Jürgens Tim P, Leone Massimo, Proietti-Cecchini Alberto, Busch Volker, Mea Eliana, Bussone Gennaro, May Arne
Department of Systems Neuroscience, University of Hamburg, Germany.
Pain. 2009 Nov;146(1-2):84-90. doi: 10.1016/j.pain.2009.07.006. Epub 2009 Aug 12.
Deep-brain stimulation (DBS) of the posterior hypothalamus has been shown to be clinically effective for drug-resistant chronic cluster headache, but the underlying mechanism is still not understood. The hypothalamus as an important centre of homeostasis is connected among others to the trigeminal system via the trigeminohypothalamic tract. We aimed to elucidate whether hypothalamic stimulation affects thermal sensation and pain perception only in the clinically affected region (the first trigeminal branch) or in other regions as well. Thus, we examined three groups: chronic cluster headache patients with unilateral DBS of the posterior hypothalamus (n = 11), chronic cluster headache patients without DBS (n = 15) and healthy controls (n = 29). Perception and pain thresholds for hot and cold stimuli were determined bilaterally in all subjects supraorbitally, at the forearm, and in the lower leg. In DBS patients, thresholds were determined with the stimulator activated and inactivated. Cold pain thresholds at the first trigeminal branch were increased on the stimulated side in the DBS group compared to healthy subjects (p = .015). The DBS group also had higher cold detection thresholds compared to non-implanted cluster headache patients (p < .05). Short-term interruption of stimulation did not induce any changes in DBS patients. Clinically relevant differences were found neither between non-stimulated cluster headache patients and healthy controls nor between the affected and the non-affected sides in the chronic cluster headache patients without DBS. These results support the notion that neurostimulation of the posterior hypothalamus is specific for cluster headache and only affects certain aspects of pain sensation.
下丘脑后部的深部脑刺激（DBS）已被证明对药物难治性慢性丛集性头痛具有临床疗效，但其潜在机制仍不清楚。下丘脑作为内稳态的重要中心，通过三叉神经下丘脑束与三叉神经系统等相连。我们旨在阐明下丘脑刺激是否仅在临床受累区域（三叉神经第一分支）影响热感觉和疼痛感知，还是也会影响其他区域。因此，我们检查了三组：接受下丘脑后部单侧DBS的慢性丛集性头痛患者（n = 11）、未接受DBS的慢性丛集性头痛患者（n = 15）和健康对照者（n = 29）。在所有受试者的双侧眶上、前臂和小腿测定冷热刺激的感知阈值和疼痛阈值。对于DBS患者，在刺激器开启和关闭的情况下测定阈值。与健康受试者相比，DBS组中刺激侧三叉神经第一分支的冷痛阈值升高（p = 0.015）。与未植入电极的丛集性头痛患者相比，DBS组的冷觉检测阈值也更高（p < 0.05）。刺激的短期中断在DBS患者中未引起任何变化。在未刺激的丛集性头痛患者与健康对照者之间，以及在未接受DBS的慢性丛集性头痛患者的患侧与未患侧之间，均未发现临床相关差异。这些结果支持以下观点，即下丘脑后部的神经刺激对丛集性头痛具有特异性，且仅影响疼痛感觉的某些方面。
