Responsiveness of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing to hypothalamic deep brain stimulation

2009 ◽  
Vol 110 (2) ◽  
pp. 279-281 ◽  
Author(s):  
Mark K. Lyons ◽  
David W. Dodick ◽  
Virgilio Gerald H. Evidente
Keyword(s):  
Deep Brain Stimulation ◽  
Functional Imaging ◽  
Brain Stimulation ◽  
Primary Headache ◽  
Headache Disorder ◽  
Trigeminal Autonomic Cephalalgias ◽  
Conjunctival Injection ◽  
Imaging Studies ◽  
Primary Headache Disorder ◽  
Deep Brain

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a severe primary headache disorder that is often refractory to medical therapy. Although the pathogenesis of this and other trigeminal autonomic cephalalgias is not completely understood, ipsilateral activation of the posterior and inferior hypothalamus has been identified on functional imaging studies during attacks. The authors report on a case of SUNCT syndrome successfully treated with hypothalamic deep brain stimulation and discuss the current literature.

scholarly journals PET Functional Imaging of Deep Brain Stimulation in Movement Disorders and Psychiatry

2009 ◽  
Vol 29 (11) ◽  
pp. 1743-1754 ◽  
Author(s):  
Benedicte Ballanger ◽  
Marjan Jahanshahi ◽  
Emmanuel Broussolle ◽  
Stéphane Thobois
Keyword(s):  
Deep Brain Stimulation ◽  
Functional Imaging ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Major Advance ◽  
Imaging Studies ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Neuropsychiatric Diseases ◽  
Deep Brain

Deep brain stimulation (DBS) represents a major advance in the treatment of various severe movement disorders or neuropsychiatric diseases. Our understanding of the mechanism of action of this surgical treatment has greatly benefited from functional imaging studies. Most of these studies have been conducted in patients with Parkinson's disease (PD) treated by bilateral subthalamic nucleus (STN) stimulation. These studies have notably underlined the fact that STN stimulation influences motor, limbic, or associative cortical-subcortical loops in various (sometimes contradictory) ways. We present an up-to-date review of the information provided by functional imaging studies in surgery for PD, dystonia, tremor, as well as in psychiatric disorders such as depression or obsessive-compulsive disorder. On the basis of this information, proposed mechanisms of action of DBS are discussed, as well as the need for additional approaches such as improved anatomical localization of the contact used for stimulation or a better understanding of the electrical distribution around the electrode.

PET functional imaging of deep brain stimulation in the healthy rat brain

2014 ◽  
Vol 45 (01) ◽  
Author(s):  
N Van Den Berge ◽  
V Keereman ◽  
C Vanhove ◽  
P van Mierlo ◽  
B Van Nieuwenhuyse ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Rat Brain ◽  
Functional Imaging ◽  
Brain Stimulation ◽  
Deep Brain

Functional imaging of subthalamic nucleus deep brain stimulation in Parkinson's disease

2011 ◽  
Vol 26 (10) ◽  
pp. 1835-1843 ◽  
Author(s):  
Tessel Boertien ◽  
Ludvic Zrinzo ◽  
Joshua Kahan ◽  
Marjan Jahanshahi ◽  
Marwan Hariz ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Functional Imaging ◽  
Brain Stimulation ◽  
Deep Brain

Management of Pulse Generators in a Breast Cancer Patient with in Situ Subthalamic Nucleus Deep Brain Stimulation

2019 ◽  
Vol 80 (03) ◽  
pp. 223-227 ◽  
Author(s):  
Byung-chul Son ◽  
Joong-Seok Kim ◽  
Woo-Chan Park ◽  
Hak-cheol Ko
Keyword(s):  
Breast Cancer ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Anterior Chest Wall ◽  
Open Circuit ◽  
Imaging Studies ◽  
Pulse Generators ◽  
Stn Dbs ◽  
Deep Brain

Although deep brain stimulation (DBS) has been used for > 25 years in the treatment of movement disorders, no report has been published on the management of DBS pulse generators implanted in the anterior chest in patients with breast cancer who require mastectomy, radiotherapy, and future imaging studies.We describe a 62-year-old female patient with advanced Parkinson's disease (PD) who was dependent on bilateral subthalamic nucleus (STN) DBS. She was diagnosed with cancer in her left breast. To avoid difficulties in imaging studies, surgery, and radiotherapy related to the breast cancer, bilateral pulse generators for STN DBS previously implanted in the anterior chest wall were repositioned to the anterior abdominal wall with replacement of long extension cables. During mastectomy and the relocation of the pulse generators, we were not aware of the risks of an open circuit and neuroleptic malignant-like syndrome due to our limited knowledge about how to manage DBS hardware.Coincident breast cancer and the need for STN DBS is underreported. Considering the uncertainties in the management of pulse generators and the incidence of breast cancer, guidelines for handling DBS hardware in the setting of cancer are needed. More careful attention should be paid to performing magnetic resonance imaging in DBS-dependent patients with chronic PD.

Complete alleviation of treatment refractory primary SUNCT syndrome with clomiphene citrate (a medicinal deep brain hypothalamic modulator)

Cephalalgia ◽  
2014 ◽  
Vol 34 (12) ◽  
pp. 1021-1024 ◽  
Author(s):  
Todd D Rozen
Keyword(s):  
Clomiphene Citrate ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Decompression Surgery ◽  
Sunct Syndrome ◽  
Primary Headache Disorder ◽  
Treatment Refractory ◽  
Putative Mechanism ◽  
Deep Brain

Objective To report the first ever case of primary short-lasting unilateral neuralgiform headache attacks (SUNCT) syndrome completely responsive to clomiphene citrate. Methods Case report. Results SUNCT is a primary headache disorder marked by frequent attacks of one-sided headache with cranial autonomic associated symptoms. When SUNCT is deemed medicinally treatment refractory, it can cause tremendous patient-related disability. Surgical treatment options are available including hypothalamic deep brain stimulation, occipital nerve stimulator placement or arterial decompression surgery, but these procedures carry significant morbidity. A patient presented with a 10 month complaint of multiple, daily short-lasting, right-sided headaches each lasting from 60 to 120 seconds in duration and occurring from 100 to 200 times per day. The head pain was associated with ipsilateral eyelid ptosis and conjunctival injection. The patient was diagnosed with SUNCT but was unresponsive to multiple recognized medicinal treatments. He had complete alleviation of his attacks with clomiphene citrate, a synthetic, non-steroidal, ovulatory stimulant that directly binds to hypothalamic estrogen receptors. The clomiphene was tolerated without any adverse events. A putative mechanism of action for clomiphene in the prevention of SUNCT will be presented. Conclusion Clomiphene citrate is a unique treatment for SUNCT and appears to be very safe and effective.

DEEP BRAIN STIMULATION IN INTRACTABLE SHORT-LASTING UNILATERAL NEURALGIFORM HEADACHE ATTACKS: A MULTICASE SERIES

2015 ◽  
Vol 86 (11) ◽  
pp. e4.119-e4
Author(s):  
Sarah Miller ◽  
Ludvic Zrinzo ◽  
Manjit Matharu
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Case Reports ◽  
Treatment Options ◽  
Red Nucleus ◽  
Primary Headache ◽  
Attack Frequency ◽  
Midbrain Tegmentum ◽  
Deep Brain

IntroductionSUNCT and SUNA are primary headache conditions characterized by short lasting attacks of unilateral pain accompanied by autonomic features. Neuroimaging studies have suggested a role of the posterior hypothalamus in its pathogenesis.AimPrevious case reports on deep brain stimulation (DBS) of the midbrain tegmentum (just posterior to the hypothalamus) for SUNCT/SUNA are limited to a total of three patients. We present clinical data on eight new patients treated with DBS.MethodEight patients underwent midbrain tegmentum DBS with an MRI-guided and verified approach. The target lay between the mammillothalamic tract and the anteromedial quadrant of the red nucleus. Headache diaries were used to monitor response.ResultsThe median follow up period was 20 months. Median improvement in attack frequency was 70%. Seven patients obtained a 30% or more reduction in attack frequency at final follow up. At final follow up, one patient had the stimulator off. Seven out of eight patients would opt to have the stimulator again and all would recommend to others.ConclusionMidbrain tegmentum DBS may be a useful treatment in intractable SUNCT. It should be reserved only for patients failing all other medical and surgical treatment options.

Sign in / Sign up

Export Citation Format

Share Document