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Posted by ScottL ( on July 18, 2001 at 18:39:18:

This article has been mentioned by several. Here it is. I find it intriguing because the hypothalamus is being stimulated, not nuked (like parts of the trigeminal nerve in gamma knife or rhizotomy). This suggests that other ways (dietery, meds, accupunture, etc) may be found to accomplish what the wire accomplishes in these surgeries.

Deep-Brain Stimulation Stops Debilitating Cluster Headaches

Viable Option in Treatment-Resistant Patients

By Neil Osterweil
WebMD Medical News

Reviewed by Michael W. Smith, MD

May 15, 2001 (Philadelphia) -- Surgeons have performed a first-of-its-kind procedure in a man with chronic cluster headaches unresponsive to treatment. The 39-year-old man's disabling headaches completely disappeared after a slim wire was implanted into his hypothalamus and hooked up to an electrical stimulator. The technique and findings were presented here recently at the annual meeting of the American Academy of Neurology.

Since the surgery, "his life has completely changed; he was totally disabled and unable to work for 5 years," Massimo Leone, MD, department of neurology and neurosurgery at the Carlo Besta National Neurological Institute in Milan, Italy, tells WebMD.

The patient's physicians had exhausted all other treatment options, so the surgeons decided to try a different approach called deep brain stimulation, which has been shown to be successful in some cases of Parkinson's disease and other movement disorders.

Through the use of PET scanning and other measures, the researchers were able to pinpoint the origin of the headaches to the inferior posterior hypothalamic gray matter. The surgeons then used a 3-dimensional imaging technique to precisely place the wire into that region. The wire runs under the patient's scalp and is connected to a small electrical stimulator implanted under the clavicle.

Within 48 hours after the wire implant, 3 volts of electrical stimulation were delivered to this area, and the patient experienced complete relief. When the stimulator was turned off on two occasions when the patient required eye surgery, the headaches returned within 24-48 hours, but they were again relieved when the stimulator was switched back on. Leone says that the patient was not aware that the stimulator had been shut off on either occasion, suggesting that therapy itself, and not a placebo effect, was responsible for stopping the pain. The patient has been free of headaches for nearly a year and has been able to return to work.

"Using surgery as an alternative to a lot of drugs that have side effects, in this case it seems that you could wean somebody completely off their drugs, and at least in this one individual, it works pretty well," Chris Janson, MD, from the department of neurosurgery at Thomas Jefferson University in Philadelphia, tells WebMD. Janson was not involved in the study.

Givonanni Broggi, MD, chairman of neurosurgery at the Carlo Besta Institute, tells WebMD that the surgeons have since performed the procedure on two additional patients, with similar success.

2001 WebMD Corporation. All rights reserved.

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