Deep brain stimulation and cluster headache

Leone, Massimo; Franzini, Angelo; Felisati, Giovanni; Mea, Eliana; Curone, Marcella; Tullo, V.; Broggi, Giovanni; Bussone, Gennaro

doi:10.1007/s10072-005-0427-4

Cited by 55 publications

(30 citation statements)

References 8 publications

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“…Nevertheless, targeting the hypothalamus with DBS has already been shown to be safe and potentially effective in managing patients with intractable chronic cluster headache. 61 Furthermore, stereotactic electrocoagulation of the LH in obese hu mans was performed safely more than 30 years ago, resulting in significant, although transient, appetite suppression and slight weight reduction in 3 patients. 90 Given this evidence, it was recently proposed that chronic bilateral DBS of the LH at high frequencies would mimic the results of lesion studies, just as STN DBS for PD mirrors the effect of subthalamotomy.…”

Section: 105mentioning

confidence: 99%

Deep brain stimulation in the treatment of obesity

Halpern¹,

Wolf²,

Bale

et al. 2008

JNS

141

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Obesity is a growing global health problem frequently intractable to current treatment options. Recent evidence suggests that deep brain stimulation (DBS) may be effective and safe in the management of various, refractory neuropsychiatric disorders, including obesity. The authors review the literature implicating various neural regions in the pathophysiology of obesity, as well as the evidence supporting these regions as targets for DBS, in order to explore the therapeutic promise of DBS in obesity.The lateral hypothalamus and ventromedial hypothalamus are the appetite and satiety centers in the brain, respectively. Substantial data support targeting these regions with DBS for the purpose of appetite suppression and weight loss. However, reward sensation associated with highly caloric food has been implicated in overconsumption as well as obesity, and may in part explain the failure rates of conservative management and bariatric surgery. Thus, regions of the brain's reward circuitry, such as the nucleus accumbens, are promising alternatives for DBS in obesity control.The authors conclude that deep brain stimulation should be strongly considered as a promising therapeutic option for patients suffering from refractory obesity. 625Abbreviations used in this paper: BMI = body mass index; DBS = deep brain stimulation; GABA = γ-aminobutyric acid; LH = lateral hypothalamus; MCH = melanin-concentrating hormone; NAc = nucleus accumbens; OCD = obsessive-compulsive disorder; PD = Parkinson disease; 6-OHDA = 6-hydroxydopamine; STN = subthalamic nucleus; VMH = ventromedial hypothalamus; VP = ventral pallidum.

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Section: 105mentioning

confidence: 99%

Deep brain stimulation in the treatment of obesity

Halpern¹,

Wolf²,

Bale

et al. 2008

JNS

141

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“…In the current single patient study we took advantage of the fact that the PIH has been identified recently as a promising target for the treatment of cluster headache (Bartsch et al, 2008;Bussone et al, 2007;Leone et al, 2005) and investigated the hypothalamic response to basic motivational stimuli by recording from electrodes placed for DBS treatment. Importantly, and in accord with our expectations, we observed changes in the averaged LFP as a function of stimulus category.…”

Section: Discussionmentioning

confidence: 99%

Human hypothalamus shows differential responses to basic motivational stimuli—an invasive electrophysiology study

Nager¹,

Krauss²,

Heldmann³

et al. 2011

Neuroscience

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Abstract-The hypothalamus supports basic motivational behaviours such as mating and feeding. Recording directly from the posterior inferior hypothalamus in a male patient receiving a deep brain stimulation (DBS) electrode for the alleviation of cluster headache, we tested the hypothalamic response to different classes of motivational stimuli (sexually relevant: pictures of dressed and undressed women; pictures of food) and pictures of common objects as control. Averaged local field potentials (LFP) to sexually relevant stimuli were characterized by a biphasic significantly enhanced response (relative to objects; bootstrapping statistics) with a first phase starting at around 200 ms and a second phase peaking at around 600 ms. Sexually relevant stimuli also showed a greatly enhanced positivity relative to other stimulus classes in surface event-related potentials in a group of 11 male control participants. It is suggested that the hypothalamus is involved in the recruitment of attentional resources by sexually relevant stimuli reflected in this surface positivity. In a second session, the response to food stimuli relative to objects was tested in two states: after fasting for 14 h, LFPs to food and object stimuli showed significant differences in between 300 and 850 ms, which disappeared after a full high-calorie meal, thus replicating classic studies in monkeys [Rolls et al., Brain Res (1976) 111:53-66]. The current data are the first to demonstrate hypothalamic responses to the sight of motivational stimuli in man and thus shows that recording from DBS electrodes might provide important information about the cognitive functions of subcortical structures.

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“…59 Unfortunately, some safety concerns remain. 60 These concerns have made us explore a new approach to reach these areas of the brain.…”

Section: Safety Issuesmentioning

confidence: 99%

Body fat and body weight reduction following hypothalamic deep brain stimulation in monkeys: an intraventricular approach

et al. 2012

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OBJECTIVE:The authors proposed an intraventricular 'floating' electrode inserted in the third ventricle (V3) adjacent to the ventromedian hypothalamus (VMH) in a freely moving Macaca fascicularis to modulate food intake (FI), body fat (BF), body weight (BW) and body mass index (BMI), as a potential treatment of obesity. METHODS: Five adult Macaca fascicularis monkeys were implanted stereotactically in the V3 contiguous to the VMH with one deep brain stimulation (DBS) electrode. The study was divided in two phases: (a) acute 24 h-fasting trials: different electrical stimulation parameters were applied to a fasting primate to determine the best combination in reducing FI; and (b) chronic 8-week stimulation trials: three cycles of intraventricular-VMH DBS lasting 8 --10 weeks were performed at 130 Hz, 80 Hz (most effective frequency reducing FI) and 30 Hz, respectively. BMI, BW, BF content, skinfolds and hormones were measured during baseline and at the end of each session of stimulation. RESULTS: Acute 24 h-fasting trials: there was a decrease in FI in all subjects at 80 Hz, (11 --19%, mean 15%). Chronic 8-week stimulation trials: a significant decrease in BW and BMI was observed in three out of four monkeys at 80 Hz (mean 8 ± 4.4%). Subcutaneous skinfolds were reduced in all four subjects at 80 Hz and slightly increased at 130 Hz. The sham monkey remained stable. No significant adverse effects were recorded. CONCLUSION: The stimulation of the VMH region through an intraventricular approach might acutely modulate FI and induce a sustained decrease in BW and fat mass in normal non-human primate. INTRODUCTIONObesity is a complex disorder that has reached epidemic proportions globally, with more than 1 billion adults overweight, according to WHO. It is associated with diminished quality of life 1 and reduces life expectancy. 2 Treatment includes non-pharmacological measures, drugs and surgical therapy. The use of pharmacological agents has demonstrated only discreet body weight (BW) reduction in controlled trials. For the surgery, some patients with morbid obesity still remain poor candidates for standard gastric bypass: complications occur in 15 --55% of bariatric patients, and the peri-surgical mortality rate is about 1.5% even in experienced centers. 3 Safer procedures, such as laparoscopic adjustable banded gastroplasty, are simpler but are not as effective. 4,5 Large room for effective and safer procedures still exists.Recently, modulation of brain circuits has emerged as a valuable clinical and research strategy in obesity. With the development of new hardware and electrophysiological techniques, deep brain stimulation (DBS) have been used for treating movement disorder, 6 pain, 7 obsessive compulsive disorders 8 --10 and clinical refractory epilepsy. 11,12 A recent report on the hypothalamic DBS applied in cases of chronic intractable cluster headaches 13 has revived the interest in the hypothalamic region, which is also wellknown to be involved in food intake (FI) and energy balance regulation. DBS is a reve...

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Deep brain stimulation and cluster headache

Cited by 55 publications

References 8 publications

Deep brain stimulation in the treatment of obesity

Deep brain stimulation in the treatment of obesity

Human hypothalamus shows differential responses to basic motivational stimuli—an invasive electrophysiology study

Body fat and body weight reduction following hypothalamic deep brain stimulation in monkeys: an intraventricular approach

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