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Dagher M, Alayoubi M, Sigal GH, Cahill CM. Unveiling the link between chronic pain and misuse of opioids and cannabis. J Neural Transm (Vienna) 2024; 131:563-580. [PMID: 38570361 DOI: 10.1007/s00702-024-02765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
Over 50 million Americans endure chronic pain where many do not receive adequate treatment and self-medicate to manage their pain by taking substances like opioids and cannabis. Research has shown high comorbidity between chronic pain and substance use disorders (SUD) and these disorders share many common neurobiological underpinnings, including hypodopaminergic transmission. Drugs commonly used for self-medication such as opioids and cannabis relieve emotional, bothersome components of pain as well as negative emotional affect that perpetuates misuse and increases the risk of progressing towards drug abuse. However, the causal effect between chronic pain and the development of SUDs has not been clearly established. In this review, we discuss evidence that affirms the proposition that chronic pain is a risk factor for the development of opioid and cannabis use disorders by outlining the clinical evidence and detailing neurobiological mechanisms that link pain and drug misuse. Central to the link between chronic pain and opioid and cannabis misuse is hypodopaminergic transmission and the modulation of dopamine signaling in the mesolimbic pathway by opioids and cannabis. Moreover, we discuss the role of kappa opioid receptor activation and neuroinflammation in the context of dopamine transmission, their contribution to opioid and cannabis withdrawal, along with potential new treatments.
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Affiliation(s)
- Merel Dagher
- MacDonald Research Laboratory Building, Department of Psychiatry and Biobehavioral Sciences, Shirley and Stefan Hatos Center for Neuropharmacology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 675 Charles E Young Drive South, Office 2774, Los Angeles, CA, 90095, USA
| | - Myra Alayoubi
- MacDonald Research Laboratory Building, Department of Psychiatry and Biobehavioral Sciences, Shirley and Stefan Hatos Center for Neuropharmacology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 675 Charles E Young Drive South, Office 2774, Los Angeles, CA, 90095, USA
- Neuroscience Interdepartmental Program, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Gabriella H Sigal
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Catherine M Cahill
- MacDonald Research Laboratory Building, Department of Psychiatry and Biobehavioral Sciences, Shirley and Stefan Hatos Center for Neuropharmacology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 675 Charles E Young Drive South, Office 2774, Los Angeles, CA, 90095, USA.
- Neuroscience Interdepartmental Program, University of California Los Angeles, Los Angeles, CA, 90095, USA.
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2
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Hamani C, Davidson B, Lipsman N, Abrahao A, Nestor SM, Rabin JS, Giacobbe P, Pagano RL, Campos ACP. Insertional effect following electrode implantation: an underreported but important phenomenon. Brain Commun 2024; 6:fcae093. [PMID: 38707711 PMCID: PMC11069120 DOI: 10.1093/braincomms/fcae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/08/2023] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Deep brain stimulation has revolutionized the treatment of movement disorders and is gaining momentum in the treatment of several other neuropsychiatric disorders. In almost all applications of this therapy, the insertion of electrodes into the target has been shown to induce some degree of clinical improvement prior to stimulation onset. Disregarding this phenomenon, commonly referred to as 'insertional effect', can lead to biased results in clinical trials, as patients receiving sham stimulation may still experience some degree of symptom amelioration. Similar to the clinical scenario, an improvement in behavioural performance following electrode implantation has also been reported in preclinical models. From a neurohistopathologic perspective, the insertion of electrodes into the brain causes an initial trauma and inflammatory response, the activation of astrocytes, a focal release of gliotransmitters, the hyperexcitability of neurons in the vicinity of the implants, as well as neuroplastic and circuitry changes at a distance from the target. Taken together, it would appear that electrode insertion is not an inert process, but rather triggers a cascade of biological processes, and, as such, should be considered alongside the active delivery of stimulation as an active part of the deep brain stimulation therapy.
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Affiliation(s)
- Clement Hamani
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Benjamin Davidson
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Sean M Nestor
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Jennifer S Rabin
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto M5G 1V7, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Rosana L Pagano
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP CEP 01308-060, Brazil
| | - Ana Carolina P Campos
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP CEP 01308-060, Brazil
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Coppola G, Abagnale C, Sebastianelli G, Goadsby PJ. Pathophysiology of cluster headache: From the trigeminovascular system to the cerebral networks. Cephalalgia 2024; 44:3331024231209317. [PMID: 38415635 DOI: 10.1177/03331024231209317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Despite advances in neuroimaging and electrophysiology, cluster headache's pathogenesis remains unclear. This review will examine clinical neurophysiology studies, including electrophysiological and functional neuroimaging, to determine if they might help us construct a neurophysiological model of cluster headache. RESULTS Clinical, biochemical, and electrophysiological research have implicated the trigeminal-parasympathetic system in cluster headache pain generation, although the order in which these two systems are activated, which may be somewhat independent, is unknown. Electrophysiology and neuroimaging have found one or more central factors that may cause seasonal and circadian attacks. The well-known posterior hypothalamus, with its primary circadian pacemaker suprachiasmatic nucleus, the brainstem monoaminergic systems, the midbrain, with an emphasis on the dopaminergic system, especially when cluster headache is chronic, and the descending pain control systems appear to be involved. Functional connection investigations have verified electrophysiological evidence of functional changes in distant brain regions connecting to wide cerebral networks other than pain. CONCLUSION We propose that under the impact of external time, an inherited misalignment between the primary circadian pacemaker suprachiasmatic nucleus and other secondary extra- suprachiasmatic nucleus clocks may promote disturbance of the body's internal physiological clock, lowering the threshold for bout recurrence.
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Affiliation(s)
- Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Chiara Abagnale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Gabriele Sebastianelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Peter J Goadsby
- NIHR King's Clinical Research Facility, and Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London UK
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
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Cheema S, Ferreira F, Parras O, Lagrata S, Kamourieh S, Pakzad A, Zrinzo L, Matharu M, Akram H. Association of Clinical and Neuroanatomic Factors With Response to Ventral Tegmental Area DBS in Chronic Cluster Headache. Neurology 2023; 101:e2423-e2433. [PMID: 37848331 PMCID: PMC10752645 DOI: 10.1212/wnl.0000000000207750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Deep brain stimulation (DBS) of the ventral tegmental area (VTA) is a surgical treatment option for selected patients with refractory chronic cluster headache (CCH). We aimed to identify clinical and structural neuroimaging factors associated with response to VTA DBS in CCH. METHODS This prospective observational cohort study examines consecutive patients with refractory CCH treated with VTA DBS by a multidisciplinary team in a single tertiary neuroscience center as part of usual care. Headache diaries and validated questionnaires were completed at baseline and regular follow-up intervals. All patients underwent T1-weighted structural MRI before surgery. We compared clinical features using multivariable logistic regression and neuroanatomic differences using voxel-based morphometry (VBM) between responders and nonresponders. RESULTS Over a 10-year period, 43 patients (mean age 53 years, SD 11.9), including 29 male patients, with a mean duration of CCH 12 years (SD 7.4), were treated and followed up for at least 1 year (mean follow-up duration 5.6 years). Overall, there was a statistically significant improvement in median attack frequency from 140 to 56 per month (Z = -4.95, p < 0.001), attack severity from 10/10 to 8/10 (Z = -4.83, p < 0.001), and duration from 110 to 60 minutes (Z = -3.48, p < 0.001). Twenty-nine (67.4%) patients experienced ≥50% improvement in attack frequency and were therefore classed as responders. There were no serious adverse events. The most common side effects were discomfort or pain around the battery site (7 patients) and transient diplopia and/or oscillopsia (6 patients). There were no differences in demographics, headache characteristics, or comorbidities between responders and nonresponders. VBM identified increased neural density in nonresponders in several brain regions, including the orbitofrontal cortex, anterior cingulate cortex, anterior insula, and amygdala, which were statistically significant (p < 0.001). DISCUSSION VTA DBS showed no serious adverse events, and, although there was no placebo control, was effective in approximately two-thirds of patients at long-term follow-up. This study did not reveal any reliable clinical predictors of response. However, nonresponders had increased neural density in brain regions linked to processing of pain and autonomic function, both of which are prominent in the pathophysiology of CCH.
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Affiliation(s)
- Sanjay Cheema
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK.
| | - Francisca Ferreira
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Olga Parras
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Susie Lagrata
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Salwa Kamourieh
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Ashkan Pakzad
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Ludvic Zrinzo
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Manjit Matharu
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
| | - Harith Akram
- From the Headache and Facial Pain Group (S.C., S.K., M.M.), UCL Queen Square Institute of Neurology; The National Hospital for Neurology and Neurosurgery (S.C., F.F., O.P., S.L., S.K., L.Z., M.M., H.A.); Functional Neurosurgery Unit (F.F., O.P., L.Z., H.A.), UCL Queen Square Institute of Neurology; Wellcome Centre for Human Neuroimaging (F.F.), 12 Queen Square; UCL EPSRC Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare (i4health) (F.F.); Centre for Medical Image Computing (A.P.), University College London; and Department of Medical Physics and Biomedical Engineering (A.P.), University College London, London, UK
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5
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Flores-García M, Rizzo A, Garçon-Poca MZ, Fernández-Dueñas V, Bonaventura J. Converging circuits between pain and depression: the ventral tegmental area as a therapeutic hub. Front Pharmacol 2023; 14:1278023. [PMID: 37849731 PMCID: PMC10577189 DOI: 10.3389/fphar.2023.1278023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
Chronic pain and depression are highly prevalent pathologies and cause a major socioeconomic burden to society. Chronic pain affects the emotional state of the individuals suffering from it, while depression worsens the prognosis of chronic pain patients and may diminish the effectiveness of pain treatments. There is a high comorbidity rate between both pathologies, which might share overlapping mechanisms. This review explores the evidence pinpointing a role for the ventral tegmental area (VTA) as a hub where both pain and emotional processing might converge. In addition, the feasibility of using the VTA as a possible therapeutic target is discussed. The role of the VTA, and the dopaminergic system in general, is highly studied in mood disorders, especially in deficits in reward-processing and motivation. Conversely, the VTA is less regarded where it concerns the study of central mechanisms of pain and its mood-associated consequences. Here, we first outline the brain circuits involving central processing of pain and mood disorders, focusing on the often-understudied role of the dopaminergic system and the VTA. Next, we highlight the state-of-the-art findings supporting the emergence of the VTA as a link where both pathways converge. Thus, we envision a promising part for the VTA as a putative target for innovative therapeutic approaches to treat chronic pain and its effects on mood. Finally, we emphasize the urge to develop and use animal models where both pain and depression-like symptoms are considered in conjunction.
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Affiliation(s)
- Montse Flores-García
- Unitat de Farmacologia, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia, Spain
- Neuropharmacology and Pain Group, Neuroscience Program, IDIBELL-Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Arianna Rizzo
- Unitat de Farmacologia, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia, Spain
- Neuropharmacology and Pain Group, Neuroscience Program, IDIBELL-Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Maria Zelai Garçon-Poca
- Unitat de Farmacologia, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia, Spain
- Neuropharmacology and Pain Group, Neuroscience Program, IDIBELL-Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Víctor Fernández-Dueñas
- Unitat de Farmacologia, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia, Spain
- Neuropharmacology and Pain Group, Neuroscience Program, IDIBELL-Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Jordi Bonaventura
- Unitat de Farmacologia, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia, Spain
- Neuropharmacology and Pain Group, Neuroscience Program, IDIBELL-Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
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Pant A, Farrokhi F, Krause K, Marsans M, Roberts J. Ten-Year Durability of Hypothalamic Deep Brain Stimulation in Treatment of Chronic Cluster Headaches: A Case Report and Literature Review. Cureus 2023; 15:e47338. [PMID: 38021829 PMCID: PMC10657219 DOI: 10.7759/cureus.47338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Chronic cluster headache (CCH) is a debilitating primary headache that causes excruciating pain without remission. Various medical and surgical treatments have been implemented over the years, yet many provide only short-term relief. Deep brain stimulation (DBS) is an emerging treatment alternative that has been shown to dramatically reduce the intensity and frequency of headache attacks. However, reports of greater than 10-year outcomes after DBS for CCH are scant. Here, we report the durability of DBS in the posterior inferior hypothalamus after 10 years on a patient with CCH. Our patient experienced an 82% decrease in the frequency of headaches after DBS, which was maintained for over 10 years. The side effects observed included depression, irritability, anxiety, and dizziness, which were alleviated by changing programming settings. In the context of current literature, DBS shows promise for long-term relief of cluster headaches when other treatments fail.
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Affiliation(s)
- Aaradhya Pant
- Neurosurgery, Virginia Mason Medical Center, Seattle, USA
| | - Farrokh Farrokhi
- Neurological Surgery, Virginia Mason Medical Center, Seattle, USA
| | - Katie Krause
- Neurological Surgery, Virginia Mason Medical Center, Seattle, USA
| | - Maria Marsans
- Neurological Surgery, Virginia Mason Medical Center, Seattle, USA
| | - John Roberts
- Neurology, Virginia Mason Medical Center, Seattle, USA
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Kim SA, Choi SY, Youn MS, Pozo-Rosich P, Lee MJ. Epidemiology, burden and clinical spectrum of cluster headache: a global update. Cephalalgia 2023; 43:3331024231201577. [PMID: 37728577 DOI: 10.1177/03331024231201577] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND This narrative review aims to broaden our understanding of the epidemiology, burden and clinical spectrum of cluster headache based on updated findings with a global perspective. METHODS We conducted a literature search on the following topics: (a) epidemiology; (b) burden: quality of life, disability, economic burden, job-related burden and suicidality; and (c) clinical spectrum: male predominance and its changes, age, pre-cluster and pre-attack symptoms, aura, post-drome, attack characteristics (location, severity, duration and associated symptoms), bout characteristics (attack frequency, bout duration and bout frequency), circadian and seasonal rhythmicity and disease course. RESULTS New large-scale population-based reports have suggested a lower prevalence than previous estimations. The impact of cluster headache creates a significant burden in terms of the quality of life, disability, economic and job-related burdens and suicidality. Several studies have reported decreasing male-to-female ratios and a wide age range at disease onset. The non-headache phases of cluster headache, including pre-cluster, pre-attack and postictal symptoms, have recently been revisited. The latest data regarding attack characteristics, bout characteristics, and circadian and seasonal rhythmicity from different countries have shown variability among bouts, attacks, individuals and ethnicities. Studies on the disease course of cluster headache have shown typical characteristics of attacks or bouts that decrease with time. CONCLUSIONS Cluster headache may be more than a "trigeminal autonomic headache" because it involves complex central nervous system phenomena. The spectrum of attacks and bouts is wider than previously recognised. Cluster headache is a dynamic disorder that evolves or regresses over time.
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Affiliation(s)
- Seung Ae Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - So Youn Choi
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | | | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research, Departament Medicina, Universtitat Autonoma de Barcelona, Spain
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Seoul National University College of Medicine, Seoul, South Korea
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8
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Yuen J, Goyal A, Rusheen AE, Kouzani AZ, Berk M, Kim JH, Tye SJ, Abulseoud OA, Oesterle TS, Blaha CD, Bennet KE, Lee KH, Oh Y, Shin H. Oxycodone-induced dopaminergic and respiratory effects are modulated by deep brain stimulation. Front Pharmacol 2023; 14:1199655. [PMID: 37408764 PMCID: PMC10318172 DOI: 10.3389/fphar.2023.1199655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction: Opioids are the leading cause of overdose death in the United States, accounting for almost 70,000 deaths in 2020. Deep brain stimulation (DBS) is a promising new treatment for substance use disorders. Here, we hypothesized that VTA DBS would modulate both the dopaminergic and respiratory effect of oxycodone. Methods: Multiple-cyclic square wave voltammetry (M-CSWV) was used to investigate how deep brain stimulation (130 Hz, 0.2 ms, and 0.2 mA) of the rodent ventral segmental area (VTA), which contains abundant dopaminergic neurons, modulates the acute effects of oxycodone administration (2.5 mg/kg, i.v.) on nucleus accumbens core (NAcc) tonic extracellular dopamine levels and respiratory rate in urethane-anesthetized rats (1.5 g/kg, i.p.). Results: I.V. administration of oxycodone resulted in an increase in NAcc tonic dopamine levels (296.9 ± 37.0 nM) compared to baseline (150.7 ± 15.5 nM) and saline administration (152.0 ± 16.1 nM) (296.9 ± 37.0 vs. 150.7 ± 15.5 vs. 152.0 ± 16.1, respectively, p = 0.022, n = 5). This robust oxycodone-induced increase in NAcc dopamine concentration was associated with a sharp reduction in respiratory rate (111.7 ± 2.6 min-1 vs. 67.9 ± 8.3 min-1; pre- vs. post-oxycodone; p < 0.001). Continuous DBS targeted at the VTA (n = 5) reduced baseline dopamine levels, attenuated the oxycodone-induced increase in dopamine levels to (+39.0% vs. +95%), and respiratory depression (121.5 ± 6.7 min-1 vs. 105.2 ± 4.1 min-1; pre- vs. post-oxycodone; p = 0.072). Discussion: Here we demonstrated VTA DBS alleviates oxycodone-induced increases in NAcc dopamine levels and reverses respiratory suppression. These results support the possibility of using neuromodulation technology for treatment of drug addiction.
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Affiliation(s)
- Jason Yuen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Abhinav Goyal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States
| | - Aaron E. Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States
| | - Abbas Z. Kouzani
- School of Engineering, Deakin University, Geelong, VIC, Australia
| | - Michael Berk
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Jee Hyun Kim
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Susannah J. Tye
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Behavioral Science, Emory University, Atlanta, GA, United States
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Charles D. Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kevin E. Bennet
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Division of Engineering, Mayo Clinic, Rochester, MN, United States
| | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Hojin Shin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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9
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Rajabian A, Vinke S, Candelario-Mckeown J, Milabo C, Salazar M, Nizam AK, Salloum N, Hyam J, Akram H, Joyce E, Foltynie T, Limousin P, Hariz M, Zrinzo L. Accuracy, precision, and safety of stereotactic, frame-based, intraoperative MRI-guided and MRI-verified deep brain stimulation in 650 consecutive procedures. J Neurosurg 2023; 138:1702-1711. [PMID: 36308483 DOI: 10.3171/2022.8.jns22968] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Suboptimal lead placement is one of the most common indications for deep brain stimulation (DBS) revision procedures. Confirming lead placement in relation to the visible anatomical target with dedicated stereotactic imaging before terminating the procedure can mitigate this risk. In this study, the authors examined the accuracy, precision, and safety of intraoperative MRI (iMRI) to both guide and verify lead placement during frame-based stereotactic surgery. METHODS A retrospective analysis of 650 consecutive DBS procedures for targeting accuracy, precision, and perioperative complications was performed. Frame-based lead placement took place in an operating room equipped with an MRI machine using stereotactic images to verify lead placement before removing the stereotactic frame. Immediate lead relocation was performed when necessary. Systematic analysis of the targeting error was calculated. RESULTS Verification of 1201 DBS leads with stereotactic MRI was performed in 643 procedures and with stereotactic CT in 7. The mean ± SD of the final targeting error was 0.9 ± 0.3 mm (range 0.1-2.3 mm). Anatomically acceptable lead placement was achieved with a single brain pass for 97% (n = 1164) of leads; immediate intraoperative relocation was performed in 37 leads (3%) to obtain satisfactory anatomical placement. General anesthesia was used in 91% (n = 593) of the procedures. Hemorrhage was noted after 4 procedures (0.6%); 3 patients (0.4% of procedures) presented with transient neurological symptoms, and 1 experienced delayed cognitive decline. Two bleeds coincided with immediate relocation (2 of 37 leads, 5.4%), which contrasts with hemorrhage in 2 (0.2%) of 1164 leads implanted on the first pass (p = 0.0058). Three patients had transient seizures in the postoperative period. The seizures coincided with hemorrhage in 2 of these patients and with immediate lead relocation in the other. There were 21 infections (3.2% of procedures, 1.5% in 3 months) leading to hardware removal. Delayed (> 3 months) retargeting of 6 leads (0.5%) in 4 patients (0.6% of procedures) was performed because of suboptimal stimulation benefit. There were no MRI-related complications, no permanent motor deficits, and no deaths. CONCLUSIONS To the authors' knowledge, this is the largest series reporting the use of iMRI to guide and verify lead location during DBS surgery. It demonstrates a high level of accuracy, precision, and safety. Significantly higher hemorrhage was encountered when multiple brain passes were required for lead implantation, although none led to permanent deficit. Meticulous audit and calibration can improve precision and maximize safety.
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Affiliation(s)
- Ali Rajabian
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; and
| | - Saman Vinke
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Joseph Candelario-Mckeown
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Catherine Milabo
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Maricel Salazar
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Abdul Karim Nizam
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Nadia Salloum
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Jonathan Hyam
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; and
| | - Harith Akram
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; and
| | - Eileen Joyce
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Thomas Foltynie
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Patricia Limousin
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
| | - Marwan Hariz
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 3Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Ludvic Zrinzo
- 1Department of Clinical and Movement Neurosciences, Functional Neurosurgery Unit, University College London, Institute of Neurology, Queen Square, London, United Kingdom
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; and
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10
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Murray M, Pahapill PA, Awad AJ. Deep Brain Stimulation for Chronic Cluster Headaches: A Systematic Review and Meta-Analysis. Stereotact Funct Neurosurg 2023; 101:232-243. [PMID: 37245509 DOI: 10.1159/000530508] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/29/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Chronic cluster headache (CCH) is a severe and debilitating sub-type of trigeminal autonomic cephalalgia that can be resistant to medical management and associated with significant impairment in quality of life. Studies of deep brain stimulation (DBS) for CCH have provided promising results but have not been assessed in a comprehensive systematic review/meta-analysis. OBJECTIVE The objective was to perform a systematic literature review and meta-analysis of patients with CCH treated with DBS to provide insight on safety and efficacy. METHODS A systematic review and meta-analysis were performed according to PRISMA 2020 guidelines. 16 studies were included in final analysis. A random-effects model was used to meta-analyze data. RESULTS Sixteen studies reported 108 cases for data extraction and analysis. DBS was feasible in >99% of cases and was performed either awake or asleep. Meta-analysis revealed that the mean difference in headache attack frequency and headache intensity after DBS were statistically significant (p < 0.0001). Utilization of microelectrode recording was associated with statistically significant improvement in headache intensity postoperatively (p = 0.006). The average overall follow-up period was 45.4 months and ranged from 1 to 144 months. Death occurred in <1%. The rate of major complications was 16.67%. CONCLUSIONS DBS for CCHs is a feasible surgical technique with a reasonable safety profile that can be successfully performed either awake or asleep. In carefully selected patients, approximately 70% of patients achieve excellent control of their headaches.
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Affiliation(s)
- Molly Murray
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter A Pahapill
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ahmed J Awad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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11
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Wang Z, Yang X, Zhao B, Li W. Primary headache disorders: From pathophysiology to neurostimulation therapies. Heliyon 2023; 9:e14786. [PMID: 37077680 PMCID: PMC10106918 DOI: 10.1016/j.heliyon.2023.e14786] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/06/2023] [Accepted: 03/16/2023] [Indexed: 04/21/2023] Open
Abstract
Primary headache disorders including migraine, cluster headache, and tension-type headache are among the most common disabling diseases worldwide. The unclear pathogenesis of primary headache disorders has led to high rates of misdiagnosis and limited available treatment options. In this review, we have summarized the pathophysiological factors for a better understanding of primary headache disorders. Advances in functional neuroimaging, genetics, neurophysiology have indicated that cortical hyperexcitability, regional brain dysfunction, central sensitization and neuroplasticity changes play vital roles in the development of primary headache disorders. Moreover, we have also discussed a series of neurostimulation approaches with their stimulation mechanism, safety and efficacy for prevention and treatment of primary headache disorders. Noninvasive or implantable neurostimulation techniques show great promise for treating refractory primary headache disorders.
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Affiliation(s)
- Ziying Wang
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, And Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
- WLA Laboratories, World Laureates Association, Shanghai, China
| | - Xiangyu Yang
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, And Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
- WLA Laboratories, World Laureates Association, Shanghai, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Binglei Zhao
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Weidong Li
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, And Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
- WLA Laboratories, World Laureates Association, Shanghai, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
- Global Institute of Future Technology, Shanghai Jiao Tong University, Shanghai, China
- Corresponding author. Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
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12
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Membrilla JA, Roa J, Díaz-de-Terán J. Preventive treatment of refractory chronic cluster headache: systematic review and meta-analysis. J Neurol 2023; 270:689-710. [PMID: 36310189 DOI: 10.1007/s00415-022-11436-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preventive treatment for refractory chronic cluster headache (rCCH) is challenging and many therapies have been tried. OBJECTIVE To study what could be considered the therapy of choice in rCCH through a systematic review and meta-analysis. METHODS This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in PROSPERO (ID CRD42021290983). A systematic search was performed in MEDLINE, Embase, Cochrane, clinicaltrials.gov, and the WHO's-International-Clinical-Trials-Registry-Platform. Studies on the preventive treatment for rCCH as defined by the European Headache Federation consensus statement were included. A meta-analysis of the pooled response rate was conducted for the different therapies. RESULTS Of 336 results, 45 were eligible for inclusion. Most articles studied the effect of neuromodulation as a preventive treatment for rCCH. The most studied neuromodulation technique was occipital nerve stimulation (ONS), with a pooled response rate in the meta-analysis of 57.3% (95% CI 0.481-0.665). Deep brain stimulation (DBS) was the second most studied treatment with a pooled response rate of 77.0% (95% CI 0.594-0.957). DBS results were more heterogeneous than ONS, which could be related to the different stimulation targets in DBS studies, and reported more serious adverse events than in ONS studies. The remaining therapies (anti-CGRP pathway drugs, warfarin, ketamine-magnesium infusions, serial occipital nerve blocks, clomiphene, onabotulinum toxin A, ketogenic diet, sphenopalatine ganglion radiofrequency or stimulation, vagus nerve stimulation, percutaneous bioelectric current stimulation, upper cervical cord stimulation, and vidian neurectomy) present weaker results or have less quality of evidence. CONCLUSIONS The results of this systematic review and meta-analysis suggest that ONS could be the first therapeutic strategy for patients with rCCH based on the current evidence.
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Affiliation(s)
- Javier A Membrilla
- Neurology Department, "La Paz" University Hospital, P.º de la Castellana 261, 28046, Madrid, Spain.
| | - Javier Roa
- Neurology Department, "La Paz" University Hospital, P.º de la Castellana 261, 28046, Madrid, Spain
| | - Javier Díaz-de-Terán
- Neurology Department, "La Paz" University Hospital, P.º de la Castellana 261, 28046, Madrid, Spain
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13
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Yuen J, Goyal A, Rusheen AE, Kouzani AZ, Berk M, Kim JH, Tye SJ, Blaha CD, Bennet KE, Lee KH, Shin H, Oh Y. High frequency deep brain stimulation can mitigate the acute effects of cocaine administration on tonic dopamine levels in the rat nucleus accumbens. Front Neurosci 2023; 17:1061578. [PMID: 36793536 PMCID: PMC9922701 DOI: 10.3389/fnins.2023.1061578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
Cocaine's addictive properties stem from its capacity to increase tonic extracellular dopamine levels in the nucleus accumbens (NAc). The ventral tegmental area (VTA) is a principal source of NAc dopamine. To investigate how high frequency stimulation (HFS) of the rodent VTA or nucleus accumbens core (NAcc) modulates the acute effects of cocaine administration on NAcc tonic dopamine levels multiple-cyclic square wave voltammetry (M-CSWV) was used. VTA HFS alone decreased NAcc tonic dopamine levels by 42%. NAcc HFS alone resulted in an initial decrease in tonic dopamine levels followed by a return to baseline. VTA or NAcc HFS following cocaine administration prevented the cocaine-induced increase in NAcc tonic dopamine. The present results suggest a possible underlying mechanism of NAc deep brain stimulation (DBS) in the treatment of substance use disorders (SUDs) and the possibility of treating SUD by abolishing dopamine release elicited by cocaine and other drugs of abuse by DBS in VTA, although further studies with chronic addiction models are required to confirm that. Furthermore, we demonstrated the use of M-CSWV can reliably measure tonic dopamine levels in vivo with both drug administration and DBS with minimal artifacts.
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Affiliation(s)
- Jason Yuen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Abhinav Goyal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States
| | - Aaron E. Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States
| | - Abbas Z. Kouzani
- School of Engineering, Deakin University, Geelong, VIC, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Jee Hyun Kim
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Susannah J. Tye
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Charles D. Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kevin E. Bennet
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Division of Engineering, Mayo Clinic, Rochester, MN, United States
| | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Hojin Shin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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14
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Levinson S, Miller M, Iftekhar A, Justo M, Arriola D, Wei W, Hazany S, Avecillas-Chasin JM, Kuhn TP, Horn A, Bari AA. A structural connectivity atlas of limbic brainstem nuclei. FRONTIERS IN NEUROIMAGING 2023; 1:1009399. [PMID: 37555163 PMCID: PMC10406319 DOI: 10.3389/fnimg.2022.1009399] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/13/2022] [Indexed: 08/10/2023]
Abstract
Background Understanding the structural connectivity of key brainstem nuclei with limbic cortical regions is essential to the development of therapeutic neuromodulation for depression, chronic pain, addiction, anxiety and movement disorders. Several brainstem nuclei have been identified as the primary central nervous system (CNS) source of important monoaminergic ascending fibers including the noradrenergic locus coeruleus, serotonergic dorsal raphe nucleus, and dopaminergic ventral tegmental area. However, due to practical challenges to their study, there is limited data regarding their in vivo anatomic connectivity in humans. Objective To evaluate the structural connectivity of the following brainstem nuclei with limbic cortical areas: locus coeruleus, ventral tegmental area, periaqueductal grey, dorsal raphe nucleus, and nucleus tractus solitarius. Additionally, to develop a group average atlas of these limbic brainstem structures to facilitate future analyses. Methods Each nucleus was manually masked from 197 Human Connectome Project (HCP) structural MRI images using FSL software. Probabilistic tractography was performed using FSL's FMRIB Diffusion Toolbox. Connectivity with limbic cortical regions was calculated and compared between brainstem nuclei. Results were aggregated to produce a freely available MNI structural atlas of limbic brainstem structures. Results A general trend was observed for a high probability of connectivity to the amygdala, hippocampus and DLPFC with relatively lower connectivity to the orbitofrontal cortex, NAc, hippocampus and insula. The locus coeruleus and nucleus tractus solitarius demonstrated significantly greater connectivity to the DLPFC than amygdala while the periaqueductal grey, dorsal raphe nucleus, and ventral tegmental area did not demonstrate a significant difference between these two structures. Conclusion Monoaminergic and other modulatory nuclei in the brainstem project widely to cortical limbic regions. We describe the structural connectivity across the several key brainstem nuclei theorized to influence emotion, reward, and cognitive functions. An increased understanding of the anatomic basis of the brainstem's role in emotion and other reward-related processing will support targeted neuromodulatary therapies aimed at alleviating the symptoms of neuropsychiatric disorders.
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Affiliation(s)
- Simon Levinson
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
- Stanford Department of Neurosurgery, Stanford University, Palo Alto CA, United States
| | - Michelle Miller
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Ahmed Iftekhar
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Monica Justo
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel Arriola
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Wenxin Wei
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Saman Hazany
- Department of Radiology, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | | | - Taylor P. Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Berlin, Germany
- Department of Neurology, Center for Brain Circuit Therapeutics, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
- Massachusetts General Hospital Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ausaf A. Bari
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
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15
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Rezaei M, Raoufy MR, Fathollahi Y, Shojaei A, Mirnajafi-Zadeh J. Tonic and phasic stimulations of ventral tegmental area have opposite effects on pentylenetetrazol kindled seizures in mice. Epilepsy Res 2023; 189:107073. [PMID: 36584482 DOI: 10.1016/j.eplepsyres.2022.107073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/16/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022]
Abstract
Dopamine may be involved in the anticonvulsant action of deep brain stimulation (DBS). Therefore, ventral tegmental area (VTA), as a brain dopaminergic nucleus, may be a suitable target for DBS anticonvulsant action. This study investigated the effect of tonic and phasic stimulations of the VTA on seizure parameters. Seizures were induced in adult mice by sequential injections of a sub-convulsive dose of 35 mg/kg pentylenetetrazole (PTZ) every 48 h to develop the chemical kindling until the mice reached full kindled state (showing three consecutive seizure stages 4 or 5). Fully kindled mice received DBS once a day as tonic (square waves at 1 Hz; pulse duration: 200 μs; intensity: 300 μA; 600 pulses in 10 min) or phasic (square waves at 100 Hz; pulse duration: 200 μs; intensity: 300 μA; 8 trains of 10 pulses at 1 min interval; 800 pulses in 10 min) stimulations applied into their VTA for 4 days. A single dose of PTZ was injected after each DBS. Simultaneously electrocorticography and video recordings were performed during the seizure for accuracy in seizure severity parameters detection. Tonic but not phasic stimulation significantly decreased the epileptiform discharge duration and the seizure behavioral parameters such as maximum seizure stage, stage 5 duration, seizure duration. In addition, focal to generalized seizure latency increased following VTA tonic stimulation. These data suggest that tonic (but not phasic) stimulation of VTA before PTZ injection on 4 test days had anticonvulsant effects on PTZ-kindled seizures.
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Affiliation(s)
- Mahmoud Rezaei
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Yaghoub Fathollahi
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Amir Shojaei
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Institute for Brain Sciences and Cognition, Tarbiat Modares University, Tehran, Iran
| | - Javad Mirnajafi-Zadeh
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Institute for Brain Sciences and Cognition, Tarbiat Modares University, Tehran, Iran.
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16
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Silvestro M, Tessitore A, Orologio I, Battista G, Siciliano M, Tedeschi G, Russo A. Cluster headache pathophysiology: What we have learned from advanced neuroimaging. Headache 2022; 62:436-452. [PMID: 35315064 PMCID: PMC9314615 DOI: 10.1111/head.14279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/12/2022]
Abstract
Background Although remarkable progress has been achieved in understanding cluster headache (CH) pathophysiology, there are still several gaps about the mechanisms through which independent subcortical and cortical brain structures interact with each other. These gaps could be partially elucidated by structural and functional advanced neuroimaging investigations. Objective Although we are aware that substantial achievements have come from preclinical, neurophysiological, and biochemical experiments, the present narrative review aims to summarize the most significant findings from structural, microstructural, and functional neuroimaging investigations, as well as the consequent progresses in understanding CH pathophysiological mechanisms, to achieve a comprehensive and unifying model. Results Advanced neuroimaging techniques have contributed to overcoming the peripheral hypothesis that CH is of cavernous sinus pathology, in transitioning from the pure vascular hypothesis to a more comprehensive trigeminovascular model, and, above all, in clarifying the role of the hypothalamus and its connections in the genesis of CH. Conclusion Altogether, neuroimaging findings strongly suggest that, beyond the theoretical model of the “pain matrix,” the model of the “neurolimbic pain network” that is accepted in migraine research could also be extended to CH. Indeed, although the hypothalamus’ role is undeniable, the genesis of CH attacks is complex and seems to not be just the result of a single “generator.” Cortical‐hypothalamic‐brainstem functional interconnections that can switch between out‐of‐bout and in‐bout periods, igniting the trigeminovascular system (probably by means of top‐down mechanisms) and the consensual trigeminal autonomic reflexes, may represent the “neuronal background” of CH.
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Affiliation(s)
- Marcello Silvestro
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Tessitore
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ilaria Orologio
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giorgia Battista
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Siciliano
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gioacchino Tedeschi
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Russo
- Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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Coppola G, Magis D, Casillo F, Sebastianelli G, Abagnale C, Cioffi E, Di Lenola D, Di Lorenzo C, Serrao M. Neuromodulation for Chronic Daily Headache. Curr Pain Headache Rep 2022; 26:267-278. [PMID: 35129825 PMCID: PMC8927000 DOI: 10.1007/s11916-022-01025-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review We reviewed the literature that explored the use of central and peripheral neuromodulation techniques for chronic daily headache (CDH) treatment. Recent Findings Although the more invasive deep brain stimulation (DBS) is effective in chronic cluster headache (CCH), it should be reserved for extremely difficult-to-treat patients. Percutaneous occipital nerve stimulation has shown similar efficacy to DBS and is less risky in both CCH and chronic migraine (CM). Non-invasive transcutaneous vagus nerve stimulation is a promising add-on treatment for CCH but not for CM. Transcutaneous external trigeminal nerve stimulation may be effective in treating CM; however, it has not yet been tested for cluster headache. Transcranial magnetic and electric stimulations have promising preventive effects against CM and CCH. Summary Although the precise mode of action of non-invasive neuromodulation techniques remains largely unknown and there is a paucity of controlled trials, they should be preferred to more invasive techniques for treating CDH.
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Affiliation(s)
- Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.
| | - Delphine Magis
- Headache and Pain Multimodal Treatment Centre (CMTCD), Department of Neurology, Neuromodulation Centre, CHR East Belgium, Verviers, Belgium
| | - Francesco Casillo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Gabriele Sebastianelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Chiara Abagnale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Ettore Cioffi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Davide Di Lenola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
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Prasad S, Mehadi A, Kaka N, Jhaveri S, Avanthika C, Patel N, Augustine I, Issani A. Diagnostic protocols and newer treatment modalities for cluster headache. Dis Mon 2022; 68:101316. [PMID: 35000758 DOI: 10.1016/j.disamonth.2021.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cluster Headaches are one of the most arguably severe forms of primary headache syndrome that affects humans. Although it is relatively uncommon, it has a significant impact on the quality of life. It is a multifactorial disease that has risk factors ranging from seasonal changes, lifestyle habits to genetics. It occurs in 2 forms- Episodic and Chronic, each having its well-defined Diagnostic Criteria. Moreover, Cluster Headache has an exhaustive list of options for both Preventive and Abortive treatment. This article focuses on Cluster Headache, its pathophysiology, risk factors, differentials, and its diverse treatment modalities. In this study, an all-language literature search was conducted on Medline, Cochrane, Embase, and Google Scholar till October 2021. The following search strings and Medical Subject Headings (MeSH) terms were used: "Cluster Headache," "Triptans," "Neuromodulation," and "Migraine." We explored the literature on Cluster Headache for its epidemiology, pathophysiology, the role of various genes and how they bring about the disease as well as its episodic and chronic variants, and treatment options. Although we have a wide variety of options for Preventive and Abortive therapy, newer more effective pharmacological and non-pharmacological interventions are being developed, and must be integrated into new treatment protocols.
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Affiliation(s)
- Sakshi Prasad
- Faculty of Medicine, National Pirogov, Memorial Medical University, 21018, Vinnytsya, Ukraine.
| | | | - Nirja Kaka
- GMERS Medical College, Himmatnagar 383001, Gujarat, India.
| | - Sharan Jhaveri
- Smt. NHL Municipal Medical college, Ahmedabad 380006, India.
| | - Chaithanya Avanthika
- Karnataka Institute of Medical Sciences,PB Road, Hubli 580022, Karnataka, India.
| | - Neil Patel
- GMERS Medical College, Himmatnagar 383001, Gujarat, India.
| | - Ivan Augustine
- Government Medical college Thrissur 680596, Kerala,India.
| | - Ali Issani
- Baqai Medical University, Karachi, Pakistan.
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Dzhafarov V, Moysak G, Rzaev J, Isagulyan E, Aslakhanova K, Murtazin V, Genov P, Vostretsova I. Sphenopalatine ganglion stimulation in the treatment of chronic refractory cluster headache. A preliminary multicenter study in Russia. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:68-73. [DOI: 10.17116/jnevro202212202168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW In this narrative review, the current literature on neurostimulation methods in the treatment of chronic cluster headache is evaluated. These neurostimulation methods include deep brain stimulation, vagus nerve stimulation, greater occipital nerve stimulation, sphenopalatine ganglion stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, supraorbital nerve stimulation, and cervical spinal cord stimulation. RECENT FINDINGS Altogether, only nVNS and SPG stimulation are supported by at least one positive sham-controlled clinical trial for preventive and acute attack (only SPG stimulation) treatment. Other clinical trials either did not control at all or controlled by differences in the stimulation technique itself but not by a sham-control. Case series report higher responder rates. The evidence for these neurostimulation methods in the treatment of chronic cluster headache is poor and in part contradictive. However, except deep brain stimulation, tolerability and safety of these methods are good so that in refractory situations application might be justified in individual cases.
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Elias GJB, Loh A, Gwun D, Pancholi A, Boutet A, Neudorfer C, Germann J, Namasivayam A, Gramer R, Paff M, Lozano AM. Deep brain stimulation of the brainstem. Brain 2021; 144:712-723. [PMID: 33313788 DOI: 10.1093/brain/awaa374] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 01/02/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus, pallidum, and thalamus is an established therapy for various movement disorders. Limbic targets have also been increasingly explored for their application to neuropsychiatric and cognitive disorders. The brainstem constitutes another DBS substrate, although the existing literature on the indications for and the effects of brainstem stimulation remains comparatively sparse. The objective of this review was to provide a comprehensive overview of the pertinent anatomy, indications, and reported stimulation-induced acute and long-term effects of existing white and grey matter brainstem DBS targets. We systematically searched the published literature, reviewing clinical trial articles pertaining to DBS brainstem targets. Overall, 164 studies describing brainstem DBS were identified. These studies encompassed 10 discrete structures: periaqueductal/periventricular grey (n = 63), pedunculopontine nucleus (n = 48), ventral tegmental area (n = 22), substantia nigra (n = 9), mesencephalic reticular formation (n = 7), medial forebrain bundle (n = 8), superior cerebellar peduncles (n = 3), red nucleus (n = 3), parabrachial complex (n = 2), and locus coeruleus (n = 1). Indications for brainstem DBS varied widely and included central neuropathic pain, axial symptoms of movement disorders, headache, depression, and vegetative state. The most promising results for brainstem DBS have come from targeting the pedunculopontine nucleus for relief of axial motor deficits, periaqueductal/periventricular grey for the management of central neuropathic pain, and ventral tegmental area for treatment of cluster headaches. Brainstem DBS has also acutely elicited numerous motor, limbic, and autonomic effects. Further work involving larger, controlled trials is necessary to better establish the therapeutic potential of DBS in this complex area.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Dave Gwun
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Aditya Pancholi
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Clemens Neudorfer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Andrew Namasivayam
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Robert Gramer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Michelle Paff
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
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Abstract
Cluster headache is a primary headache form occurring in paroxysmal excruciatingly severe unilateral head pain attacks usually grouped in periods lasting 1-2months, the cluster periods. A genetic component is suggested by the familial occurrence of the disease but a genetic linkage is yet to be identified. Contemporary activation of trigeminal and cranial parasympathetic systems-the so-called trigemino-parasympathetic reflex-during the headache attacks seem to cause the pain and accompanying oculo-facial autonomic phenomena respectively. At peripheral level, the increased calcitonin gene related peptide (CGRP) plasma levels suggests trigeminal system activation during cluster headache attacks. The temporal pattern of the disease both in terms of circadian rhythmicity and seasonal recurrence has suggested involvement of the hypothalamic biological clock in the pathophysiology of cluster headache. The posterior hypothalamus was investigate as the cluster generator leading to activation of the trigemino-parasympathetic reflex, but the accumulated experience after 20 years of hypothalamic electrical stimulation to treat the condition indicate that this brain region rather acts as pain modulator. Efficacy of monoclonal antibodies to treat episodic cluster headache points to a key role of CGRP in the pathophysiology of the condition.
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Abstract
Background Cluster headache is a highly disabling primary headache disorder which is widely described as the most painful condition a human can experience. Aim To provide an overview of the clinical characteristics, epidemiology, risk factors, differential diagnosis, pathophysiology and treatment options of cluster headache, with a focus on recent developments in the field. Methods Structured review of the literature on cluster headache. Results Cluster headache affects approximately one in 1000 of the population. It is characterised by attacks of severe unilateral head pain associated with ipsilateral cranial autonomic symptoms, and the tendency for attacks to occur with circadian and circannual periodicity. The pathophysiology of cluster headache and other primary headache disorders has recently become better understood and is thought to involve the hypothalamus and trigeminovascular system. There is good quality evidence for acute treatment of attacks with parenteral triptans and high flow oxygen; preventive treatment with verapamil; and transitional treatment with oral corticosteroids or greater occipital nerve injection. New pharmacological and neuromodulation therapies have recently been developed. Conclusion Cluster headache causes distinctive symptoms, which once they are recognised can usually be managed with a variety of established treatments. Recent pathophysiological understanding has led to the development of newer pharmacological and neuromodulation therapies, which may soon become established in clinical practice.
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Affiliation(s)
- Sanjay Cheema
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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Cappon D, Ryterska A, Akram H, Lagrata S, Cheema S, Hyam J, Zrinzo L, Matharu M, Jahanshahi M. The sensitivity to change of the cluster headache quality of life scale assessed before and after deep brain stimulation of the ventral tegmental area. J Headache Pain 2021; 22:52. [PMID: 34092221 PMCID: PMC8182939 DOI: 10.1186/s10194-021-01251-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background Cluster headache (CH) is a trigeminal autonomic cephalalgia (TAC) characterized by a highly disabling headache that negatively impacts quality of life and causes limitations in daily functioning as well as social functioning and family life. Since specific measures to assess the quality of life (QoL) in TACs are lacking, we recently developed and validated the cluster headache quality of life scale (CH-QoL). The sensitivity of CH-QoL to change after a medical intervention has not been evaluated yet. Methods This study aimed to test the sensitivity to change of the CH-QoL in CH. Specifically we aimed to (i) assess the sensitivity of CH-QoL to change before and following deep brain stimulation of the ventral tegmental area (VTA-DBS), (ii) evaluate the relationship of changes on CH-QoL with changes in other generic measures of quality of life, as well as indices of mood and pain. Ten consecutive CH patients completed the CH-QoL and underwent neuropsychological assessment before and after VTA-DBS. The patients were evaluated on headache frequency, severity, and load (HAL) as well as on tests of generic quality of life (Short Form-36 (SF-36)), mood (Beck Depression Inventory, Hospital Anxiety and Depression Rating Scale), and pain (McGill Pain Questionnaire, Headache Impact Test, Pain Behaviour Checklist). Results The CH-QoL total score was significantly reduced after compared to before VTA-DBS. Changes in the CH-QoL total score correlated significantly and negatively with changes in HAL, the SF-36, and positively and significantly with depression and the evaluative domain on the McGill Pain Questionnaire. Conclusions Our findings demonstrate that changes after VTA-DBS in CH-QoL total scores are associated with the reduction of frequency, duration, and severity of headache attacks after surgery. Moreover, post VTA-DBS improvement in CH-QoL scores is associated with an amelioration in quality of life assessed with generic measures, a reduction of depressive symptoms, and evaluative pain experience after VTA-DBS. These results support the sensitivity to change of the CH-QoL and further demonstrate the validity and applicability of CH-QoL as a disease specific measure of quality of life for CH.
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Affiliation(s)
- Davide Cappon
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA.,Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Agata Ryterska
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK.,Department of Psychology, Queen Mary University of London, London, UK
| | - Harith Akram
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Sanjay Cheema
- Department of Psychology, Queen Mary University of London, London, UK
| | - Jonathan Hyam
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK
| | - Manjit Matharu
- Department of Psychology, Queen Mary University of London, London, UK
| | - Marjan Jahanshahi
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, WC1N 3BG, London, UK. .,MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China.
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Knotkova H, Hamani C, Sivanesan E, Le Beuffe MFE, Moon JY, Cohen SP, Huntoon MA. Neuromodulation for chronic pain. Lancet 2021; 397:2111-2124. [PMID: 34062145 DOI: 10.1016/s0140-6736(21)00794-7] [Citation(s) in RCA: 198] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 12/23/2022]
Abstract
Neuromodulation is an expanding area of pain medicine that incorporates an array of non-invasive, minimally invasive, and surgical electrical therapies. In this Series paper, we focus on spinal cord stimulation (SCS) therapies discussed within the framework of other invasive, minimally invasive, and non-invasive neuromodulation therapies. These therapies include deep brain and motor cortex stimulation, peripheral nerve stimulation, and the non-invasive treatments of repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and transcutaneous electrical nerve stimulation. SCS methods with electrical variables that differ from traditional SCS have been approved. Although methods devoid of paraesthesias (eg, high frequency) should theoretically allow for placebo-controlled trials, few have been done. There is low-to-moderate quality evidence that SCS is superior to reoperation or conventional medical management for failed back surgery syndrome, and conflicting evidence as to the superiority of traditional SCS over sham stimulation or between different SCS modalities. Peripheral nerve stimulation technologies have also undergone rapid development and become less invasive, including many that are placed percutaneously. There is low-to-moderate quality evidence that peripheral nerve stimulation is effective for neuropathic pain in an extremity, low quality evidence that it is effective for back pain with or without leg pain, and conflicting evidence that it can prevent migraines. In the USA and many areas in Europe, deep brain and motor cortex stimulation are not approved for chronic pain, but are used off-label for refractory cases. Overall, there is mixed evidence supporting brain stimulation, with most sham-controlled trials yielding negative findings. Regarding non-invasive modalities, there is moderate quality evidence that repetitive transcranial magnetic stimulation does not provide meaningful benefit for chronic pain in general, but conflicting evidence regarding pain relief for neuropathic pain and headaches. For transcranial direct current stimulation, there is low-quality evidence supporting its benefit for chronic pain, but conflicting evidence regarding a small treatment effect for neuropathic pain and headaches. For transcutaneous electrical nerve stimulation, there is low-quality evidence that it is superior to sham or no treatment for neuropathic pain, but conflicting evidence for non-neuropathic pain. Future research should focus on better evaluating the short-term and long-term effectiveness of all neuromodulation modalities and whether they decrease health-care use, and on refining selection criteria and treatment variables.
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Affiliation(s)
- Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Harquail Centre for Neuromodulation, University of Toronto, Toronto, ON, Canada
| | - Eellan Sivanesan
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Jee Youn Moon
- Department of Anesthesiology, Seoul National University, Seoul, South Korea
| | - Steven P Cohen
- Department of Neurology, Department of Physical Medicine & Rehabilitation, and Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Anesthesiology and Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Marc A Huntoon
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
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Mavridis T, Breza M, Deligianni C, Mitsikostas DD. Current advances in the management of cluster headaches. Expert Opin Pharmacother 2021; 22:1931-1943. [PMID: 33989098 DOI: 10.1080/14656566.2021.1924148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Cluster headache (CH) is probably the most severe idiopathic pain condition, yet its current medical management remains poor.Areas covered: Only repurpose medicines are currently in use for the prevention of CH, partially because the pathophysiology of the condition is still elusive. In this article we performed a systematic review to evaluate the evidence for efficacy of the currently available or emerging treatments for CH.Expert opinion: We found several ongoing randomized clinical trials testing prophylactic treatments for CH and only few for the standard ones. Recent data from randomized trials with monoclonal antibodies targeting the calcitonin gene related peptide pathway (anti-CGRP mAbs) are controversial, although its role in the pathogenesis of the condition is well documented. This inconsistency may depict inadequacies in clinical trial designing. Anti-CGRP mAbs and antagonists of pituitary adenylate cyclase-activating polypeptide (PACAP) along with neuromodulation techniques, are curing the necessary valuable evidence that could illuminate the therapeutical future for cluster headache. Orexin pathway is another attractive target for CH treatment. To improve the evidence for efficacy, we further propose that the design of the clinical trials for CH needs to be radically reviewed to allow more patients to participate.
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Affiliation(s)
- Theodoros Mavridis
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianthi Breza
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimos D Mitsikostas
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Torres CV, Blasco G, Navas García M, Ezquiaga E, Pastor J, Vega-Zelaya L, Pulido Rivas P, Pérez Rodrigo S, Manzanares R. Deep brain stimulation for aggressiveness: long-term follow-up and tractography study of the stimulated brain areas. J Neurosurg 2021; 134:366-375. [PMID: 32032944 DOI: 10.3171/2019.11.jns192608] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/26/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Initial studies applying deep brain stimulation (DBS) of the posteromedial hypothalamus (PMH) to patients with pathological aggressiveness have yielded encouraging results. However, the anatomical structures involved in its therapeutic effect have not been precisely identified. The authors' objective was to describe the long-term outcome in their 7-patient series, and the tractography analysis of the volumes of tissue activated in 2 of the responders. METHODS This was a retrospective study of 7 subjects with pathological aggressiveness. The findings on MRI with diffusion tensor imaging (DTI) in 2 of the responders were analyzed. The authors generated volumes of tissue activated according to the parameters used, and selected those volumes as regions of interest to delineate the tracts affected by stimulation. RESULTS The series consisted of 5 men and 2 women. Of the 7 patients, 5 significantly improved with stimulation. The PMH, ventral tegmental area, dorsal longitudinal fasciculus, and medial forebrain bundle seem to be involved in the stimulation field. CONCLUSIONS In this series, 5 of 7 medication-resistant patients with severe aggressiveness who were treated with bilateral PMH DBS showed a significant long-lasting improvement. The PMH, ventral tegmental area, dorsal longitudinal fasciculus, and medial forebrain bundle seem to be in the stimulation field and might be responsible for the therapeutic effect of DBS.
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Affiliation(s)
| | | | | | - Elena Ezquiaga
- 5Department of Psychiatry, University Hospital La Princesa, Madrid, Spain
| | - Jesús Pastor
- 3Clinical Neurophysiology, University Hospital La Princesa, Madrid
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Rizzi M, Gambini O, Marras CE. Posterior hypothalamus as a target in the treatment of aggression: From lesioning to deep brain stimulation. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:95-106. [PMID: 34266615 DOI: 10.1016/b978-0-12-819973-2.00007-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Intermittent explosive disorder can be described as a severe "affective aggression" condition, for which drugs and other supportive therapies are not fully effective. In the first half of the 19th century, experimental studies progressively increased knowledge of aggressive disorders. A neurobiologic approach revealed the posterior hypothalamic region as a key structure for the modulation of aggression. In the 1960s, patients with severe aggressive disorder, frequently associated with intellectual disability, were treated by bilateral stereotactic lesioning of the posterior hypothalamic area, with efficacy. This therapy was later abandoned because of issues related to the misuse of psychosurgery. In the last 2 decades, however, the same diencephalic target has been selected for the reversible treatment by deep brain stimulation, with success. This chapter presents a comprehensive approach to posterior hypothalamic surgery for the treatment of severely aggressive patients and discusses the experimental steps that allowed this surgical target to be selected. Surgical experiences are reported, together with considerations on target features and related encephalic circuits.
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Affiliation(s)
- Michele Rizzi
- "C.Munari" Epilepsy Surgery Center, Department of Neuroscience, ASST GOM Niguarda, Milan, Italy.
| | - Orsola Gambini
- Department of Health of Sciences, University of Milan, Milan, Italy; CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Neuromodulation in headache and craniofacial neuralgia: Guidelines from the Spanish Society of Neurology and the Spanish Society of Neurosurgery. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Yang S, Boudier-Revéret M, Choo YJ, Chang MC. Association between Chronic Pain and Alterations in the Mesolimbic Dopaminergic System. Brain Sci 2020; 10:brainsci10100701. [PMID: 33023226 PMCID: PMC7600461 DOI: 10.3390/brainsci10100701] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
Chronic pain (pain lasting for >3 months) decreases patient quality of life and even occupational abilities. It can be controlled by treatment, but often persists even after management. To properly control pain, its underlying mechanisms must be determined. This review outlines the role of the mesolimbic dopaminergic system in chronic pain. The mesolimbic system, a neural circuit, delivers dopamine from the ventral tegmental area to neural structures such as the nucleus accumbens, prefrontal cortex, anterior cingulate cortex, and amygdala. It controls executive, affective, and motivational functions. Chronic pain patients suffer from low dopamine production and delivery in this system. The volumes of structures constituting the mesolimbic system are known to be decreased in such patients. Studies on administration of dopaminergic drugs to control chronic pain, with a focus on increasing low dopamine levels in the mesolimbic system, show that it is effective in patients with Parkinson’s disease, restless legs syndrome, fibromyalgia, dry mouth syndrome, lumbar radicular pain, and chronic back pain. However, very few studies have confirmed these effects, and dopaminergic drugs are not commonly used to treat the various diseases causing chronic pain. Thus, further studies are required to determine the effectiveness of such treatment for chronic pain.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Woman’s University Seoul Hospital, Ewha Woman’s University School of Medicine, Seoul 07804, Korea;
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2W 1T8, Canada;
| | - Yoo Jin Choo
- Production R&D Division Advanced Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Deagu 41061, Korea;
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea
- Correspondence:
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Nowacki A, Schober M, Nader L, Saryyeva A, Nguyen TK, Green AL, Pollo C, Krauss JK, Fontaine D, Aziz TZ. Deep Brain Stimulation for Chronic Cluster Headache: Meta‐Analysis of Individual Patient Data. Ann Neurol 2020; 88:956-969. [DOI: 10.1002/ana.25887] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Andreas Nowacki
- Department of Neurosurgery, Inselspital Bern University Hospital, University Bern Bern Switzerland
| | - Martin Schober
- Department of Neurosurgery, Inselspital Bern University Hospital, University Bern Bern Switzerland
| | - Lydia Nader
- Thuy Hospital Universitario Central de Asturias Oviedo Spain
| | - Assel Saryyeva
- Department of Neurosurgery Medical School Hannover Hannover Germany
| | - Thuy‐Anh Khoa Nguyen
- Department of Neurosurgery, Inselspital Bern University Hospital, University Bern Bern Switzerland
- ARTORG Center for Biomedical Engineering Research University of Bern Bern Switzerland
| | - Alexander L. Green
- Nuffield Department of Clinical Neuroscience University of Oxford Oxford UK
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital Bern University Hospital, University Bern Bern Switzerland
| | | | - Denys Fontaine
- Department of Neurosurgery, Centre Hospitalier Universitaire de Nice, FHU INOVPAIN University Cote d'Azur Nice France
| | - Tipu Z. Aziz
- Nuffield Department of Clinical Neuroscience University of Oxford Oxford UK
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Belvís R, Irimia P, Seijo-Fernández F, Paz J, García-March G, Santos-Lasaosa S, Latorre G, González-Oria C, Rodríguez R, Pozo-Rosich P, Láinez JM. Neuromodulation in headache and craniofacial neuralgia: guidelines from the Spanish Society of Neurology and the Spanish Society of Neurosurgery. Neurologia 2020; 36:61-79. [PMID: 32718873 DOI: 10.1016/j.nrl.2020.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/11/2020] [Accepted: 04/15/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Numerous invasive and non-invasive neuromodulation devices have been developed and applied to patients with headache and neuralgia in recent years. However, no updated review addresses their safety and efficacy, and no healthcare institution has issued specific recommendations on their use for these 2 conditions. METHODS Neurologists from the Spanish Society of Neurology's (SEN) Headache Study Group and neurosurgeons specialising in functional neurosurgery, selected by the Spanish Society of Neurosurgery (SENEC), performed a comprehensive review of articles on the MEDLINE database addressing the use of the technique in patients with headache and neuralgia. RESULTS We present an updated review and establish the first set of consensus recommendations of the SEN and SENC on the use of neuromodulation to treat headache and neuralgia, analysing the current levels of evidence on its effectiveness for each specific condition. CONCLUSIONS Current evidence supports the indication of neuromodulation techniques for patients with refractory headache and neuralgia (especially migraine, cluster headache, and trigeminal neuralgia) selected by neurologists and headache specialists, after pharmacological treatment options are exhausted. Furthermore, we recommend that invasive neuromodulation be debated by multidisciplinary committees, and that the procedure be performed by teams of neurosurgeons specialising in functional neurosurgery, with acceptable rates of morbidity and mortality.
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Affiliation(s)
- R Belvís
- Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - P Irimia
- Clínica Universitaria de Navarra, Pamplona, España.
| | | | - J Paz
- Hospital Universitario La Paz, Madrid, España
| | | | | | - G Latorre
- Hospital Universitario de Fuenlabrada, Madrid, España
| | | | - R Rodríguez
- Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - J M Láinez
- Hospital Clínico Universitario, Valencia, España
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Ferraro S, Nigri A, Demichelis G, Pinardi C, Chiapparini L, Giani L, Proietti Cecchini A, Leone M. Understanding Cluster Headache Using Magnetic Resonance Imaging. Front Neurol 2020; 11:535. [PMID: 32695062 PMCID: PMC7338680 DOI: 10.3389/fneur.2020.00535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/14/2020] [Indexed: 12/26/2022] Open
Abstract
Cluster headache is an excruciating pain syndrome characterized by unilateral head pain attacks, lasting between 15 and 180 min, accompanied by marked ipsilateral cranial autonomic symptoms, such as lacrimation and conjunctival injection. Despite important insights provided by neuroimaging studies and deep brain stimulation findings, the pathophysiology of cluster headache and its pathways of chronicization are still elusive. In this mini-review, we will provide an overview of the functional and structural neuroimaging studies in episodic and chronic cluster headache conditions conducted to clarify the underlying pathophysiology.
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Affiliation(s)
- Stefania Ferraro
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Nigri
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Greta Demichelis
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pinardi
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luisa Chiapparini
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Giani
- Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Massimo Leone
- Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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D'Amico D, Raggi A, Grazzi L, Lambru G. Disability, Quality of Life, and Socioeconomic Burden of Cluster Headache: A Critical Review of Current Evidence and Future Perspectives. Headache 2020; 60:809-818. [DOI: 10.1111/head.13784] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Domenico D'Amico
- Neuroalgology Unit and Headache Center Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Giorgio Lambru
- Guy's and St Thomas' NHS Foundation Trust King's College London London UK
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Schulte LH, Haji AA, May A. Phase dependent hypothalamic activation following trigeminal input in cluster headache. J Headache Pain 2020; 21:30. [PMID: 32228453 PMCID: PMC7106813 DOI: 10.1186/s10194-020-01098-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Task-free imaging approaches using PET have shown the posterior hypothalamus to be specifically activated during but not outside cluster headache attacks. Evidence from task related functional imaging approaches however is scarce. METHODS Twenty-one inactive cluster headache patients (episodic cluster headache out of bout), 16 active cluster headache patients (10 episodic cluster headache in bout, 6 chronic cluster headache) and 18 control participants underwent high resolution brainstem functional magnetic resonance imaging of trigeminal nociception using gaseous ammonia as a painful stimulus. RESULTS Following trigeminonociceptive stimulation with ammonia there was a significantly stronger activation within the posterior hypothalamus in episodic cluster headache patients out of bout when compared to controls. When contrasting estimates of the pain contrast, active cluster headache patients where in between the two other groups but did not differ significantly from either. CONCLUSION The posterior hypothalamus might thus be hyperexcitable in cluster headache patients outside the bout while excitability to external nociceptive stimuli decreases during in bout periods, probably due to frequent hypothalamic activation and possible neurotransmitter exhaustion during cluster attacks.
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Affiliation(s)
- Laura H Schulte
- Department of Systems Neuroscience, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany.,Clinic for Psychiatry, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany
| | - Ame Abdu Haji
- Department of Systems Neuroscience, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany.
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Dantas SAF, Alho EJL, da Silva JJ, Mendes Neto NN, Fonoff ET, Hamani C. Deep brain stimulation modulates hypothalamic-brainstem fibers in cluster headache: case report. J Neurosurg 2020; 132:717-720. [PMID: 30835692 DOI: 10.3171/2018.11.jns181412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/15/2018] [Indexed: 11/06/2022]
Abstract
Hypothalamic deep brain stimulation (DBS) has been used for more than a decade to treat cluster headache (CH) but its mechanisms remain poorly understood. The authors have successfully treated a patient with CH using hypothalamic DBS and found that the contact used for chronic stimulation was located in a white matter region posterior to the mammillary bodies. Fiber tracts crossing that region were the medial forebrain bundle and those interconnecting the hypothalamus and brainstem, including the dorsal longitudinal fasciculus. Because the stimulation of axons is an important mechanism of DBS, some of its clinical effects in CH may be related to the stimulation of fibers interconnecting the hypothalamus and brainstem.
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Affiliation(s)
- Sérgio A F Dantas
- 1Department of Neurosurgery, Federal University of Rio Grande do Norte, Natal
| | - Eduardo J L Alho
- 2Department of Neurology, University of São Paulo Medical School, São Paulo
| | - Juliano J da Silva
- 1Department of Neurosurgery, Federal University of Rio Grande do Norte, Natal
| | - Nilson N Mendes Neto
- 3Department of Internal Medicine, Onofre Lopes University Hospital, Natal, Brazil
- 4Extension Center, University of California, Davis, California; and
| | | | - Clement Hamani
- 2Department of Neurology, University of São Paulo Medical School, São Paulo
- 5Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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van der Velden L, Vinck MA, Wadman WJ. Resonance in the Mouse Ventral Tegmental Area Dopaminergic Network Induced by Regular and Poisson Distributed Optogenetic Stimulation in-vitro. Front Comput Neurosci 2020; 14:11. [PMID: 32132914 PMCID: PMC7040182 DOI: 10.3389/fncom.2020.00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/28/2020] [Indexed: 11/13/2022] Open
Abstract
Neurons in many brain regions exhibit spontaneous, intrinsic rhythmic firing activity. This rhythmic firing activity may determine the way in which these neurons respond to extrinsic synaptic inputs. We hypothesized that neurons should be most responsive to inputs at the frequency of the intrinsic oscillation frequency. We addressed this question in the ventral tegmental area (VTA), a dopaminergic nucleus in the midbrain. VTA neurons have a unique propensity to exhibit spontaneous intrinsic rhythmic activity in the 1-5 Hz frequency range, which persists in the in-vitro brain slice, and form a network of weakly coupled oscillators. Here, we combine in-vitro simultaneous recording of action potentials from a 60 channel multi-electrode-array with cell-type-specific optogenetic stimulation of the VTA dopamine neurons. We investigated how VTA neurons respond to wide-band stochastic (Poisson input) as well as regular laser pulses. Strong synchrony was induced between the laser input and the spike timing of the neurons, both for regular pulse trains and Poisson pulse trains. For rhythmically pulsed input, the neurons demonstrated resonant behavior with the strongest phase locking at their intrinsic oscillation frequency, but also at half and double the intrinsic oscillation frequency. Stochastic Poisson pulse stimulation provided a more effective stimulation of the entire population, yet we observed resonance at lower frequencies (approximately half the oscillation frequency) than the neurons' intrinsic oscillation frequency. The non-linear filter characteristics of dopamine neurons could allow the VTA to predict precisely timed future rewards based on past sensory inputs, a crucial component of reward prediction error signaling. In addition, these filter characteristics could contribute to a pacemaker role for the VTA in synchronizing activity with other regions like the prefrontal cortex and the hippocampus.
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Affiliation(s)
- Luuk van der Velden
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Martin A Vinck
- Ernst Strüngmann Institute (ESI) for Neuroscience in Cooperation With Max Planck Society, Frankfurt am Main, Germany
| | - Wytse J Wadman
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
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38
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Akram H, Zrinzo L. Cluster Headache: Deep Brain Stimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sokolov AY, Lyubashina OA, Vaganova YS, Amelin AV. [Peripheral neurostimulation in headache treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:79-88. [PMID: 31793548 DOI: 10.17116/jnevro201911910179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
According to rough estimates, at least one third of the population in developed countries suffers, to varying degrees, from certain forms of primary headache, the modern pharmacotherapy of which is not always effective and has a number of limitations. The non-pharmacological treatment of headache can be an alternative to the prescription of pharmacological agents and the only possible assistance option for patients developing drug-resistant cephalalgias. This review describes various methods of electrical neuromodulation that are used for the management of primary headaches. The authors provide information on current stages in implementation of implantable and non-invasive equipment into clinical practice, which makes possible electrical stimulations of peripheral nerves and of the sphenopalatine ganglion, as well as allows transcranial magnetic stimulation. Also the appearance and usage of portable electrical devices available on the world market are described, and mechanisms that can underlie anticephalgic action of neuromodulation therapy are discussed. Special attention is paid to the methods that are applied for electrostimulation of the vagus nerve and occipital nerves.
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Affiliation(s)
- A Yu Sokolov
- Valdman Institute of Pharmacology, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; Pavlov Institute of Physiology of the Russian Academy of Sciences, St. Petersburg, Russia
| | - O A Lyubashina
- Valdman Institute of Pharmacology, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; Pavlov Institute of Physiology of the Russian Academy of Sciences, St. Petersburg, Russia
| | - Yu S Vaganova
- Valdman Institute of Pharmacology, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - A V Amelin
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
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40
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Efficacy and safety of surgical treatment of cluster headache. Med Clin (Barc) 2019; 154:75-79. [PMID: 31753322 DOI: 10.1016/j.medcli.2019.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/16/2019] [Accepted: 03/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cluster headache (CR) is the most severe human headache and is chronic in 10%-20% of patients, and 10% can become refractory to all effective drugs. In this scenario, surgical procedures are indicated: radiofrequencies of the sphenopalatine ganglion ipsilateral to pain (RF-SPG), bilateral stimulation of the occipital nerves (NOM-S) and deep brain stimulation (DBS) of the ipsilateral posterior hypothalamus. The efficacy and safety of each of these procedures has been specifically analyzed, but the progress of a series of patients following this surgical route in order of aggressiveness has not been described. PATIENTS Patients with chronic and refractory CR according to the criteria of the European Headache Federation. The patients underwent RF-SPG, NOM-S sequentially if the previous procedure had been ineffective, and DBS if the previous procedure had been ineffective. RESULTS We prospectively included 44 patients between November 2003 and June 2018 with an average age of 38.3 years; 70% were men. The mean follow-up was 87.4 months. Nineteen patients responded to 74 procedures of RF-SPG (33.3%). Of the remaining 25 patients, a NOM-S device was implanted in 22, showing an efficacy of 50%. Finally, 9 patients underwent ECP of the ipsilateral lower-posterior hypothalamus with an efficacy of 88.8%. No serious complications were found following any of these 3 procedures. CONCLUSIONS The sequential application of these three surgical procedures succeeded in reversing the serious situation of chronic CR refractory to an episodic CR in 93% of patients with acceptable surgical morbidity.
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Abstract
BACKGROUND The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine. FINDINGS This has been intensely discussed in the last decades and the advent of modern imaging studies refined the involvement of rostral parts of the pons in acute migraine attacks, but more importantly suggested a predominant role of the hypothalamus and alterations in hypothalamic functional connectivity shortly before the beginning of migraine headaches. This was shown in the NO-triggered and also in the preictal stage of native human migraine attacks. Another headache type that is clinically even more suggestive of hypothalamic involvement is cluster headache, and indeed a structure in close proximity to the hypothalamus has been identified to play a crucial role in attack generation. CONCLUSION It is very likely that spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in susceptibility thresholds that ultimately start but also terminate headache attacks. We will review clinical and neuroscience evidence that puts the hypothalamus in the center of scientific attention when attack generation is discussed.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Rami Burstein
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical center, Department of Anesthesia, Harvard medical School, Boston, MA, USA
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Ferraro S, Nigri A, Bruzzone MG, Demichelis G, Pinardi C, Brivio L, Giani L, Proietti A, Leone M, Chiapparini L. Cluster headache: insights from resting-state functional magnetic resonance imaging. Neurol Sci 2019; 40:45-47. [PMID: 30941629 DOI: 10.1007/s10072-019-03874-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The comprehension of cluster headache (CH) has greatly benefited from the tremendous progress of the neuroimaging techniques over the last 20 years. Since the pioneering study of May et al. (1998), the neuroimaging results have indeed revolutionized the conception of this disease, now considered as a dysfunction of the central nervous system. Clinical, neuroendocrinological, and neuroimaging studies strongly suggested the involvement of the hypothalamus as the generator of cluster headache attacks. However, the latency of the improvement and the inefficacy of the hypothalamic deep brain stimulation (DBS) in the acute phase suggested that the hypothalamus might play a modulating role, pointing to the presence of some dysfunctional brain networks, normalized or modulated by the DBS. Despite the great importance of possible dysfunctional hypothalamic networks in cluster headache pathophysiology, only quite recently the scientific community has begun to explore the functional connectivity of these circuits using resting-state functional magnetic resonance imaging. This is a neuroimaging technique extensively employed to investigate the functional connectivity among separated regions of the brain at rest in the low-frequency domain (< 0.1 Hz). Here, we present a review of the few resting-state functional magnetic resonance imaging studies investigating the hypothalamic network contributing to a deeper comprehension of this neurological disorder. These studies seem to demonstrate that both the hypothalamus and the diencephalic-mesencephalic junction regions might play an important role in the pathophysiology of CH. However, future studies are needed to confirm the results and to clarify if the observed dysfunctional networks are a specific neural fingerprint of the CH pathophysiology or an effect of the severe acute pain. It will be also crucial to clarify the neural pathways of the chronicization of this disorder.
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Affiliation(s)
- Stefania Ferraro
- Department of Neuroradiology, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', 20133, Milan, Italy
| | - Anna Nigri
- Department of Neuroradiology, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', 20133, Milan, Italy.
| | - Maria Grazia Bruzzone
- Department of Neuroradiology, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', 20133, Milan, Italy
| | - Greta Demichelis
- Department of Neuroradiology, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', 20133, Milan, Italy
| | - Chiara Pinardi
- Department of Neuroradiology, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', 20133, Milan, Italy
| | - Luca Brivio
- Department of Neuroradiology, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', 20133, Milan, Italy
| | - Luca Giani
- Department of Neurology and Headache Centre, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Alberto Proietti
- Department of Neurology and Headache Centre, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Massimo Leone
- Department of Neurology and Headache Centre, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', Milan, Italy
| | - Luisa Chiapparini
- Department of Neuroradiology, IRCCS Fondazione Istituto Neurologico 'Carlo Besta', 20133, Milan, Italy
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Garcia-Ortega R, Edwards T, Moir L, Aziz TZ, Green AL, FitzGerald JJ. Burst Occipital Nerve Stimulation for Chronic Migraine and Chronic Cluster Headache. Neuromodulation 2019; 22:638-644. [PMID: 31199547 DOI: 10.1111/ner.12977] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/02/2019] [Accepted: 04/24/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Occipital nerve stimulation (ONS) is widely used for headache syndromes including chronic migraine (CM) and chronic cluster headache (CCH). The paraesthesia associated with tonic stimulation can be bothersome and can limit therapy. It is now clear in spinal cord stimulation that paraesthesia-free waveforms can produce effective analgesia, but this has not been reported in ONS for CM or CCH. MATERIALS AND METHODS Seventeen patients (12 CM and 5 CCH) were treated with bilateral burst pattern ONS, including 4 who had previously had tonic ONS. Results were assessed in terms of the frequency of headaches (number of headache days per month for CM, and number of attacks per day for CCH) and their intensity on the numeric pain rating scale. RESULTS Burst ONS produced a statistically significant mean reduction of 10.2 headache days per month in CM. In CCH, there were significant mean reductions in headache frequency (92%) and intensity (42%). CONCLUSION Paraesthesia is not necessary for good quality analgesia in ONS. Larger studies will be required to determine whether the efficacies of the two stimulation modes differ. Burst ONS is imperceptible and therefore potentially amenable to robustly blinded clinical trials.
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Affiliation(s)
- Rodrigo Garcia-Ortega
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tamara Edwards
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Liz Moir
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tipu Z Aziz
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alexander L Green
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James J FitzGerald
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Abstract
PURPOSE OF REVIEW Cluster headache stands among the worst debilitating pain conditions. Available treatments for cluster headache have often disabling side effects, are not tolerated, or are ineffective. The management of drug-refractory chronic forms is challenging. New treatments are warranted and reported here. RECENT FINDINGS In cluster headache acute treatment, delivery systems like Demand Valve Oxygen or nonrebreather-type masks could enhance the effectiveness of inhaled oxygen therapy. Noninvasive vagus nerve stimulation relieves cluster headache pain at short-term in episodic patients. Sphenopalatine ganglion stimulation combines acute and preventive properties in subsets of patients and is of interest in selected refractory chronic forms. In cluster headache prevention, 'hypothalamic' deep brain stimulation is being refined using slightly different stereotactic coordinates or lower risk methods like endoventricular stimulation. Anti-CGRP monoclonal antibodies provide interesting results in episodic cluster headache, have a good safety profile, but do not appear effective in chronic cluster headache. SUMMARY These novel approaches provide additional alternatives to conventional cluster headache management, but results obtained in chronic forms are often disappointing. Research on cluster headache is often hampered by the lack of awareness in the medical world and by the relatively low prevalence of cluster headache compared with migraine. However, common features shared by these two primary headaches could help developing disease-specific therapies.
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45
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Nowacki A, Moir L, Owen SL, Fitzgerald JJ, Green AL, Aziz TZ. Deep brain stimulation of chronic cluster headaches: Posterior hypothalamus, ventral tegmentum and beyond. Cephalalgia 2019; 39:1111-1120. [PMID: 30897941 DOI: 10.1177/0333102419839992] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We present long-term follow-up results and analysis of stimulation sites of a prospective cohort study of six patients with chronic cluster headaches undergoing deep brain stimulation of the ipsilateral posterior hypothalamic region. METHODS The primary endpoint was the postoperative change in the composite headache severity score "headache load" after 12 months of chronic stimulation. Secondary endpoints were the changes in headache attack frequency, headache attack duration and headache intensity, quality of life measures at 12, 24, and 48 months following surgery. Stimulating contact positions were analysed and projected onto the steroetactic atlas of Schaltenbrand and Wahren. RESULTS There was a significant reduction of headache load of over 93% on average at 12 months postoperatively that persisted over the follow-up period of 48 months (p = 0.0041) and that was accompanied by a significant increase of reported quality of life measures (p = 0.03). Anatomical analysis revealed that individual stimulating electrodes were located in the red nucleus, posterior hypothalamic region, mesencephalic pretectal area and centromedian nucleus of the thalamus. CONCLUSIONS Our findings confirming long-term effectiveness of deep brain stimulation for chronic cluster headaches suggest that the neuroanatomical substrate of deep brain stimulation-induced headache relief is probably not restricted to the posterior hypothalamic area but encompasses a more widespread area.
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Affiliation(s)
- Andreas Nowacki
- 1 Department of Neurosurgery, Oxford University Hospital Foundation Trust, Oxford, UK
| | - Liz Moir
- 1 Department of Neurosurgery, Oxford University Hospital Foundation Trust, Oxford, UK
| | - Sarah Lf Owen
- 2 Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - James J Fitzgerald
- 3 Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Alexander L Green
- 3 Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Tipu Z Aziz
- 3 Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
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46
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Cappon D, Ryterska A, Lagrata S, Miller S, Akram H, Hyam J, Zrinzo L, Matharu M, Jahanshahi M. Ventral tegmental area deep brain stimulation for chronic cluster headache: Effects on cognition, mood, pain report behaviour and quality of life. Cephalalgia 2019; 39:1099-1110. [DOI: 10.1177/0333102419839957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Deep brain stimulation in the ventral tegmental area (VTA-DBS) has provided remarkable therapeutic benefits in decreasing headache frequency and severity in patients with medically refractory chronic cluster headache (CH). However, to date the effects of VTA-DBS on cognition, mood and quality of life have not been examined in detail. Methods The aim of the present study was to do so in a case series of 18 consecutive patients with cluster headache who underwent implantation of deep brain stimulation electrodes in the ventral tegmental area. The patients were evaluated preoperatively and after a mean of 14 months of VTA-DBS on tests of global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis–Kaplan Executive Function System), and attention (Paced Auditory Serial Addition Test). Depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), and hopelessness (Beck Hopelessness Scale) were also assessed. Subjective pain experience (McGill Pain Questionnaire), behaviour (Pain Behaviour Checklist) and quality of life (Short Form-36) were also evaluated at the same time points. Results VTA-DBS resulted in significant improvement of headache frequency (from a mean of five to two attacks daily, p < .001) and severity (from mean Verbal Rating Scale [VRS] of 10 to 7, p < .001) which was associated with significant reduction of anxiety (from mean HADS-A of 11.94 to 8.00, p < .001) and help-seeking behaviours (from mean PBC of 4.00 to 2.61, p < .001). VTA-DBS did not produce any significant change to any tests of cognitive function and any other outcome measures (BDI, HADS-D, SAS, BHS, McGill Pain Questionnaire, Short Form-36). Conclusion We confirm the efficacy of VTA-DBS in the treatment of medically refractory chronic cluster headache. The reduction of headache frequency and severity was associated with a significant reduction of anxiety. Furthermore, the result suggests that VTA-DBS for chronic cluster headache improves pain-related help-seeking behaviours and does not produce any change in cognition.
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Affiliation(s)
- Davide Cappon
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Agata Ryterska
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Psychology, Queen Mary University of London, London, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Sarah Miller
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Harith Akram
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jonatham Hyam
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Marjan Jahanshahi
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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Buture A, Boland JW, Dikomitis L, Ahmed F. Update on the pathophysiology of cluster headache: imaging and neuropeptide studies. J Pain Res 2019; 12:269-281. [PMID: 30655693 PMCID: PMC6324919 DOI: 10.2147/jpr.s175312] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Cluster headache (CH) is the most severe primary headache condition. Its pathophysiology is multifaceted and incompletely understood. This review brings together the latest neuroimaging and neuropeptide evidence on the pathophysiology of CH. METHODS A review of the literature was conducted by searching PubMed and Web of Science. The search was conducted using the following keywords: imaging studies, voxel-based morphometry, diffusion-tensor imaging, diffusion magnetic resonance imaging, tractography, connectivity, cerebral networks, neuromodulation, central modulation, deep brain stimulation, orexin-A, orexin-B, tract-based spatial statistics, single-photon emission computer tomography studies, positron-emission tomography, functional magnetic resonance imaging, magnetic resonance spectroscopy, trigeminovascular system, neuropeptides, calcitonin gene-related peptide, neurokinin A, substance P, nitric oxide synthase, pituitary adenylate cyclase-activating peptide, vasoactive intestinal peptide, neuropeptide Y, acetylcholine, noradrenaline, and ATP. "Cluster headache" was combined with each keyword for more relevant results. All irrelevant and duplicated records were excluded. Search dates were from October 1976 to May 2018. RESULTS Neuroimaging studies support the role of the hypothalamus in CH, as well as other brain areas involved in the pain matrix. Activation of the trigeminovascular system and the release of neuropeptides play an important role in CH pathophysiology. Among neuropeptides, calcitonin gene-related peptide, vasoactive intestinal peptide, and pituitary adenylate cyclase-activating peptide have been reported to be reliable biomarkers for CH attacks, though not specific for CH. Several other neuropeptides are involved in trigeminovascular activation, but the current evidence does not qualify them as reliable biomarkers in CH. CONCLUSION CH has a complex pathophysiology and the pain mechanism is not completely understood. Recent neuroimaging studies have provided insight into the functional and structural network bases of CH pathophysiology. Although there has been important progress in neuropeptide studies, a specific biomarker for CH is yet to be found.
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Affiliation(s)
- Alina Buture
- Department of Neurology, Hull Royal Infirmary, Hull, UK,
- Hull York Medical School, University of Hull, Hull, UK,
| | | | - Lisa Dikomitis
- School of Medicine and Institute of Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Fayyaz Ahmed
- Department of Neurology, Hull Royal Infirmary, Hull, UK,
- Hull York Medical School, University of Hull, Hull, UK,
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Vyas DB, Ho AL, Dadey DY, Pendharkar AV, Sussman ES, Cowan R, Halpern CH. Deep Brain Stimulation for Chronic Cluster Headache: A Review. Neuromodulation 2018; 22:388-397. [DOI: 10.1111/ner.12869] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Daivik B. Vyas
- Department of Neurosurgery Stanford University Stanford CA USA
| | - Allen L. Ho
- Department of Neurosurgery Stanford University Stanford CA USA
| | - David Y. Dadey
- Department of Neurosurgery Stanford University Stanford CA USA
| | | | - Eric S. Sussman
- Department of Neurosurgery Stanford University Stanford CA USA
| | - Robert Cowan
- Department of Neurology Stanford University Stanford CA USA
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Jakobs M, Jesser J, Albrecht T, Wick A, Unterberg A, Ahmadi R. Location and Volume of MRI Artifacts in Patients With Implanted Sphenopalatine Ganglion Neurostimulators for Treatment of Chronic Cluster Headache. Neuromodulation 2018; 22:978-985. [PMID: 30270483 DOI: 10.1111/ner.12861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/22/2018] [Accepted: 08/15/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Sphenopalatine ganglion stimulation (SPG-S) is an invasive form of neuromodulation by which a neurostimulator is implanted into the pterygopalatine fossa to treat refractory chronic cluster headache. The implant is MRI conditional, up to 3 T, however there is no clinical data on the shape, size, and location of the artifact produced by the implant. MATERIALS AND METHODS Records of patients with SPG-S were analyzed for postoperative cranial MRI scans. MRI and intraoperative CT scans for visualization of the implant were fused and volumetry was performed for both the implant and the MRI artifact in different MRI sequences. RESULTS In total, n = 3 patients with postoperative MRI scans were identified. The mean CT artifact volume was 0.73 cm3 (±0.15 cm3 ). MRI artifact volume differed between sequences (range: 25.2-220.7 cm3 ). The intracranial space was largely unaffected besides the pole of the ipsilateral temporal lobe and the basal frontal gyrus. MRI artifacts affected the extracranial space (orbit, maxillary and ethmoid sinuses, and parts of the parotid gland). No adverse events occurred during or after MRI scans. CONCLUSIONS Cranial MRI scans with SPG-S implants were safely performed in three patients following the manufacturer's MRI conditions. MRI artifacts were mostly located in the extracranial space. Brain MRI imaging is largely unaffected. CONFLICT OF INTEREST The authors declare no potential conflicts of interest with respect to research, authorship, and/or publication of this article.
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Affiliation(s)
- Martin Jakobs
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jessica Jesser
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tobias Albrecht
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Antje Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rezvan Ahmadi
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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