Hypothalamic deep brain stimulation in positron emission tomography.
Recently, functional imaging data have underscored the crucial role the hypothalamus plays in cluster headache, one of the most severe forms of primary headache. This prompted the application of hypothalamic deep brain stimulation. Yet, it is not apparent how stimulation of an area that is thought to act as a pace-maker for acute headache attacks is able to prevent these attacks from occurring. We addressed this issue by examining 10 operated chronic cluster headache patients, using H2(15O)-positron emission tomography and alternately switching the hypothalamic stimulator on and off. The stimulation induced activation in the ipsilateral hypothalamic gray (the site of the stimulator tip), the ipsilateral thalamus, somatosensory cortex and praecuneus, the anterior cingulate cortex, and the ipsilateral trigeminal nucleus and ganglion. We additionally observed deactivation in the middle temporal gyrus, posterior cingulate cortex, and contralateral anterior insula. Both activation and deactivation are situated in cerebral structures belonging to neuronal circuits usually activated in pain transmission and notably in acute cluster headache attacks. Our data argue against an unspecific antinociceptive effect or pure inhibition of hypothalamic activity. Instead, the data suggest a hitherto unrecognized functional modulation of the pain processing network as the mode of action of hypothalamic deep brain stimulation in cluster headache.
Department of Systems Neuroscience, University of Hamburg, D-20246 Hamburg, Germany. a.may@uke.uni-hamburg.de
Arne
A
May
Massimo
M
Leone
Henning
H
Boecker
Till
T
Sprenger
Tim
T
Juergens
Gennaro
G
Bussone
Thomas R
TR
Tolle
D000328:Adult; D001931:Brain Mapping / Q000379:methods*; D003027:Cluster Headache / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000000981:diagnostic imaging / Q000503:physiopathology; D049268:Positron-Emission Tomography / Q000379:methods; D016896:Treatment Outcome