| Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations. | |
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MedLine Citation:
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PMID: 20672915 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECT: The aim of this study was to review the indications for and results of deep brain stimulation (DBS) of the posterior hypothalamus (pHyp) in the treatment of drug-refractory and severe painful syndromes of the face, disruptive and aggressive behavior associated with epilepsy, and below-average intelligence. The preoperative clinical picture, functional imaging studies, and overall clinical results in the literature are discussed. METHODS: All patients underwent stereotactic implantation of deep-brain electrodes within the pHyp. Data from several authors have been collected and reported for each clinical entity, as have clinical results, adverse events, and neurophysiological characteristics of the pHyp. RESULTS: The percentage of patients with chronic cluster headache who responded to DBS was 50% in the overall reported series. The response rate was 100% for short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing and for chronic paroxysmal hemicrania, although only 2 patients and 1 patient, respectively, have been described as having these conditions. None of the 4 patients suffering from refractory neuropathic trigeminal pain benefited from the procedure (0% response rate), whereas all 5 patients (100%) affected with refractory trigeminal neuralgia (TN) due to multiple sclerosis (MS) and undergoing pHyp DBS experienced a significant decrease in pain attacks within the first branch of cranial nerve V. Six (75%) of 8 patients presenting with aggressive behavior and mental retardation benefited from pHyp stimulation; 6 patients were part of the authors' series and 2 were reported in the literature. CONCLUSIONS: In carefully selected patients, DBS of the pHyp can be considered an effective procedure for the treatment of refractory trigeminal autonomic cephalalgias, aggressive behavior, and MS-related TN in the first trigeminal branch. Only larger and prospective studies along with multidisciplinary approaches (including, by necessity, neuroimaging studies) can lead us to better patient selection that would reduce the rate of nonresponders. |
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Authors:
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Angelo Franzini; Giuseppe Messina; Roberto Cordella; Carlo Marras; Giovanni Broggi |
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Publication Detail:
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Type: Case Reports; Comparative Study; Journal Article; Review |
Journal Detail:
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Title: Neurosurgical focus Volume: 29 ISSN: 1092-0684 ISO Abbreviation: Neurosurg Focus Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-08-02 Completed Date: 2010-09-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100896471 Medline TA: Neurosurg Focus Country: United States |
Other Details:
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Languages: eng Pagination: E13 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy. angelo@angelofranzini.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aggression / psychology Cluster Headache / therapy* Deep Brain Stimulation / methods* Epilepsy / psychology, therapy Female Headache / therapy Humans Hypothalamus, Posterior / physiology* Longitudinal Studies Mental Retardation / therapy Neurophysiology SUNCT Syndrome / therapy Treatment Outcome Trigeminal Autonomic Cephalalgias / therapy* Trigeminal Nerve Diseases / therapy |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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