Hypothalamic Deep Brain Stimulation for the Treatment of Chronic Cluster Headaches: A Series Report

2007 ◽  
pp. 48-50
Author(s):  
A. Franzini ◽  
P. Ferroli ◽  
M. Leone ◽  
G. Bussone ◽  
G. Broggi
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cluster Headaches ◽  
Series Report ◽  
Deep Brain

Endoventricular Deep Brain Stimulation of the Third Ventricle

Neurosurgery ◽  
2016 ◽  
Vol 79 (6) ◽  
pp. 806-815 ◽  
Author(s):  
Stéphan Chabardès ◽  
Romain Carron ◽  
Eric Seigneuret ◽  
Napoleon Torres ◽  
Laurent Goetz ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Third Ventricle ◽  
Depression Scale ◽  
Common Side Effect ◽  
The Third ◽  
Potential Efficacy ◽  
Cluster Headaches ◽  
Deep Brain ◽  
Stimulation Of

Abstract BACKGROUND: The third ventricle (3rd V) is surrounded by centers related to satiety, homeostasis, hormones, sleep, memory, and pain. Stimulation of the wall of the 3rd V could be useful to treat disorders related to dysfunction of the hypothalamus. OBJECTIVE: To assess safety and efficacy of endoventricular electrical stimulation of the hypothalamus using a floating deep brain stimulation (DBS) lead laid on the floor of the 3rd V to treat refractory cluster headaches (CH). METHODS: Seven patients, aged 24 to 60 years, experiencing chronic CH (mean chronic duration 5.8 ± 2.5 years) were enrolled in this pilot, prospective, open study assessing the safety and potential efficacy of chronic DBS of the 3rd V. Number of attacks was collected during baseline and was compared with those occurring at 3, 6, and 12 months postoperation. Any side effects that occurred during or after surgery were reported. Effect on mood was assessed using the Hospital Anxiety and Depression scale during baseline and at 6 and 12 months postoperation. RESULTS: Insertion of the lead into the posterior 3rd V and chronic stimulation was feasible and safe in all patients. The voltage ranged from 0.9 to 2.3 volts. The most common side effect was transient trembling vision during stimulation. At 12 months, 3 of 7 patients were pain free, 2 had 90% improvement, 1 of 7 had 75% improvement, and 1 of 7 was not significantly improved. CONCLUSION: This proof of concept demonstrates the feasibility, safety, and potential efficacy of 3rd V DBS using an endoventricular road that could be applied to treat various diseases involving hypothalamic areas.

Modulation of food intake following deep brain stimulation of the ventromedial hypothalamus in the vervet monkey

2008 ◽  
Vol 108 (2) ◽  
pp. 336-342 ◽  
Author(s):  
Goran Laćan ◽  
Antonio A. F. De Salles ◽  
Alessandra A. Gorgulho ◽  
Scott E. Krahl ◽  
Leonardo Frighetto ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Food Intake ◽  
Brain Stimulation ◽  
Vervet Monkey ◽  
Ventromedial Hypothalamus ◽  
Vervet Monkeys ◽  
Stereotactic Techniques ◽  
Freely Moving ◽  
Cluster Headaches ◽  
Deep Brain

Object Deep brain stimulation (DBS) has become an effective therapy for an increasing number of brain disorders. Recently demonstrated DBS of the posterior hypothalamus as a safe treatment for chronic intractable cluster headaches has drawn attention to this target, which is involved in the regulation of diverse autonomic functions and feeding behavior through complex integrative mechanisms. In this study, the authors assessed the feasibility of ventromedial hypothalamus (VMH) DBS in freely moving vervet monkeys to modulate food intake as a model for the potential treatment of eating disorders. Methods Deep brain stimulation electrodes were bilaterally implanted into the VMH of 2 adult male vervet monkeys by using the stereotactic techniques utilized in DBS in humans. Stimulators were implanted subcutaneously on the upper back, allowing ready access to program stimulation parameters while the animal remained conscious and freely moving. In anesthetized animals, intraoperatively and 6–10 weeks postsurgery, VMH DBS parameters were selected according to minimal cardiovascular and autonomic nervous system responses. Thereafter, conscious animals were subjected to 2 cycles of VMH DBS for periods of 8 and 3 days, and food intake and behavior were monitored. Animals were then killed for histological verification of probe placement. Results During VMH DBS, total food consumption increased. The 3-month bilateral implant of electrodes and subsequent periods of high-frequency VMH stimulation did not result in significant adverse behavioral effects. Conclusions This is the first study in which techniques of hypothalamic DBS in humans have been applied in freely moving nonhuman primates. Future studies can now be conducted to determine whether VMH DBS can change hypothalamic responsivity to endocrine signals associated with adiposity for long-term modulation of food intake.

Deep brain stimulation of chronic cluster headaches: Posterior hypothalamus, ventral tegmentum and beyond

Cephalalgia ◽  
2019 ◽  
Vol 39 (9) ◽  
pp. 1111-1120 ◽  
Author(s):  
Andreas Nowacki ◽  
Liz Moir ◽  
Sarah LF Owen ◽  
James J Fitzgerald ◽  
Alexander L Green ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Hypothalamic Region ◽  
Headache Attack ◽  
Quality Of Life Measures ◽  
Cluster Headaches ◽  
Deep Brain

Objective We present long-term follow-up results and analysis of stimulation sites of a prospective cohort study of six patients with chronic cluster headaches undergoing deep brain stimulation of the ipsilateral posterior hypothalamic region. Methods The primary endpoint was the postoperative change in the composite headache severity score “headache load” after 12 months of chronic stimulation. Secondary endpoints were the changes in headache attack frequency, headache attack duration and headache intensity, quality of life measures at 12, 24, and 48 months following surgery. Stimulating contact positions were analysed and projected onto the steroetactic atlas of Schaltenbrand and Wahren. Results There was a significant reduction of headache load of over 93% on average at 12 months postoperatively that persisted over the follow-up period of 48 months ( p = 0.0041) and that was accompanied by a significant increase of reported quality of life measures ( p = 0.03). Anatomical analysis revealed that individual stimulating electrodes were located in the red nucleus, posterior hypothalamic region, mesencephalic pretectal area and centromedian nucleus of the thalamus. Conclusions Our findings confirming long-term effectiveness of deep brain stimulation for chronic cluster headaches suggest that the neuroanatomical substrate of deep brain stimulation-induced headache relief is probably not restricted to the posterior hypothalamic area but encompasses a more widespread area.

The effect of posterior hypothalamus region deep brain stimulation on sleep

Cephalalgia ◽  
2013 ◽  
Vol 34 (3) ◽  
pp. 219-223 ◽  
Author(s):  
Stjepana Kovac ◽  
Mary-Anne Wright ◽  
Sofia H Eriksson ◽  
Ludvic Zrinzo ◽  
Manjit Matharu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Sleep Disorders ◽  
Brain Stimulation ◽  
Case Reports ◽  
Posterior Part ◽  
Sleep Patterns ◽  
Before And After ◽  
Promising Treatment ◽  
Cluster Headaches ◽  
Deep Brain

Background Early observations by von Economo showed that the posterior part of the hypothalamus (PH) plays a prominent role in sleep-wake regulation. The PH is a candidate area involved in cluster headaches and other trigeminal autonomic cephalalgias (TACs) and is targeted for deep brain stimulation (DBS). Case reports Sleep studies in two men, 69- and 39-years-old, with pre-existing sleep disorders, before and after PH-DBS for pharamacoresistant cluster headache and SUNCT syndrome showed that PH-DBS led to a dramatic alteration of the patients’ sleep patterns. This coincided with an improvement of the predominantly diurnal TACs, suggesting a PH-DBS-induced change in sleep patterns. Hypnograms after DBS demonstrated disrupted sleep and a prolonged period of wakefulness after midnight in both patients, which was reproduced the second night. Conclusions PH-DBS, a promising treatment for severe refractory TACs, affects sleep quality and pre-existing sleep disorders. This needs to be considered when treating patients with PH-DBS.

Nicht-medikamentöse Optionen zur Behandlung pharmakoresistenter Epilepsien

2018 ◽  
Vol 75 (7) ◽  
pp. 448-454
Author(s):  
Thomas Grunwald ◽  
Judith Kröll
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Tiefe Hirnstimulation ◽  
Ketogene Diät ◽  
Deep Brain

Zusammenfassung. Wenn mit den ersten beiden anfallspräventiven Medikamenten keine Anfallsfreiheit erzielt werden konnte, so ist die Wahrscheinlichkeit, dies mit anderen Medikamenten zu erreichen, nur noch ca. 10 %. Es sollte dann geprüft werden, warum eine Pharmakoresistenz besteht und ob ein epilepsiechirurgischer Eingriff zur Anfallsfreiheit führen kann. Ist eine solche Operation nicht möglich, so können palliative Verfahren wie die Vagus-Nerv-Stimulation (VNS) und die tiefe Hirnstimulation (Deep Brain Stimulation) in eine bessere Anfallskontrolle ermöglichen. Insbesondere bei schweren kindlichen Epilepsien stellt auch die ketogene Diät eine zu erwägende Option dar.

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