Deep brain stimulation modulates hypothalamic-brainstem fibers in cluster headache: case report

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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.

ABBREVIATIONS CH = cluster headache; DBS = deep brain stimulation; DTI = diffusion tensor imaging; SPG = sphenopalatine ganglion; VTA = ventral tegmental area.
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Contributor Notes

Correspondence Clement Hamani: Sunnybrook Health Sciences Centre, Toronto, ON, Canada. clement.hamani@sunnybrook.ca.INCLUDE WHEN CITING Published online March 1, 2019; DOI: 10.3171/2018.11.JNS181412.Disclosures Dr. Hamani reports receiving support of non–study-related clinical or research effort from Medtronic. Dr. Fonoff has given expert testimony for Boston Scientific unrelated to the contents of this report.
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