Maltese doctor in breakthrough surgery

Ludvic Zrinzo: “This is the first time that functional imaging has led to a therapy”.

Ludvic Zrinzo: “This is the first time that functional imaging has led to a therapy”.

Maltese neurosurgeon Ludvic Zrinzo has brought new hope to cluster headache sufferers through revolutionary surgery that blocks damaging electrical stimuli in the brain.

The finding is important since it is the first time that functional imaging has been translated into a therapy that benefits patients and can serve as a model for other diseases like severe depression, Mr Zrinzo told The Sunday Times.

The thought process for the surgery goes back some 15 years, when brain imaging, called fMRI, localised the part of the brain which was overactive during these headaches.

This led to pilot trials similar to those used for Parkinson’s Disease – where there is solid evidence that deep brain stimulation is therapeutic – and applying it to so-called cluster headaches.

Cluster headaches are described by patients in pain terms as the equivalent of having hot iron rod thrust into their eye.

In severe cases, the headaches can last up to three hours, and patients can get up to 10 attacks in a day.

This headache, estimated to affect one in 1,000 people, is unresponsive to medication in 10 per cent of patients. The severe searing pain has even driven some patients to commit suicide, Mr Zrinzo said.

The trial was carried out by Mr Zrinzo and neurologist Manjit Matharu at the National Hospital for Neurology and Neurosurgery at Queen’s Square in London.

Eight patients, who had severe cluster headaches and were unresponsive to any form of treatment, were offered this form of therapy.

Two years down the line from the first procedure, all patients registered progress. Three patients were free of pain while the one who benefitted the least registered a reduction of 60 per cent in cluster headaches.

“If you consider that these patients had tried everything else and remained resistant to treatment, it is very encouraging,” Mr Zrinzo said.

The surgery works by inserting an electrode into the brain and linking to a stimulator under the chest. When the stimulator is switched on, an electric current passes into the brain, blocking the damaging signals that cause cluster headaches.

Although Mr Zrinzo cautioned that it was “too early to cry triumph” because the patients in the trial needed further follow up to better identify the benefits of the surgery, he said it was an important finding.

“This is the first time that functional imaging has led to a therapy,” he said, hoping it would pave the way for further investigative trials for other diseases.

Similar studies with deep brain stimulation were being carried out in other countries for cluster headaches. In Canada, he said, the same surgery was being performed to treat severe depression.

The National Hospital for Neurosurgery, where Mr Zrinzo works, plans to treat severe depression in this manner next year as part of the European trial for depression.

However, Mr Zrinzo said that it should be introduced in areas where there is hard and fast science that it will work.

Last October, Health Minister Joe Cassar hailed the introduction of deep brain stimulation in the upcoming year, saying a consultant at Mater Dei Hospital was to be sent to London’s National Hospital to work with a medical team in preparation for this new service. The actual operation would be carried out by a surgeon who worked in London, who would be brought to Malta twice a year.

Mr Zrinzo graduated from the University of Malta as a doctor, and continued to work and train in the country for a number of years before moving to London to pursue a career in neurosurgery.

Coming from a family of doctors, he is the son of Lawrence Zrinzo, who first introduced neurosurgery to Malta.


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