TY - JOUR
AU - M. Mofatteh
AU - A. Mohamed
AU - M. S. Mashayekhi
AU - G. P. Skandalakis
AU - C. Neudorfer
AU - S. Arfaie
AU - A. MohanaSundaram
AU - M. Sabahi
AU - A. Anand
AU - R. Aboulhosn
AU - X. Liao
AU - A. Horn
AU - K. Ashkan
A1 - 
AB - BACKGROUND: Deep brain stimulation (DBS) has been successfully used for the treatment of circuitopathies including movement, anxiety, and behavioral disorders. The hypothalamus is a crucial integration center for many peripheral and central pathways relating to cardiovascular, metabolic, and behavioral functions and constitutes a potential target for neuromodulation in treatment-refractory conditions. To conduct a systematic review, investigating hypothalamic targets in DBS, their indications, and the primary clinical findings. METHODS: PubMed, Scopus, and Web of Science databases were searched in accordance with the PRISMA guideline to identify papers published in English studying DBS of the hypothalamus in humans. RESULTS: After screening 3,148 papers, 34 studies consisting of 412 patients published over two decades were included in the final review. Hypothalamic DBS was indicated in refractory headaches (n = 238, 57.8%), aggressive behavior (n = 100, 24.3%), mild Alzheimer's disease (n = 58, 14.1%), trigeminal neuralgia in multiple sclerosis (n = 5, 1.2%), Prader-Willi syndrome (n = 4, 0.97%), and atypical facial pain (n = 3, 0.73%). The posterior hypothalamus was the most common DBS target site across 30 studies (88.2%). 262 (63.6%) participants were males, and 110 (26.7%) were females. 303 (73.5%) patients were adults whereas 33 (8.0%) were pediatrics. The lowest mean age of participants was 15.25 ± 4.6 years for chronic refractory aggressiveness, and the highest was 68.5 ± 7.9 years in Alzheimer's disease patients. The mean duration of the disease ranged from 2.2 ± 1.7 (mild Alzheimer's disease) to 19.8 ± 10.1 years (refractory headaches). 213 (51.7%) patients across 29 studies (85.3%) reported symptom improvements which ranged from 23.1% to 100%. 25 (73.5%) studies reported complications, most of which were associated with higher voltage stimulations. CONCLUSIONS: DBS of the hypothalamus is feasible in selected patients with various refractory conditions ranging from headaches to aggression in both pediatric and adult populations. Future large-scale studies with long-term follow-up are required to validate the safety and efficacy data and extend these findings.
AD - School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK. mmofatteh01@qub.ac.uk.; Neuro International Collaboration (NIC), London, UK. mmofatteh01@qub.ac.uk.; Medical Sciences Division, University of Oxford, Oxford, UK.; Neuro International Collaboration (NIC), Oxford, UK.; Faculty of Medicine, Division of Neurosurgery, University of Ottawa, Ottawa, ON, Canada.; Neuro International Collaboration (NIC), Vancouver, Ottawa, ON, Canada.; Department of Neurosurgery, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece.; Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.; Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.; 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 and Neurosurgery, McGill University, Montreal, QC, Canada.; Division of Neurosurgery, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.; Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA.; Neuro International Collaboration (NIC), Montreal, QC, Canada.; School of Pharmacy, Sathyabama Institute of Science and Technology, Chennai, Tamilnadu, India.; Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA.; Koirala Institute of Health Sciences, B. P, Dharan, Nepal.; School of Medicine, University of Aberdeen, Aberdeen, UK.; Department of Neurosurgery, First People's Hospital of Foshan, Foshan, Guangdong Province, China.; Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.; Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.; Departments of Neurology and Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.; Neuro International Collaboration (NIC), London, UK.; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.; King's Health Partners Academic Health Sciences Centre, London, UK.; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.
AN - 39904782
BT - Acta Neurochir (Wien)
C5 - General Literature
CP - 1
DA - Feb 4
DO - 10.1007/s00701-025-06430-w
DP - NLM
ET - 20250204
IS - 1
JF - Acta Neurochir (Wien)
LA - eng
N2 - BACKGROUND: Deep brain stimulation (DBS) has been successfully used for the treatment of circuitopathies including movement, anxiety, and behavioral disorders. The hypothalamus is a crucial integration center for many peripheral and central pathways relating to cardiovascular, metabolic, and behavioral functions and constitutes a potential target for neuromodulation in treatment-refractory conditions. To conduct a systematic review, investigating hypothalamic targets in DBS, their indications, and the primary clinical findings. METHODS: PubMed, Scopus, and Web of Science databases were searched in accordance with the PRISMA guideline to identify papers published in English studying DBS of the hypothalamus in humans. RESULTS: After screening 3,148 papers, 34 studies consisting of 412 patients published over two decades were included in the final review. Hypothalamic DBS was indicated in refractory headaches (n = 238, 57.8%), aggressive behavior (n = 100, 24.3%), mild Alzheimer's disease (n = 58, 14.1%), trigeminal neuralgia in multiple sclerosis (n = 5, 1.2%), Prader-Willi syndrome (n = 4, 0.97%), and atypical facial pain (n = 3, 0.73%). The posterior hypothalamus was the most common DBS target site across 30 studies (88.2%). 262 (63.6%) participants were males, and 110 (26.7%) were females. 303 (73.5%) patients were adults whereas 33 (8.0%) were pediatrics. The lowest mean age of participants was 15.25 ± 4.6 years for chronic refractory aggressiveness, and the highest was 68.5 ± 7.9 years in Alzheimer's disease patients. The mean duration of the disease ranged from 2.2 ± 1.7 (mild Alzheimer's disease) to 19.8 ± 10.1 years (refractory headaches). 213 (51.7%) patients across 29 studies (85.3%) reported symptom improvements which ranged from 23.1% to 100%. 25 (73.5%) studies reported complications, most of which were associated with higher voltage stimulations. CONCLUSIONS: DBS of the hypothalamus is feasible in selected patients with various refractory conditions ranging from headaches to aggression in both pediatric and adult populations. Future large-scale studies with long-term follow-up are required to validate the safety and efficacy data and extend these findings.
PY - 2025
SN - 0001-6268 (Print); 0001-6268
SP - 33
ST - Deep brain stimulation of the hypothalamic region: a systematic review
T1 - Deep brain stimulation of the hypothalamic region: a systematic review
T2 - Acta Neurochir (Wien)
TI - Deep brain stimulation of the hypothalamic region: a systematic review
U1 - General Literature
U3 - 10.1007/s00701-025-06430-w
VL - 167
VO - 0001-6268 (Print); 0001-6268
Y1 - 2025
ER -