The effect of posterior hypothalamus region deep brain stimulation on sleep

Kovač, Stjepana; Wright, Mary-Anne; Eriksson, Sofia; Zrinzo, Ludvic; Matharu, Manjit; Walker, Matthew C.

doi:10.1177/0333102413505241

Cited by 20 publications

(19 citation statements)

References 16 publications

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“…Interestingly, the polysomnogram of cluster headache patients (both inside or outside a cluster period) may show decreased number and frequency of REM sleep periods ( Sahota and Dexter, 1990 ; Barloese et al, 2015 ), though REM sleep abnormalities are not always reported ( Vetrugno et al, 2007 ). The alleviation of cluster headache symptoms after posterior hypothalamic DBS implantation may also be accompanied by changes in sleep quality and architecture, though these changes are not always pleasant (e.g., frequent overnight awakenings) ( Vetrugno et al, 2007 ; Kovac et al, 2014 ).…”

Section: Circadian Rhythm/sleepmentioning

confidence: 99%

Neuroendocrine Associations Underlying the Persistent Therapeutic Effects of Classic Serotonergic Psychedelics

et al. 2018

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Recent reports on the effects of psychedelic-assisted therapies for mood disorders and addiction, as well as the effects of psychedelics in the treatment of cluster headache, have demonstrated promising therapeutic results. In addition, the beneficial effects appear to persist well after limited exposure to the drugs, making them particularly appealing as treatments for chronic neuropsychiatric and headache disorders. Understanding the basis of the long-lasting effects, however, will be critical for the continued use and development of this drug class. Several mechanisms, including biological and psychological ones, have been suggested to explain the long-lasting effects of psychedelics. Actions on the neuroendocrine system are some such mechanisms that warrant further investigation in the study of persisting psychedelic effects. In this report, we review certain structural and functional neuroendocrinological pathologies associated with neuropsychiatric disorders and cluster headache. We then review the effects that psychedelic drugs have on those systems and provide preliminary support for potential long-term effects. The circadian biology of cluster headache is of particular relevance in this area. We also discuss methodologic considerations for future investigations of neuroendocrine system involvement in the therapeutic benefits of psychedelic drugs.

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Section: Circadian Rhythm/sleepmentioning

confidence: 99%

Neuroendocrine Associations Underlying the Persistent Therapeutic Effects of Classic Serotonergic Psychedelics

et al. 2018

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“…30 These data are complementary to data from recent human trials of posterior hypothalamic stimulation for the treatment of cluster headaches that report prolonged periods of wakefulness and disrupted sleep after DBS. 48…”

Section: Hypothalamusmentioning

confidence: 99%

Neurostimulation to improve level of consciousness in patients with epilepsy

Gummadavelli¹,

Kundishora²,

Willie

et al. 2015

FOC

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When drug-resistant epilepsy is poorly localized or surgical resection is contraindicated, current neurostimulation strategies such as deep brain stimulation and vagal nerve stimulation can palliate the frequency or severity of seizures. However, despite medical and neuromodulatory therapy, a significant proportion of patients continue to experience disabling seizures that impair awareness, causing disability and risking injury or sudden unexplained death. We propose a novel strategy in which neuromodulation is used not only to reduce seizures but also to ameliorate impaired consciousness when the patient is in the ictal and postictal states. Improving or preventing alterations in level of consciousness may have an effect on morbidity (e.g., accidents, drownings, falls), risk for death, and quality of life. Recent studies may have elucidated underlying networks and mechanisms of impaired consciousness and yield potential novel targets for neuromodulation. The feasibility, benefits, and pitfalls of potential deep brain stimulation targets are illustrated in human and animal studies involving minimally conscious/vegetative states, movement disorders, depth of anesthesia, sleep-wake regulation, and epilepsy. We review evidence that viable therapeutic targets for impaired consciousness associated with seizures may be provided by key nodes of the consciousness system in the brainstem reticular activating system, hypothalamus, basal ganglia, thalamus, and basal forebrain.

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“…Much of what is known about neurostimulation and sleep derives from the use of DBS to treat movement disorders like Parkinson's disease . DBS of some brainstem structures, including the subthalamic nucleus and the pedunculopontine nucleus, is generally associated with improvement in sleep quality, but development of a sleep disorder is possible too, and stimulation of other deep targets can worsen sleep . The therapeutic mechanisms of VNS and DBS are thought to involve brainstem pathways that also play important roles in sleep, but RNS System leads are typically placed in the neocortex or hippocampus, where the effects of stimulation on sleep are less clear.…”

Section: Discussionmentioning

confidence: 99%

Sleep disruption is not observed with brain‐responsive neurostimulation for epilepsy

Ruoff

Jarosiewicz

et al. 2020

Epilepsia Open

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Objective: Neurostimulation devices that deliver electrical impulses to the nervous system are widely used to treat seizures in patients with medically refractory epilepsy, but the effects of these therapies on sleep are incompletely understood. Vagus nerve stimulation can contribute to obstructive sleep apnea, and thalamic deep brain stimulation can cause sleep disruption. A device for brain-responsive neurostimulation (RNS ® System, NeuroPace, Inc) is well tolerated in clinical trials, but potential effects on sleep are unknown. Methods: Six adults with medically refractory focal epilepsy treated for at least six months with the RNS System underwent a single night of polysomnography (PSG).RNS System lead locations included mesial temporal and neocortical targets. Sleep stages and arousals were scored according to standard guidelines. Stimulations delivered by the RNS System in response to detections of epileptiform activity were identified by artifacts on scalp electroencephalography. Results: One subject was excluded for technical reasons related to unreliable identification of stimulation artifact on EEG during PSG. In the remaining five subjects, PSG showed fragmented sleep with frequent arousals. Arousal histograms aligned to stimulations revealed a significant peak in arousals just before stimulation. In one of these subjects, the arousal peak began before stimulation and extended ~1 seconds after stimulation. A peak in arousals occurring only after stimulation was not observed. Significance: In this small cohort of patients, brain-responsive neurostimulation does not appear to disrupt sleep. If confirmed in larger studies, this could represent a potential clinical advantage of brain-responsive neurostimulation over other neurostimulation modalities. K E Y W O R D S arousal, brain-responsive neurostimulation, epilepsy, polysomnography, RNS, sleep 156 | RUOFF et al. | 157 RUOFF et al.

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The effect of posterior hypothalamus region deep brain stimulation on sleep

Abstract: PH-DBS, a promising treatment for severe refractory TACs, affects sleep quality and pre-existing sleep disorders. This needs to be considered when treating patients with PH-DBS.

Cited by 20 publications

References 16 publications

Neuroendocrine Associations Underlying the Persistent Therapeutic Effects of Classic Serotonergic Psychedelics

Neuroendocrine Associations Underlying the Persistent Therapeutic Effects of Classic Serotonergic Psychedelics

Neurostimulation to improve level of consciousness in patients with epilepsy

Sleep disruption is not observed with brain‐responsive neurostimulation for epilepsy

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