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Cns basal ganglia

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Cns basal ganglia

  1. 1. <ul><li>BASAL GANGLIA </li></ul>
  2. 2. Basal Ganglia (Nuclei) <ul><li>Group of deep, interrelated subcortical N </li></ul><ul><li>Accessory motor system that </li></ul><ul><ul><ul><li>Functions usually not by itself but in close association with cerebral cortex & corticospinal motor control system </li></ul></ul></ul><ul><ul><ul><li>Most input signals from: cerebral cortex </li></ul></ul></ul><ul><ul><ul><li>Most output signals back to: cerebral cortex </li></ul></ul></ul>
  3. 3. Anatomy <ul><ul><li>Caudate </li></ul></ul><ul><ul><li>Putamen </li></ul></ul><ul><ul><li>Globus pallidus </li></ul></ul><ul><ul><li>Substantia nigra </li></ul></ul><ul><ul><li>Subthalamic nucleus </li></ul></ul>
  4. 4. Anatomy Overview
  5. 5. Anatomy
  6. 6. The Putamen Circuit – Executing Patterns of Motor Activity
  7. 7. The Putamen Circuit - Functions <ul><li>Putamen circuit + cerebral cortex </li></ul><ul><ul><ul><li>Controls complex patterns of motor activity </li></ul></ul></ul><ul><ul><ul><ul><li>Writing, Cutting paper with scissors, Hammering nails </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Shooting a basketball through a hoop, passing a football, Throwing a baseball </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Most aspects of vocalization </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Controlled movements of the eyes </li></ul></ul></ul></ul><ul><ul><ul><ul><li>And virtually any other skilled movements </li></ul></ul></ul></ul>
  8. 8. The Putamen Circuit - Lesions <ul><li>Globus Pallidus: </li></ul><ul><ul><ul><li>Spontaneous, continuous writhing movements of a hand, an arm, the neck, or the face – Athetosis </li></ul></ul></ul><ul><li>Subthalamus: </li></ul><ul><ul><ul><li>Sudden flailing movements of an entire limb – Hemiballismus </li></ul></ul></ul><ul><li>Putamen: </li></ul><ul><ul><ul><li>Flicking movements in hands, face, & other parts of body – Chorea </li></ul></ul></ul><ul><li>Substantia Nigra: </li></ul><ul><ul><ul><li>Common and extremely severe disease of rigidity , akinesia , and tremors - Parkinson ’ s disease </li></ul></ul></ul>
  9. 9. The Caudate Circuit – Cognitive Control of Sequences of Motor Patterns <ul><ul><li>Cognition </li></ul></ul><ul><ul><ul><li>Most motor actions occur as a consequence of cognition </li></ul></ul></ul><ul><ul><ul><li>Caudate nucleus is pivotol </li></ul></ul></ul>
  10. 10. The Caudate Circuit <ul><li>Timing and Scaling of movements </li></ul>
  11. 12. BG Circuit - Neurotransmitters
  12. 13. ? <ul><li>What was common between Yasir Arafat , Muhammad Ali & Adolph Hitler ? </li></ul>
  13. 14. Parkinson’s Disease <ul><li>Degenerative disorder of basal ganglia </li></ul><ul><li>Dopamine depletion results from: </li></ul><ul><ul><ul><li>Degeneration dopamine nigrostriatal system </li></ul></ul></ul><ul><ul><ul><li>Antipsychotic drugs that block dopamine receptors </li></ul></ul></ul><ul><ul><ul><li>Toxic reaction to a chemical agent </li></ul></ul></ul><ul><ul><ul><ul><ul><li>The Northern California drug dealer!* </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Severe carbon monoxide poisoning </li></ul></ul></ul>
  14. 15. Parkinson’s Disease – Clinical <ul><li>Tremor (involuntary tremor) </li></ul><ul><ul><ul><ul><li>Affects distal segments of limbs (hands and feet; head, neck, face, lips, tongue; or jaw) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Characterized by rhythmic, alternating flexion & contraction movements (4-6 beats/minute) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Disappears during voluntary movement </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Start unilateral- spread bilateral </li></ul></ul></ul></ul><ul><li>Rigidity </li></ul><ul><ul><ul><ul><li>Resistance to movement of both flexors & extensors throughout the full range of motion </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Most evident during passive joint movement </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>involves jerky, cogwheel-type movements requiring considerable energy </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Start unilateral- spread bilateral </li></ul></ul></ul></ul>
  15. 16. Parkinson’s Disease – Clinical <ul><li>Bradykinesia (slowness of movement) </li></ul><ul><ul><ul><li>Movements: </li></ul></ul></ul><ul><ul><ul><ul><li>Are slow to initiate & perform </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Difficult to stop </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Are stiff & staccato in character instead of smooth </li></ul></ul></ul></ul><ul><ul><ul><li>While walking: </li></ul></ul></ul><ul><ul><ul><ul><li>Walking and turning en bloc is difficult </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Freezing spells </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>take small, shuffling steps without swinging arms </li></ul></ul></ul></ul><ul><ul><ul><li>Posture: </li></ul></ul></ul><ul><ul><ul><ul><li>Lean forward to maintain center of gravity </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Loss of postural reflexes – fall (often backward) </li></ul></ul></ul></ul><ul><ul><ul><li>Masked face: </li></ul></ul></ul><ul><ul><ul><ul><li>Emotional & voluntary facial movements become limited </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Loss of blinking reflex </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Failure to express emotion </li></ul></ul></ul></ul><ul><ul><ul><li>Throat: </li></ul></ul></ul><ul><ul><ul><ul><li>Tongue, palate, and throat muscles – rigid </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Drooling common </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Speech: </li></ul></ul></ul><ul><ul><ul><ul><li>slow and monotonous, without modulation and poorly articulated </li></ul></ul></ul></ul>
  16. 17. Parkinson’s Disease – Clinical <ul><li>Advanced Parkinsonian features: </li></ul><ul><ul><ul><li>Dementia (similar to Alzheimer’s disease) </li></ul></ul></ul><ul><ul><ul><li>Falls </li></ul></ul></ul><ul><ul><ul><li>Fluctuations in motor function </li></ul></ul></ul><ul><ul><ul><li>Neuropsychiatric disorders </li></ul></ul></ul><ul><ul><ul><li>Sleep disorders </li></ul></ul></ul>
  17. 20. Parkinson’s Disease – Treatment <ul><li>Nonpharmacologic </li></ul><ul><ul><ul><li>Group support </li></ul></ul></ul><ul><ul><ul><li>Education </li></ul></ul></ul><ul><ul><ul><li>Daily exercise, adequate nutrition </li></ul></ul></ul><ul><ul><ul><li>Botulism toxin injections </li></ul></ul></ul><ul><li>Pharmacologic </li></ul><ul><ul><ul><li>Antiparkinson drugs act by: </li></ul></ul></ul><ul><ul><ul><ul><li>Increasing functional ability of underactive dopaminergic system </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Increase dopamine levels (levodopa) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Augment release of dopamine (amantadine) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Function as dopamine agonists (bromocriptine) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Inhibit metabolic breakdown of dopamine (selegiline) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Reducing excessive influence of excitatory cholinergic neurons </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Anticholinergic drugs </li></ul></ul></ul></ul></ul>
  18. 21. Parkinson’s Disease – Treatment <ul><li>Surgical </li></ul><ul><ul><ul><li>Thalamotomy or pallidectomy performed using stereotactic surgery </li></ul></ul></ul>
  19. 22. Overall Motor Control

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