Article

Hypothalamic stimulation for intractable cluster headache: Long-term experience

Istituto Nazionale Neurologico Carlo Besta, Milano, Italy.
Neurology (Impact Factor: 8.29). 08/2006; 67(1):150-2. DOI: 10.1212/01.wnl.0000223319.56699.8a
Source: PubMed

ABSTRACT

The authors report long-term results of continuous hypothalamic stimulation in 16 chronic drug-refractory patients with cluster headache (CH). At a mean follow-up of 23 months, 13 patients are persistently pain-free or almost pain-free, and the other 3 are improved. There are no persistent side effects. Hypothalamic stimulation is an effective, safe, and well-tolerated alternative to surgery for chronic patients with drug-refractory CH.

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    • "Frontiers in Systems Neuroscience www.frontiersin.org December 2013 | Volume 7 | Article 112 | 1 SYSTEMS NEUROSCIENCE Leone et al., 2006 "
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    ABSTRACT: High-frequency deep brain stimulation is used to treat a wide range of brain disorders, like Parkinson's disease. The stimulated networks usually share common electrophysiological signatures, including hyperactivity and/or dysrhythmia. From a clinical perspective, HFS is expected to alleviate clinical signs without generating adverse effects. Here, we consider whether the classical open-loop HFS fulfills these criteria and outline current experimental or theoretical research on the different types of closed-loop DBS that could provide better clinical outcomes. In the first part of the review, the two routes followed by HFS-evoked axonal spikes are explored. In one direction, orthodromic spikes functionally de-afferent the stimulated nucleus from its downstream target networks. In the opposite direction, antidromic spikes prevent this nucleus from being influenced by its afferent networks. As a result, the pathological synchronized activity no longer propagates from the cortical networks to the stimulated nucleus. The overall result can be described as a reversible functional de-afferentation of the stimulated nucleus from its upstream and downstream nuclei. In the second part of the review, the latest advances in closed-loop DBS are considered. Some of the proposed approaches are based on mathematical models, which emphasize different aspects of the parkinsonian basal ganglia: excessive synchronization, abnormal firing-rate rhythms, and a deficient thalamo-cortical relay. The stimulation strategies are classified depending on the control-theory techniques on which they are based: adaptive and on-demand stimulation schemes, delayed and multi-site approaches, stimulations based on proportional and/or derivative control actions, optimal control strategies. Some of these strategies have been validated experimentally, but there is still a large reservoir of theoretical work that may point to ways of improving practical treatment.
    Full-text · Article · Dec 2013 · Frontiers in Systems Neuroscience
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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. "

    Full-text · Dataset · Dec 2012
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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. "

    Full-text · Dataset · Dec 2012
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