Deep Brain Stimulation for Blood Pressure Control

This chapter focuses on the use of deep brain stimulation (DBS) for controlling blood pressure. Hypertension and orthostatic hypotension refractory to medical treatment present a considerable disease burden, with high associated morbidity and mortality. The periaqueductal gray area (PAG) is an important region for the modulation of pain targeted by DBS electrodes during the treatment of chronic, intractable neuropathic pain. The electrical stimulation of the PAG in animals elicits defence reactions, where dorsal regions are associated with active coping and hypertensive effects and ventral regions with passive coping and hypotensive effects. Thus PAG DBS has been related to hypertensive and chronotropic cardiovascular effects. In a study of 15 chronic neuropathic pain patients (two patients having bilateral implants), blood pressure and heart rate were continuously measured while DBS parameters were altered from 10 to 50 Hz. Cardiovascular responses to stimulation were consistent, as measured on at least three occasions, for any pair of electrode contacts used. Arterial blood pressure reduced significantly overall in seven pairs of electrode contacts in seven patients. Conversely, blood pressure increased significantly in six pairs of contacts in six patients. The demonstration that PAG DBS can increase as well as decrease blood pressure raises the possibility that orthostatic or postural hypotension might be treatable by neurosurgery. © 2009 Elsevier Ltd All rights reserved.