Hypothalamic Deep-Brain Stimulation: Target and Potential Mechanism for the Treatment of Cluster Headache

Cephalalgia ◽  
2008 ◽  
Vol 28 (7) ◽  
pp. 799-803 ◽  
Author(s):  
A May
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Antinociceptive Effect ◽  
Primary Headaches ◽  
Imaging Data ◽  
Pain Transmission ◽  
Positron Emission ◽  
Deep Brain

Recently, functional imaging data have underscored the crucial role of the hypothalamus in trigemino-autonomic headaches, a group of severe primary headaches. This prompted the application of hypothalamic deep-brain stimulation (DBS), with the intention to preventing cluster headache (CH) attacks in selected severe therapy-refractory cases. To date, a total of 50 operated intractable CH patients, one patient with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing and three with atypical facial pain, have been reported. However, it is not apparent why the spontaneous bursts of activation in the inferior posterior hypothalamus result in excruciating head pain, whereas continuous electrical stimulation of the identical area is able to prevent these attacks. Recently, this issue has been addressed by examining 10 operated chronic CH patients, using H215O-positron emission tomography and alternately switching the hypothalamic stimulator on and off. The stimulation-induced activation in the ipsilateral posterior inferior hypothalamic grey (the site of the stimulator tip) as well as activation and de-activation in several cerebral structures belonging to neuronal circuits usually activated in pain transmission. These data argue against an unspecific antinociceptive effect or pure inhibition of hypothalamic activity as the mode of action of hypothalamic DBS and suggest functional modulation of the pain-processing network.

Deep Brain Stimulation for Intractable Chronic Cluster Headache: Proposals for Patient Selection

Cephalalgia ◽  
2004 ◽  
Vol 24 (11) ◽  
pp. 934-937 ◽  
Author(s):  
M Leone ◽  
A May ◽  
A Franzini ◽  
G Broggi ◽  
D Dodick ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Brain Area ◽  
Chronic Cluster Headache ◽  
Primary Headaches ◽  
Positron Emission ◽  
Academic Medical ◽  
Deep Brain

Cluster headache is the most severe of the primary headaches. Positron emission tomography and functional MRI studies have shown that the ipsilateral posterior hypothalamus is activated during cluster headache attacks and is structurally asymmetric in these patients. These changes are highly specific for the condition and suggest that the cluster headache generator may be located in that brain area; they further suggest that electrical stimulation of that region might produce clinical improvement in chronic cluster headache sufferers refractory to medical therapy. In five patients with severe intractable chronic cluster headache, hypothalamic electrical stimulation produced complete and long-term pain relief with no relevant side-effects. We therefore consider it essential to propose criteria for selecting chronic cluster headache patients for hypothalamic deep brain stimulation before this procedure is undertaken at other academic medical centres.

scholarly journals Medical Hypothesis: Deep Brain Stimulation for Intractable Migraine

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Parisa Gazerani ◽  
◽  
Brian E Cairns ◽  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Chronic Migraine ◽  
Brain Stimulation ◽  
Therapeutic Option ◽  
Brain Structures ◽  
Invasive Technique ◽  
Primary Headaches ◽  
Medical Hypothesis ◽  
Deep Brain

Deep Brain Stimulation (DBS) has been introduced as an innovative treatment for several neurological disorders, including Parkinson’s disease, essential tremor, and dystonia and it has been proven effective in helping individuals affected by these disorders; hence, enhancing their quality of life. DBS has also been investigated for the treatment of cluster and other primary headaches. Electrodes are surgically implanted into brain structures, for example the posterior hypothalamus in case of cluster headache. Hypothalamic DBS has been successfully used to treat patients with cluster headache and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). In these headache conditions, DBS may reduce headache frequency by half, however, some side effects have also been reported that are mainly related to infection where the electrodes are placed, syncope, and diplopia. Hypothalamic DBS is proposed to modulate neuronal structures that are directly or indirectly involved in detection or transmission of painful stimuli or in the processing of this information. Reports of the use of DBS for chronic migraine are not found in the literature. This commentary explores the medical hypothesis that DBS could be considered as a therapeutic option for intractable chronic migraine. This hypothesis is based on the commonalities between cluster headache and migraine in terms of some shared symptoms, and potential overlap of underlying mechanisms. However, due to the absence of clinical evidence supporting the use of DBS in CM, the fact that disease-specific optimization of DBS parameters must be considered carefully, and considering the optimal CNS structures to target are currently unknown, it is concluded that this interventional and invasive technique should be avoided for CM for the present time.

Deep brain stimulation modulates hypothalamic-brainstem fibers in cluster headache: case report

2020 ◽  
Vol 132 (3) ◽  
pp. 717-720 ◽  
Author(s):  
Sérgio A. F. Dantas ◽  
Eduardo J. L. Alho ◽  
Juliano J. da Silva ◽  
Nilson N. Mendes Neto ◽  
Erich Talamoni Fonoff ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Clinical Effects ◽  
Chronic Stimulation ◽  
Mammillary Bodies ◽  
Fiber Tracts ◽  
White Matter Region ◽  
Deep Brain ◽  
Stimulation Of

Hypothalamic deep brain stimulation (DBS) has been used for more than a decade to treat cluster headache (CH) but its mechanisms remain poorly understood. The authors have successfully treated a patient with CH using hypothalamic DBS and found that the contact used for chronic stimulation was located in a white matter region posterior to the mammillary bodies. Fiber tracts crossing that region were the medial forebrain bundle and those interconnecting the hypothalamus and brainstem, including the dorsal longitudinal fasciculus. Because the stimulation of axons is an important mechanism of DBS, some of its clinical effects in CH may be related to the stimulation of fibers interconnecting the hypothalamus and brainstem.

Deep brain stimulation in headache

Cephalalgia ◽  
2016 ◽  
Vol 36 (12) ◽  
pp. 1143-1148 ◽  
Author(s):  
Massimo Leone ◽  
Alberto Proietti Cecchini
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Chronic Cluster Headache ◽  
Hypothalamic Stimulation ◽  
Hypothalamic Area ◽  
Unilateral Headache ◽  
Randomised Controlled ◽  
Invasive Neurostimulation ◽  
Deep Brain

Background: Deep brain stimulation of the posterior hypothalamic area was first introduced in 2000 to treat drug-refractory chronic cluster headache (CH). Findings: So far, hypothalamic stimulation has been employed in 79 patients suffering from various forms of intractable short-lasting unilateral headache forms, mainly trigeminal autonomic cephalalgias. The majority were (88.6%) chronic CH, including one patient who suffered from symptomatic chronic CH-like attacks; the remaining were short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), one had paroxysmal hemicranias and one symptomatic trigeminal neuralgia. Overall, after a mean follow up of 2.2 years, 69.6% (55) hypothalamic-stimulated patients showed a ≥50% improvement. Conclusions: These observations need confirmation in randomised, controlled trials. A key role of the posterior hypothalamic area in the pathophysiology of unilateral short-lasting headaches, possibly by regulating the duration rather than triggering the attacks, can be hypothesised. Because of its invasiveness, hypothalamic stimulation can be proposed only after other, less-invasive, neurostimulation procedures have been tried.

Deep Brain Stimulation for Intractable Chronic Cluster Headache: Results of Neuroimaging and Neurovegetative Assessment

2003 ◽  
Vol 6 (3) ◽  
pp. 206-206
Author(s):  
Angelo Franzini ◽  
Giovanni Broggi ◽  
Gennaro Bussone ◽  
Paolo Ferroli ◽  
Massimo Leone ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Chronic Cluster Headache ◽  
Deep Brain

scholarly journals Understanding Deep Brain Stimulation: In Vivo Metabolic Consequences of the Electrode Insertional Effect

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Marta Casquero-Veiga ◽  
David García-García ◽  
Manuel Desco ◽  
María Luisa Soto-Montenegro
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Statistical Parametric Mapping ◽  
Metabolic Effects ◽  
Metabolic Pattern ◽  
Cortical Areas ◽  
Positron Emission ◽  
Male Wistar Rats ◽  
Deep Brain

Deep brain stimulation (DBS) is a neurosurgery technique widely used in movement disorders, although its mechanism of action remains unclear. In fact, apart from the stimulation itself, the mechanical insertion of the electrode may play a crucial role. Here we aimed to distinguish between the insertional and the DBS effects on brain glucose metabolism. To this end, electrodes were implanted targeting the medial prefrontal cortex in five adult male Wistar rats. Positron Emission Tomography (PET) studies were performed before surgery (D0) and seven (D7) and nine days (D9) after that. DBS was applied during the 18FDG uptake of the D9 study. PET data were analysed with statistical parametric mapping. We found an electrode insertional effect in cortical areas, while DBS resulted in a more widespread metabolic pattern. The consequences of simultaneous electrode and DBS factors revealed a combination of both effects. Therefore, the insertion metabolic effects differed from the stimulation ones, which should be considered when assessing DBS protocols.

scholarly journals The medial forebrain bundle as a target for deep brain stimulation for obsessive-compulsive disorder

CNS Spectrums ◽  
2016 ◽  
Vol 22 (3) ◽  
pp. 282-289 ◽  
Author(s):  
Volker A. Coenen ◽  
Thomas E. Schlaepfer ◽  
Peter Goll ◽  
Peter C. Reinacher ◽  
Ulrich Voderholzer ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Major Depression ◽  
Brain Stimulation ◽  
Medial Forebrain Bundle ◽  
Reward System ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Deep Brain

Deep brain stimulation (DBS) is a promising putative modality for the treatment of refractory psychiatric disorders such as major depression and obsessive-compulsive disorder (OCD). Several targets have been posited; however, a clear consensus on differential efficacy and possible modes of action remain unclear. DBS to the supero-lateral branch of the medial forebrain bundle (slMFB) has recently been introduced for major depression (MD). Due to our experience with slMFB stimulation for MD, and because OCD might be related to similar dysfunctions of the reward system, treatment with slMFB DBS seams meaningful. Here we describe our first 2 cases together with a hypothetical mode of action.We describe diffusion tensor imaging (DTI) fiber tractographically (FT)-assisted implantation of the bilateral DBS systems in 2 male patients. In a selected literature overview, we discuss the possible mode of action. Both patients were successfully implanted and stimulated. The follow-up time was 12 months. One patient showed a significant response (Yale–Brown Obsessive-Compulsive Scale [YBOCS] reduction by 35%); the other patient reached remission criteria 3 months after surgery (YBOCS<14) and showed mild OCD just above the remission criterion at 12 months follow-up.While the hypermetabolism theory for OCD involves the cortico–striato–thalamo–cortical (CSTC) network, we think that there is clinical evidence that the reward system plays a crucial role. Our findings suggest an important role of this network in mechanisms of disease development and recovery. In this uncontrolled case series, continuous bilateral DBS to the slMFB led to clinically significant improvements of ratings of OCD severity. Ongoing research focuses on the role of the reward system in OCD, and its yet-underestimated role in this underlying neurobiology of the disease.

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