Document Detail


Lessons from 8 years' experience of hypothalamic stimulation in cluster headache.
MedLine Citation:
PMID:  18547215     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Neuroimaging studies in cluster headache (CH) patients have increased understanding of attack-associated events and provided clues to the pathophysiology of the condition. They have also suggested stimulation of the ipsilateral posterior inferior hypothalamus as a treatment for chronic intractable CH. After 8 years of experience, stimulation has proved successful in controlling the pain attacks in almost 60% of chronic CH patients implanted at various centres. Although hypothalamic implant is not without risks, it has generally been performed safely. Implantation affords an opportunity to perform microrecordings of individual posterior hypothalamic neurons. These studies are at an early stage, but suggest the possibility of identifying precisely the target site by its electrophysiological characteristics. Autonomic studies of patients undergoing posterior hypothalamic stimulation provide further evidence that long-term stimulation is safe, revealing that it can cause altered modulation of the mechanisms of orthostatic adaptation without affecting the baroreflex, cardiorespiratory interactions or efferent sympathetic and vagal functions. Chronically stimulated patients have an increased threshold for cold pain at the site of the first trigeminal branch ipsilateral to the stimulated side; when the stimulator is switched off, changes in sensory and pain thresholds do not occur immediately, suggesting that long-term stimulation is required to induce sensory and nociceptive changes. Posterior inferior hypothalamic stimulation is now established as a treatment for many chronic CH patients. The technique is shedding further light on the pathophysiology of the disease, and is also providing clues to functioning of the hypothalamus itself.
Authors:
M Leone; A Proietti Cecchini; A Franzini; G Broggi; P Cortelli; P Montagna; A May; T Juergens; R Cordella; F Carella; G Bussone
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cephalalgia : an international journal of headache     Volume:  28     ISSN:  1468-2982     ISO Abbreviation:  Cephalalgia     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-12     Completed Date:  2008-08-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200710     Medline TA:  Cephalalgia     Country:  England    
Other Details:
Languages:  eng     Pagination:  787-97; discussion 798     Citation Subset:  IM    
Affiliation:
Headache Centre, Neurology Department III, Fodazione Istituto Nazionale Neurologico Carlo Besta, Milano, Italy. leone@istituto-besta.it <leone@istituto-besta.it>
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MeSH Terms
Descriptor/Qualifier:
Adult
Algorithms
Cluster Headache / physiopathology,  therapy*
Deep Brain Stimulation*
Dominance, Cerebral / physiology
Electrodes, Implanted
Female
Follow-Up Studies
Humans
Hypothalamus, Posterior / physiopathology*
Long-Term Care
Magnetic Resonance Imaging
Male
Middle Aged
Neuronavigation
Postoperative Complications / physiopathology
Stereotaxic Techniques
Tomography, X-Ray Computed
Trigeminal Autonomic Cephalalgias / physiopathology,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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