerated, with transient and reversible adverse effects involving focal neurological deficits (i.e., diplopia) being the most common. Importantly, long-term benefits were observed in vast populations, improving their overall quality of life. Furthermore, DBS demonstrated effects beyond localized hypothalamic stimulation, with evidence suggesting modulation of the pain processing network. Additionally, DBS was found to alleviate nocturnal CH attacks without disrupting circadian rhythms. These findings suggest that DBS holds promise as a therapeutic option for CH, particularly in individuals refractory to other treatments.

Conclusion: Existing research suggests that DBS, particularly when targeting the posterior hypothalamus, can significantly reduce CH 'attack' frequency, severity, and duration. Further research should focus on patient selection criteria and a deeper understanding of the mechanisms underpinning DBS to optimize its effectiveness in managing such a disabling cephalgia.

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来源期刊
BMC Neurology
BMC Neurology 医学-临床神经学
CiteScore
4.20
自引率
0.00%
发文量
428
审稿时长
3-8 weeks
期刊介绍: BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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