Recently, it was shown that a slowed motor cortical drive in hepatic encephalopathy (HE) results in mini-asterixis (MA). During forearm elevation, the authors have now investigated the coupling between motor cortex and thalamic activity using magnetoencephalography in six cirrhotic patients with HE and MA and in six control subjects. HE patients showed thalamo-motor-cortical coupling at a significantly lower frequency than the coupling in control subjects. The pathologic motor cortical drive in HE probably results from altered thalamocortical oscillatory coupling.