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Thalamocortical dysrhythmia II. Clinical and surgical aspects

Published online by Cambridge University Press:  12 April 2006

D. Jeanmonod
Affiliation:
Neurochirurgische Klinik, Lab. for Functional Neurosurgery, Universitätsspital Zürich, Sternwartstrasse 6, 8091 Zürich, Switzerland
M. Magnin
Affiliation:
Neurochirurgische Klinik, Lab. for Functional Neurosurgery, Universitätsspital Zürich, Sternwartstrasse 6, 8091 Zürich, Switzerland
A. Morel
Affiliation:
Neurochirurgische Klinik, Lab. for Functional Neurosurgery, Universitätsspital Zürich, Sternwartstrasse 6, 8091 Zürich, Switzerland
M. Siegemund
Affiliation:
Neurochirurgische Klinik, Lab. for Functional Neurosurgery, Universitätsspital Zürich, Sternwartstrasse 6, 8091 Zürich, Switzerland
A. Cancro
Affiliation:
Department of Psychiatry, New York University School of Medicine, New York, NY, USA
M. Lanz
Affiliation:
Psychiatrie-Zentrum Hard, Zürich, Switzerland
R. Llinás
Affiliation:
Department of Physiology and Neuroscience, New York University School of Medicine, New York, NY, USA
U. Ribary
Affiliation:
Department of Physiology and Neuroscience, New York University School of Medicine, New York, NY, USA
E. Kronberg
Affiliation:
Department of Physiology and Neuroscience, New York University School of Medicine, New York, NY, USA
J. Schulman
Affiliation:
Department of Physiology and Neuroscience, New York University School of Medicine, New York, NY, USA
M. Zonenshayn
Affiliation:
Department of Physiology and Neuroscience, New York University School of Medicine, New York, NY, USA

Abstract

The companion paper (Llinás et al., 2001) presents evidence, at both cellular and network levels, for the role of resonant oscillatory thalamocortical properties in normal and pathological brain function. Here we present confirmatory single cell electrophysiology from the thalami of thalamocortical dysrhythmia (TCD) patients and review our surgical approach towards the relief of this chronic disabling condition, in its many forms. The goal of surgery is a rebalancing of the abnormal thalamocortical oscillation responsible for TCD. Our approach uses small strategically placed pre-thalamic and medial thalamic lesions that serve to make subcritical the low frequency thalamocortical reentry network attractor via desinhibition and desamplification. The lesions address classical and new stereotactic targets that provide therapeutic efficiency coupled with the sparing of the specific thalamocortical loops.

Type
Research Article
Copyright
2001 Elsevier Science Ltd

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