Download Basal ganglia

What?
 Movement disorder(s) is a progressive CNS disorder , affecting 1% of
people over 60 years of age
 1.5 million USA (120,000 UK)
 3rd commonest cause of disability
 1% over 60, 5% over 85
Parkinsonism
by
What?
Primary symptoms or cardinal symptoms

Rigidity - increased tone or stiffness in the
muscles

Tremor - 25% of patients experience very slight
tremor or none at all

Bradykinesia - slowness of movement

Akinesia - impaired movement initiation and
poverty of movement

Postural insability

Gait disturbances
What?
Secondary symptoms
 Poor balance
 Depression, Psychomotor







retardation
Sleep disturbances
Dizziness
Stooped posture
Constipation
Dementia
Problems with speech,
breathing, swallowing, and
sexual function
Mask face
History Should focus on
 Development of
 Tremor typically
neurologic
symptoms
 Depression
 Other illness
( Hypothyroidism,
Drugs , Trauma,
slow , unilateral,
initially , restings,
 Dementia in 15% to
2o% of patient
Why?
Family history
Rural living
Pesticide exposure
Gender (♂)
Diet (bad food)
Age
Head injury
Race (Caucasian)
Non-smoking
Where?
 Dopaminergic system
Substantia nigra
 Striatum
 Other
 Basal ganglia (globus pallidus, subthalamic nucleus)
 Hippocampus, cortex, hypothalamus, thalamus
 Olfactory bulb
 Non-dopaminergic systems (locus coeruleus, raphe nuclei)

Projection neurones with long axons
Basics
Normal brain
Substantia
Nigra
Dopamine
Striatum
Motor cortex
via
globus pallidus
and thalamus
Movement
Striatum
M
Motor
to ccortex
r x
Movement
Movement
Parkinson’s Disease
Substantia
Nigra
Dopamine
Where?
Motor cortex
Globus pallidus
Thalamus
Striatum Caudate
Putamen
Substantia nigra
Normal
Cortex
Glutamate
Glutamate
Striatum
Basal ganglia
Thalamus
ACh
D
D2
1
GABA
DA
SNPC
GABA/
Subs P
GABA/
enkephalin
DA
GP (external) /
Subthalamic Nucleus
Glutamate
Globus Pallidus (internal) / Substantia
Nigra (pars reticular)
D1
D2
Basal Ganglia
Overall
Facilitation + Inhibition =
Reduction
Inhibits/stabilises thalamocortical
network
Controls kinetic aspects of
movement
- amplitude, direction and
velocity
Allows intended but suppresses
unintended movements
Parkinsonian
Cortex
Striatum
Thalamus
ACh
D
Basal ganglia
D2
1
SNPC
GP (external) /
Subthalamic Nucleus
Globus Pallidus (internal) / Substantia
Nigra (pars reticular)
D1
D2
Basal Ganglia
Overall
Facilitation + Inhibition =
Increase
Increases output
Loss of thalamocortical network
stabilisation
Loss of kinetic control
Striatum
Ach
Striatum
DA
DA
Ach
GP
GP
Cortex
Cortex
Normal
Parkinsonian
Pathophysiology
 Loss of DA neurones
from SNPC


Pigmented
> 80 %
 Degeneration of NS
pathway
 Loss of caudate-
putamen DA content
SN Pathophysiology
Pathophysiology
 Formation of Lewy bodies (a-
Halo
synuclein)
 Cytoplasmic
 Neurones and glia
Core
Treatment should focus on :
 Proper maintenance of NM function
 Reductiion of complications
 Rehabilitation
 Psychotherapy and patient and family support
 Pharmacotherapy
 Surgery