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Extrapyramidal Syndrome

The document discusses extrapyramidal syndromes and provides details about the basal ganglia, its connections and pathways. It describes the role of basal ganglia in motor, cognitive and limbic functions. The document also discusses Parkinson's disease including its classification, pathology, and treatment involving dopaminergic drugs and other medications.

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43 views

Extrapyramidal Syndrome

The document discusses extrapyramidal syndromes and provides details about the basal ganglia, its connections and pathways. It describes the role of basal ganglia in motor, cognitive and limbic functions. The document also discusses Parkinson's disease including its classification, pathology, and treatment involving dopaminergic drugs and other medications.

Uploaded by

cera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Extrapyramidal syndromes

- Dr Raksha Mallya
SR, Department of medicine
Extrapyramidal motor system
Consists of-
• basal ganglia
• All tracts – other than corticospinal and corticobulbar tracts
i.e. rubrospinal, vestibulospinal, tectospinal, reticulospinal
Basal ganglia
• It is a collection of masses of grey matter situated at the base of the
forebrain and top of mid brain within each hemisphere

• Includes: lentiform nucleus (globus pallidus + putamen), caudate


nucleus, subthalamic nucleus and substantia nigra (pars compacta
and reticulata)
Caudate nucleus
Connection of the basal ganglia
• Input – to caudate nucleus and putamen
• Output – from globus pallidus

• Input- corticostriate, thalamostriate, nigrostriate fibers


• Output- striatopallidal, striatonigral
Basal ganglia pathways
• There are 2 pathways – depending on whether striatal outslow
connects directly with Gpi firs, or Gpe and STN .

• Direct pathway- excitatory


• Indirect pathway - inhibitory
Basal ganglia pathways
Neurotransmitters of basal ganglia
• DOPAMINE- produced by pars compacta
• It has excitatory effect upton cells in the striatum via D1 receptors (direct
pathway)
• Inhibitory effect upon cells in the striatum via D2 receptors ( indirect
pathway)

• ACETYLCHOLINE- produced byinterneurons that synapse on the GABA


producing neurons
• Has an inhibitory effect in the direct pathway and excitatory effect in the
indirect pathway
Connections of basal ganglia
• There are 5 parallel and separate closed circuits – motor,
occulomotor, prefrontal, lateral orbitofrontal, limbic loops

• These loops form 3 major divisions – sensory motor, associative and


limbic – related to motor, cognitive and emotional functions
Function of basal ganglia
• Motor loop- Involved in scaling the strength of muscle contraction,
organizing the sequence of excitation of cell columns in the motor
cortex

• Cognitive loop- Caudate nucleus is involved in motor learning and


planning ahead in preforming complex motor activity

• Limbic loop is involved in motor expression of emotions


Classification of Parkinson's
• Primary/idiopathic
• Secondary/Aquired- drugs, toxins, vascular, NPH, infections
drugs- antipsychotics, metoclopramide, flunarizine
• Hereditary- Parkin gene mutation
• Atypical- Multisystem atrophy, progressive supranuclear palsy,
corticobasilar degeneration, frontotemporal dementia
Pathology
• Loss of dopaminergic neurons in the substantia nigra
• Due to accumulation of intracellular alpha – synuclein, leading to cell
damage and apoptosis
Treatment
• Goals-

• Manage symptoms
• To minimize side effects of drugs
Treatment
• Dopaminergic drugs-

✓ Levodopa + dopa decarboxylase inhibitors- carbidopa


✓dopamine agonist- ropinirole, pamipexole
✓Catechol O methy transferase inhibitors- entacapone, tolcapone
✓Mono-amino oxidase inhibitors- selegeline, rasageline

• Anticholinergics- benztropine, trihexyphenidyl


• Amantidine- dopa agonist, NMDA receptor antagonist
• Deep brain stimulation
Mechanism of action of drugs

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