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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Hypothalamus stimulation
        
(Message started by: Nienke on Aug 29^th, 2007, 3:41pm)

Title: Hypothalamus stimulation
Post by Nienke on Aug 29^th, 2007, 3:41pm

Hi hi!

Did anyone of you heard of Hypothalamus stimulation??

Cluster headache is the most severe among primary headaches. Positron emission tomography and functional MRI studies have demonstrated that the ipsilateral posterior hypothalamus is activated during cluster headache attacks and is structurally asymmetric in these patients thus indicating that cluster headache may originate at that level. These hypothalamic abnormalities in cluster headache led to the suggestion that deep brain stimulation of ipsilateral posterior inferior hypothalamus might produce clinical improvement in otherwise treatment refractory chronic cluster headache patients. In a patient with severe intractable chronic cluster headache, hypothalamic electrical stimulation produced complete and long-term pain relief with no relevant side effects. So far other operations have been performed and the results are encouraging in terms of both pain relief and safety. The efficacy of hypothalamic electrical stimulation provides some hints into cluster headache pathophysiology.

Title: Re: Hypothalamus stimulation
Post by JDH on Aug 29^th, 2007, 4:06pm

say what?

Title: Re: Hypothalamus stimulation
Post by thomas on Aug 29^th, 2007, 4:20pm

on 08/29/07 at 16:06:30, JDH wrote:

say what?

I think she is referring to "deep-brain" stimulation. I have seen where it has had some positive effects in a few siezure type disorders and I thought they had had some success with this in Italy.

Title: Re: Hypothalamus stimulation
Post by Ray on Aug 29^th, 2007, 6:12pm

Dear Nienke:

This would be a last resort treatment when nothing else provided any relief. It is, after all, brain surgery. In my mind, if I've survived this long without this surgery, I don't want to try it, thank you very much.

With regards,

Ray

Title: Re: Hypothalamus stimulationhttp://news.bbc.co.uk/
Post by Garys_Girl on Sep 3^rd, 2007, 8:05pm

This is a last resort treatment for chronic clusterheads. The problem with deep brain stimulation is the risk of stroke - and a stroke that might kill you.

Here's info on the basis of the studies: http://news.bbc.co.uk/2/hi/health/380497.stm

Here's a very brief description of one study: http://www.headachedrugs.com/archives2/stimulation.html

Here's an article on occipital nerve stimulation and clusters - safer: http://www.reuters.com/article/healthNews/idUSN0731193520070308?pageNumber=2&sp=true

Apparently it's also been tested at the Jefferson Headache Clinic in Philly (Mayo is testing for Migraines): http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showAbstract&doi=10.1046/j.1468-2982.2002.00410.x

Hope this helps,

Laurie

Title: Re: Hypothalamus stimulation
Post by UN solved on Sep 3^rd, 2007, 9:21pm

Dr. Black from the Mayo Clinic told me via e-mail that they had tried to twice in strictly unilateral episodics and both were unsuccessful. The comments he later made about those 2 were contradictory to what he told me. What to believe ??

Try this last ! ... Right before suicide !!

UNsolved

Title: Re: Hypothalamus stimulation
Post by chewy on Sep 3^rd, 2007, 10:08pm

Not sure who but this is one of our recurring under numerous AKA sh#itheads.

Title: Re: Hypothalamus stimulation
Post by Nienke on Oct 20^th, 2007, 8:56am

Sorry for the late reaction!
Laurie, thanks for the links!!! I've read them and they look good...
Dr. Ferrari, THE cluster-specialist in Holland said in a presentation that he thinks it worth trying...

I think I'll first try Lithium before trying the deepbrain stimulation.. Because the idea of operattion in my brain scars me off at the moment ;)...

Thanks for all your reactions!

Title: Re: Hypothalamus stimulation
Post by HeadhurtinMama on Oct 20^th, 2007, 10:12am

Personally, I don't like the idea of someone sticking a probe in my brain. I would try just about anything before this one.

Title: Re: Hypothalamus stimulation
Post by Ray on Oct 20^th, 2007, 4:04pm

I saw Dr. Ferrari in Leiden in 1989-1990. He must have changed a lot since then, because he was not a proponent of radical treatments when I saw him.

I stand by my previous comments.

Pain Free wishes,

Ray

Title: Re: Hypothalamus stimulation
Post by Globi77411 on Nov 9^th, 2007, 5:34am

Hi Nienke,

I am surprised as well that prof. Ferrari is so positive about DBS. Did he tell you where you can have this operation? In Holland? I think it’s a big gamble to have this operations. Things can go really wrong. I have seen this procedure on Tv when they where operating on somebody with epilepsy….i think. It looks like hell. You are awake when they are putting in the wire. It doesn’t hurt……but only the idea makes me already shiver.

Title: Re: Hypothalamus stimulation
Post by Bob_Johnson on Nov 9^th, 2007, 11:00am

Brain. 2005 Apr; 128 (Pt 4): 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]

=================
Acute Hypothalamic Stimulation Not Effective for Ongoing Cluster Headache

Susan Jeffrey
Medscape Medical News 2006. © 2006 Medscape

December 4, 2006 — Although long-term hypothalamic stimulation is effective in improving drug-resistant cluster headache (CH), a new study suggests that acute stimulation does not effectively address ongoing attacks.

"The discrepancy between the findings of this study and the effectiveness of long-term hypothalamic stimulation in preventing drug-resistant chronic CH attacks suggests that long-term effectiveness is the result of complex mechanisms, probably involving the resetting of a complex circuit including brain structures additional to the trigeminal system, hypothalamus, and connections between them," the authors, led by Massimo Leone, MD, from the Istituto Nazionale Neurologico Carlo Besta, in Milan, Italy, conclude.

Their report is featured in the November 28 issue of Neurology.

Chronic Prophylaxis vs Acute Attacks

Functional imaging has shown that during cluster headaches — intense headaches that last from 15 to 180 minutes — patients show hypothalamic activation. Continuous hypothalamic stimulation has been shown to be effective in reducing cluster headache, with the inhibition of this activation thought to be the mechanism of efficacy, the authors note. In this study, the aim was to assess the effect of acute hypothalamic stimulation on CH attacks among 16 patients who had been implanted with a stimulator to address chronic drug-resistant cluster headaches.

All patients had had daily CH attacks for at least a year prior to implantation and had drug-resistant chronic CH according to International Headache Society criteria.

In each patient, at least 6 attacks were treated in this acute fashion. In the immediate postoperative period, the stimulator was turned on when an attack began and stimulation was continued either for 5 minutes after resolution of the pain or for not more than 20 minutes. After 7 to 14 days, continuous stimulation was begun at low amplitude and gradually increased to the final effective amplitude. During that time, attacks were treated acutely by increasing the monopolar amplitude when the attack began.

Of 108 evaluable attacks, a pain-intensity reduction of greater than 50% occurred in only 25 attacks, or 23.1%, and in 16% the pain resolved completely.

"In previous studies investigating the efficacy of drug treatments (triptans) in aborting CH attacks, up to 31% of attacks responded to placebo, indicating that hypothalamic stimulation under the conditions we investigated is probably not effective as an acute treatment for CH attacks," the authors conclude.

A Sensible Conclusion

In a commentary accompanying the paper, Peter J. Goadsby, MD, DSc, from the National Hospital for Neurology and Neurosurgery, in London, United Kingdom, writes that given their results, the authors "sensibly conclude that intermittent acute is less effective than continuous stimulation."

However, although only 5 years ago neurostimulation therapy seemed "futuristic," he notes, "there is a growing consensus that medically intractable chronic cluster headache now has an option to very simply transform the disorder."

Whether a less invasive approach of occipital nerve stimulation will have a similar benefit is now being studied. "What is clear is for a subset of patients with this important neurologic disorder, destructive invasive surgery with its associated morbidity and mortality may no longer be necessary. If this indeed proves to be the case, our patients will benefit."

Controlled trials of neurostimulation therapy "are the appropriate next step," Dr. Goadsby concludes.

Neurology 2006;67:1844-1845, 1735.

Title: Re: Hypothalamus stimulation
Post by thebbz on Nov 9^th, 2007, 7:57pm

Thanks again for the infomation all.
thebb
Right before suicide. Never without EVERYTHING else a couple of times first.
thebb