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Connectivity of an effective hypothalamic surgical target for cluster headache. J Clin Neurosci

University Laboratory of Physiology, University of Oxford, Oxford, UK.
Journal of Clinical Neuroscience (Impact Factor: 1.32). 11/2007; 14(10):955-60. DOI: 10.1016/j.jocn.2006.07.012
Source: PubMed

ABSTRACT The purpose of this study was to look at the connectivity of the posterior inferior hypothalamus in a patient implanted with a deep brain stimulating electrode using probabilistic tractography in conjunction with postoperative MRI scans. In a patient with chronic cluster headache we implanted a deep brain stimulating electrode into the ipsilateral postero-medial hypothalamus to successfully control his pain. To explore the connectivity, we used the surgical target from the postoperative MRI scan as a seed for probabilistic tractography, which was then linked to diffusion weighted imaging data acquired in a group of healthy control subjects. We found highly consistent connections with the reticular nucleus and cerebellum. In some subjects, connections were also seen with the parietal cortices, and the inferior medial frontal gyrus. Our results illustrate important anatomical connections that may explain the functional changes associated with cluster headaches and elucidate possible mechanisms responsible for triggering attacks.

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Available from: John Frederick Stein, Aug 23, 2015
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    • "These arguments led Leone et al. (2001) to treat refractory chronic cluster headache by high-frequency DBS targeting this region. To date, 41 patients with chronic cluster headache treated by DBS have been reported, and $60% of these cases showed marked improvement (Schoenen et al., 2005; Leone et al., 2006a; Owen et al., 2007; Starr et al., 2007; Bartsch et al., 2008). However, the mechanism of action, specifically the anatomic structures inducing the therapeutic effect in response to high-frequency stimulation, is still unknown. "
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    • "These arguments led Leone et al. (2001) to treat refractory chronic cluster headache by high-frequency DBS targeting this region. To date, 41 patients with chronic cluster headache treated by DBS have been reported, and $60% of these cases showed marked improvement (Schoenen et al., 2005; Leone et al., 2006a; Owen et al., 2007; Starr et al., 2007; Bartsch et al., 2008). However, the mechanism of action, specifically the anatomic structures inducing the therapeutic effect in response to high-frequency stimulation, is still unknown. "
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    • "Visual disturbances, mainly diplopia, are the main limiting side effects induced by hypothalamic stimulation [Fontaine et al. 2010; Bartsch et al. 2008; Mateos et al. 2007; Owen et al. 2007; "
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    ABSTRACT: Cluster headache (CH) is a short-lasting unilateral headache associated with ipsilateral craniofacial autonomic manifestations. A positron emission tomography (PET) study has shown that the posterior hypothalamus is activated during CH attacks, suggesting that hypothalamic hyperactivity plays a key role in CH pathophysiology. On this basis, stimulation of the ipsilateral posterior hypothalamus was hypothesized to counteract such hyperactivity to prevent intractable CH. Ten years after its introduction, hypothalamic stimulation has been proved to successfully prevent attacks in more than 60% of 58 hypothalamic implanted drug-resistant chronic CH patients. The implantation procedure has generally been proved to be safe, although it carries a small risk of brain haemorrhage. Long-term stimulation is safe, and nonsymptomatic impairment of orthostatic adaptation is the only noteworthy change. Microrecording studies will make it possible to better identify the target site. Neuroimaging investigations have shown that hypothalamic stimulation activates ipsilateral trigeminal complex, but with no immediate perceived sensation within the trigeminal distribution. Other studies on the pain threshold in chronically stimulated patients showed increased threshold for cold pain in the distribution of the first trigeminal branch ipsilateral to stimulation. These studies suggest that activation of the hypothalamus and of the trigeminal system are both necessary, but not sufficient to generate CH attacks. In addition to the hypothalamus, other unknown brain areas are likely to play a role in the pathophysiology of this illness. Hypothalamus implantation is associated with a small risk of intracerebral haemorrhage and must be performed by an expert neurosurgical team, in selected patients.
    Therapeutic Advances in Neurological Disorders 05/2010; 3(3):187-95. DOI:10.1177/1756285610370722
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