Image

8:51 PM / Tuesday November 29, 2022

6 Feb 2011

Brain stimulation helps

  • Facebook
  • Twitter
February 6, 2011 Category: Health Posted by:

By Nancy Walsh

MedPage Today

 

British researchers have successfully treated refractory hypertension with deep brain stimulation, opening the door to a new approach to managing this difficult — and not uncommon — condition.

 

The finding was serendipitous, explained Nikunj K. Patel, MD, of the University of Bristol, and colleagues in the Jan. 25 issue of Neurology.

 

The patient, a 55-year-old man, had had an ischemic stroke. While he was in the hospital, his blood pressure fluctuated from 153/89 mm Hg to 265/96 mm Hg, and quadruple antihypertensive therapy was begun, with daily atenolol (50 mg), diltiazem (240 mg), perindopril (4 mg), and indapamide (1.25 mg), the doses of which were increased over the following several months.

 

The sequelae of his stroke resolved, but he then developed a persistent, severe, left-sided central pain syndrome.

 

The pain was resistant to conventional treatment, and because deep brain stimulation has been helpful in some cases of chronic central pain, the patient was referred to Patel’s neurosurgery center for treatment.

 

Patel’s group used a stereotactic technique, guided by magnetic resonance imaging, to target the area of the brain known as the ventrolateral periaqueductal gray/periventricular gray (PAG/PVG), which is associated with analgesic responses.

 

The patient’s pain decreased, and so did his blood pressure — plummeting to 80/53 mm Hg on the quadruple antihypertensive regimen.

 

The blood pressure medications were withdrawn, and for the subsequent eight weeks the patient’s blood pressure remained at about 110/65 mm Hg.

 

At 12 weeks there was a slight increase in pressure, to 124/76 mm Hg, and the patient was given perindopril, 4 mg, with indapamide, 1.5 mg.

 

The antihypertensives were again withdrawn at 27 months, and at 33 months his blood pressure was 118/70 mm Hg.

 

Pain was initially improved but returned to preprocedure levels at 4 months; hypertensive control was not linked to pain control, according to the investigators.

 

“With hypertension in so many patients being resistant to multiple drug therapy, alternative strategies are needed,” the researchers observed.

 

“The present data and those of others indicate that manipulating the autonomic nervous system is a powerful approach for chronic control of hypertension in humans,” they wrote.

 

They noted that their study provides class IV evidence (the weakest level of evidence based on a case report) for the use of deep brain stimulation in patients whose hypertension fails to respond to medical therapy.

 

Animal studies have suggested that stimulation with a 10 Hz frequency — as was used in this patient — could induce both analgesia and hypotension through excitatory effects on the PAG/PVG neurons.

 

Various neuronal structures adjoining ventrolateral PAG, such as the rostral ventrolatral medulla and locus cereleus, may be involved in the hypotensive response to deep brain stimulation in an inhibitory manner, Patel and colleagues expained.

 

In addition, that response may result from alterations in cerebral perfusion and decreases in sympathetic neuronal activity.

 

Deep brain stimulation of the PAG/PVG, Patel’s group concluded, “provides an opportunity to elucidate central mechanisms controlling blood pressure in patients with refractory hypertension.”

 

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner.

  • Facebook
  • Twitter

Leave a Comment

Recent News

Local

Message from Catherine Hicks Philadelphia Branch NAACP President and Publisher of the SUN on passing of former PA Senator T. Milton Street

November 29, 2022

Tweet Share Pin Email The Philadelphia Branch NAACP and the Philadelphia SUN family, is saddened to hear...

Stateside

Buffalo gunman pleads guilty in racist supermarket massacre

November 28, 2022

Tweet Share Pin Email By CAROLYN THOMPSON BUFFALO, N.Y. (AP) — The white gunman who massacred 10...

Week In Review

Biden admin to ask high court to take up student debt plan

November 24, 2022

Tweet Share Pin Email ABOVE PHOTO: Light illuminates part of the Supreme Court building on Capitol Hill...

Politics

Georgia runoff: Why one Senate seat is crucial for Democrats

November 24, 2022

Tweet Share Pin Email ABOVE PHOTO: This combination of photos shows, Sen. Raphael Warnock, D-Ga., speaking to...

Health

How to shop for the right Medicare plan and avoid costly mistakes

November 24, 2022

Tweet Share Pin Email BPT Inflation is putting the squeeze on all Americans, but no one is...

Color Of Money

Top financial to-dos to end the year strong and prepare for 2023

November 24, 2022

Tweet Share Pin Email BPT  The holidays are a time full of good cheer, but not necessarily...

The Philadelphia Sunday Sun Staff