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        Cluster Headache Help and Support >> Cluster Headache Specific >> anything new on stimulation to Hypothalamus?
        
(Message started by: sgarner on Aug 4^th, 2006, 10:29pm)

Title: anything new on stimulation to Hypothalamus?
Post by sgarner on Aug 4^th, 2006, 10:29pm

New England Journal of Medicine 11/08/2001 Volume 345:1428-1429 Number 19

"Stereotactic Stimulation of Posterior Hypothalamic Gray Matter in a Patient with Intractable Cluster Headache"

Cluster headache is the most severe form of primary headache.1 Positron-emission tomography has shown activation of the homolateral posterior inferior hypothalamic gray matter during attacks of cluster headaches, a finding that is apparently specific to the condition,2,3 and voxel-based morphometric magnetic resonance imaging (MRI) has documented alteration of the same area,4 suggesting that cluster headache may be initiated in this area. We reasoned that stereotactic stimulation of this area might prevent activation and relieve intractable forms of cluster headache.

We report on a 39-year-old, right-handed man who had excruciatingly painful daily cluster headaches for five years. The attacks lasted between 30 minutes and 4 hours, occurred two to five times a day, and were associated with striking oculofacial swelling. Ninety percent were on the right side, and the remainder were on the left; they were never bilateral.5 Extensive investigation including cerebral MRI, magnetic resonance angiography, and catheter angiography excluded other conditions.5 No drugs produced worthwhile benefit.5 After a second percutaneous thermal rhizotomy, the right-sided headaches disappeared. Unfortunately, from that moment, the left-sided attacks worsened to mirror exactly those that had previously occurred on the right side. Left trigeminal surgery was contraindicated by the risk of corneal sequelae, which could have left the patient totally blind (he was blind in the right eye as a result of a hemorrhage in the vitreous humor).

We proposed the stereotactic implantation of an electrode, targeting the posterior inferior homolateral hypothalamic gray matter.2,3,4 After informed consent was obtained, the operation was performed with the patient under local anesthesia. The electrode (model 3089, Medtronic, Minneapolis) was inserted 6 mm posterior to the midpoint between the anterior and posterior commissures, 2 mm left of the midline, and 8 mm below the commissural plane.2,3,4 Intraoperative electrical stimulation induced no side effects. The permanent generator (Soletra, Medtronic), embedded in a subclavicular pocket, was connected through a subcutaneous tunnel.

Therapeutic stimulation was continuous and unipolar. The position of the permanent electrode was verified by postoperative MRI (Figure 1). When stimulation was provided at a frequency of 180 Hz, a voltage of 3 V, and a pulse width of 60 µsec, the attacks disappeared after 48 hours. Twice, without the patient's being aware of it, the stimulator was switched off and the left-sided attacks reappeared 48 hours later. When the stimulator was turned on again, the attacks disappeared 48 hours later. Thirteen months after the operation, the patient remains free of pain. The precision and safety of this method suggest that it should be tried in other patients with intractable chronic cluster headaches.

Massimo Leone, M.D.

http://www.ouch-us.org/chgeneral/hypothalamus/hypothalamus4.htm

Title: Re: anything new on stimulation to Hypothalamus?
Post by Bob_Johnson on Aug 5^th, 2006, 8:29am

Brain. 2005 Apr; 128(Pt4):940-7

Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action.

Schoenen J, Di Clemente L, Vandenheede M, Fumal A, De Pasqua V, Mouchamps M, Remacle JM, de Noordhout AM.

University Department of Neurology, University of Liege, Liege, Belgium; University Department of Neuroanatomy, University of Liege, Liege, Belgium.

Summary We enrolled six patients suffering from refractory chronic cluster headache in a pilot trial of neurostimulation of the ipsilateral ventroposterior hypothalamus using the stereotactic coordinates published previously. After the varying durations needed to determine optimal stimulation parameters and a mean follow-up of 14.5 months, the clinical outcome is excellent in three patients (two are pain-free; one has fewer than three attacks per month), but unsatisfactory in one patient, who only has had transient remissions. Mean voltage is 3.28 V, diplopia being the major factor limiting its increase. When the stimulator was switched off in one pain-free patient, attacks resumed after 3 months until it was turned on again. In one patient the implantation procedure had to be interrupted because of a panic attack with autonomic disturbances. Another patient died from an intracerebral haemorrhage that developed along the lead tract several hours after surgery; there were no other vascular changes on post-mortem examination. After 1 month, the hypothalamic stimulation induced resistance against the attack-triggering agent nitroglycerin and tended to increase pain thresholds at extracephalic, but not at cephalic, sites. It had no detectable effect on neurohypophyseal hormones or melatonin excretion. We conclude that hypothalamic stimulation has remarkable efficacy in most, but not all, patients with treatment-resistant chronic cluster headache. Its efficacy is not due to a simple analgesic effect or to hormonal changes. Intracerebral haemorrhage cannot be neglected in the risk evaluation of the procedure. Whether it might be more prevalent than in deep-brain stimulation for movement disorders remains to be determined.

PMID: 15689358 [PubMed]
=================
Neurology. 2006 Jul 11;67(1):150-2.

Hypothalamic stimulation for intractable cluster headache: long-term experience.

Leone M, Franzini A, Broggi G, Bussone G.

Istituto Nazionale Neurologico Carlo Besta, Milano, Italy. leone@istituto-besta.it

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.

PMID: 16832097 [PubMed - in process]

Title: Re: anything new on stimulation to Hypothalamus?
Post by unsolved1 on Aug 5^th, 2006, 1:01pm

On 5/10/2006 ... Dr. Black from the Mayo Clinic said ...

Quote:

we have placed two deep brain stimulators for chronic cluster headache--it has been helpful though has not resolved the attacks. Thus far, we are only considering strictly one-sided sufferers as candidates.

:-/
UNsolved