Insomnia after bilateral stereotactic thalamotomy in man.

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Abstract
A left chemothalamectomy was performed on a 58 year old man with Parkinsonism. Approximately 2 years later a right cryothalomotomy was performed on the same patient. This procedure was followed by irreducible insomnia. For 96 hr., night and day, the patient showed no capacity for sleeping. He was fully alert and well oriented. The patient then showed an inversion of the sleep-wakefulness rhythm, which progressively became more regular. During recovery, polygraphs showed abnormal sleep. Phases 1 and 3 were markedly prolonged, phase 2 was poorly represented and phase 4 was missing completely. The chemothalamectomy most probably involved the ventralis lateralis, ventralis intermedium, ventralis posterior and subthalamus. The cryothalamotomy probably additionally involved the centro-medianus. This case of unusual insomnia supports the hypothesis that the thalamus, especially the non-specific nuclei, is instrumental in sleep-inducing mechanisms.