TY - JOUR
T1 - Electrophysiology and Structural Connectivity of the Posterior Hypothalamic Region
T2 - Much to Learn From a Rare Indication of Deep Brain Stimulation
AU - Kakusa, Bina
AU - Saluja, Sabir
AU - Dadey, David Y.A.
AU - Barbosa, Daniel A.N.
AU - Gattas, Sandra
AU - Miller, Kai J.
AU - Cowan, Robert P.
AU - Kouyoumdjian, Zepure
AU - Pouratian, Nader
AU - Halpern, Casey H.
N1 - Funding Information:
This study was supported by funds from K12NS080223 (CH), the Brain & Behavior Research Foundation, the Neurosurgery Research and Education Foundation, the John A. Blume Foundation, the William Randolph Hearst Foundation, the Stanford Medical Scholars Research Fellowship, and start-up funds from Stanford’s Department of Neurosurgery.
Funding Information:
Funding. This study was supported by funds from K12NS080223 (CH), the Brain & Behavior Research Foundation, the Neurosurgery Research and Education Foundation, the John A. Blume Foundation, the William Randolph Hearst Foundation, the Stanford Medical Scholars Research Fellowship, and start-up funds from Stanford?s Department of Neurosurgery.
Publisher Copyright:
© Copyright © 2020 Kakusa, Saluja, Dadey, Barbosa, Gattas, Miller, Cowan, Kouyoumdjian, Pouratian and Halpern.
PY - 2020/5/15
Y1 - 2020/5/15
N2 - Cluster headache (CH) is among the most common and debilitating autonomic cephalalgias. We characterize clinical outcomes of deep brain stimulation (DBS) to the posterior hypothalamic region through a novel analysis of the electrophysiological topography and tractography-based structural connectivity. The left posterior hypothalamus was targeted ipsilateral to the refractory CH symptoms. Intraoperatively, field potentials were captured in 1 mm depth increments. Whole-brain probabilistic tractography was conducted to assess the structural connectivity of the estimated volume of activated tissue (VAT) associated with therapeutic response. Stimulation of the posterior hypothalamic region led to the resolution of CH symptoms, and this benefit has persisted for 1.5-years post-surgically. Active contacts were within the posterior hypothalamus and dorsoposterior border of the ventral anterior thalamus (VAp). Delta- (3 Hz) and alpha-band (8 Hz) powers increased and peaked with proximity to the posterior hypothalamus. In the posterior hypothalamus, the delta-band phase was coupled to beta-band amplitude, the latter of which has been shown to increase during CH attacks. Finally, we identified that the VAT encompassing these regions had a high proportion of streamlines of pain processing regions, including the insula, anterior cingulate gyrus, inferior parietal lobe, precentral gyrus, and the brainstem. Our unique case study of posterior hypothalamic region DBS supports durable efficacy and provides a platform using electrophysiological topography and structural connectivity, to improve mechanistic understanding of CH and this promising therapy.
AB - Cluster headache (CH) is among the most common and debilitating autonomic cephalalgias. We characterize clinical outcomes of deep brain stimulation (DBS) to the posterior hypothalamic region through a novel analysis of the electrophysiological topography and tractography-based structural connectivity. The left posterior hypothalamus was targeted ipsilateral to the refractory CH symptoms. Intraoperatively, field potentials were captured in 1 mm depth increments. Whole-brain probabilistic tractography was conducted to assess the structural connectivity of the estimated volume of activated tissue (VAT) associated with therapeutic response. Stimulation of the posterior hypothalamic region led to the resolution of CH symptoms, and this benefit has persisted for 1.5-years post-surgically. Active contacts were within the posterior hypothalamus and dorsoposterior border of the ventral anterior thalamus (VAp). Delta- (3 Hz) and alpha-band (8 Hz) powers increased and peaked with proximity to the posterior hypothalamus. In the posterior hypothalamus, the delta-band phase was coupled to beta-band amplitude, the latter of which has been shown to increase during CH attacks. Finally, we identified that the VAT encompassing these regions had a high proportion of streamlines of pain processing regions, including the insula, anterior cingulate gyrus, inferior parietal lobe, precentral gyrus, and the brainstem. Our unique case study of posterior hypothalamic region DBS supports durable efficacy and provides a platform using electrophysiological topography and structural connectivity, to improve mechanistic understanding of CH and this promising therapy.
KW - cluster headache
KW - deep brain stimulation
KW - diffusion tractography
KW - local field potential
KW - posterior hypothalamus
UR - http://www.scopus.com/inward/record.url?scp=85085504963&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85085504963&partnerID=8YFLogxK
U2 - 10.3389/fnhum.2020.00164
DO - 10.3389/fnhum.2020.00164
M3 - Article
C2 - 32670034
AN - SCOPUS:85085504963
SN - 1662-5161
VL - 14
JO - Frontiers in Human Neuroscience
JF - Frontiers in Human Neuroscience
M1 - 164
ER -