Neuropsychiatric thalamocortical dysrhythmia: surgical implications

Thalamic single cell physiology and magnetoencephalographic data have characterized a physiopathologic condition that we have called thalamocortical dysrhythmia. This syndrome consists of increased thalamocortical, recurrent, low-frequency, oscillatory electrical activity that brings about a set of chronic neuropsychiatric manifestations, including psychotic, affective, and obsessive-compulsive disorders. We propose a surgical approach. designed to modify the abnormally functioning thalamocortical loops. This is achieved via reduction of the thalamic overinhibition that caused low-frequency thalamocortical oversynchronization. Results from 11 patients illustrate the therapeutic value of the procedure as well as the necessity for its coupling to appropriate psychotherapeutic support to alleviate individual psychoreactive manifestations.