gabriella horvath basal gangliacongress.cnsfederation.org/course-notes/2017_course...2017-05-04 1...
TRANSCRIPT
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BasalGanglia:func.onalcircuitries,neurotransmi9ers
andearlymotordevelopment
GabriellaHorvathCNSF,ChildNeurologyDayVictoria,June24,2017
Objec.ves
• Overviewofbasalgangliaanatomy• Basalgangliafunc.onalcircuitries• Neurotransmi9ersinthebasalganglia• Developmentalaspectsofmovement• Cogni.ve-motorinterac.onsofthebasalgangliaindevelopment
Disclosures
• Nothingtodisclose
Basalganglia:orchestraformovementBasalgangliacircuitry:dancefloorNeurotransmi9ers:musicofthemind
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Itallstartshere:
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Dopaminergicmodula.onofdirectandindirectpathways Cholinergicmodula.on
ofdirectandindirectpathways
TheRateModel
• Developedinthe1980searly1990s• Describestheconnec.vity,neurochemistryandphysiologyoftheBG(Albinetal,DeLong)
TheRateModel• Keycomponents:– interconnectednetwork– involvedinmotorandcogni.vefunc.ons– cortexgeneratesmotordemands,BGexecuteswithposi.vefeedbacksystem
– dopamineactsdifferen.allyinstriatum– compe.ngac.onssuppressed– networkoutputisintegratedatthelevelofGpiandSNr,whichinhibitordisinhibitthalamocor.caland/orbrainstem
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TheRateModel• Keyconcepts:
– Dopaminehasopposingeffectsonthedirectandindirectpathways
– Abla.onorinac.va.onofindirectpathwayneuronsleadstoincreasedorexcessivemovement
– Abla.onofindirectpathwayleadstodecreasedmovement
– Ac.va.onofindirectpathwayleadstodecreasedmovement
– Ac.va.onofdirectpathwayleadstoincreasedmovement– DecreasesinBGoutputcorrelateswithincreasedmovement
– IncreasesinBGoutputcorrelateswithdecreasedmovement
InconsistenciesoftheRateModel
• Lesioningors.mula.onoftheGpiistherapeu.cinbothhypokine.candhyperkine.cmovementdisorders
• Furtherstudieshaveshownthatdifferentgroupsofneuronswithinpar.cularnucleusmaybeac.vatedorsuppressedatthesame.meinordertoreleasedifferentmotorprograms
Neurotransmi9ers
• Neuromodulatoryprojec.onsystems:– Dopamine– Serotonin– Norepinephrine
• Classicalneurotransmi9ersystems:– Glutamate– GABA– acetylcholine
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Developmentalaspectsofmovement
• Developingsenseofself• Uprightposi.onneedspriorfaileda9emptsassociatedwithpain
• Thediscomfortresultsinself-pacedmovements
• Usingthecorrectcombina.ontotakethefirstsuccessfulstep
• Thiswillconsolidatelaterintoamorecomplexmotorpa9ern
Developmentalaspectsofmovement
• TheBGarekeyelementsinthecontrolofreward-basedlearning,sequencing,discreteelementsthatcons.tuteacompletemotoractandcogni.vefunc.on
• Connec.onsbetweenBGandcortexareorganizedintocircuits–loopsreciprocallyinterconnectalargeanddiversesetofcor.calareaswithBG– Neuronalac.vitywithinBGassociatedwithmotorcortexcorrelateswithmovement
– Neuronalac.vitywithintheBGandcerebellarloopsassociatedwiththeprefrontalcortexisrealtedtocogni.vefunc.on
Earlydevelopment• Needtounderstand:– Phylogeny(evolu.on)andontogeny(development)ofthemotorsystem
• Movementormo.onisessen.alforthedevelopmentofafunc.onalmusculoskeletalsysteminafetusorinfant
• Humanfetushas11separatemovementpa9ernsofincreasingcomplexityasgesta.onprogresses:– Twitching,independentlimb,isolatedheadmovement,combina.onmovements,quazi-startle,hand-facemovements,isolatedbodyextension,thumbsucking,breathing
Earlydevelopment
• Post-delivery:– remodelingoftheinnerva.onofagonist-antagonistmusclepairsoftheperipheralneuromuscularsystem
– Centrallydriventruncal,armandlegflexorandextensorposturalstages
• Newborn:Dystonic-ThalamicMan– Persistentflexedtrunkandlimbposturesasscoiatedwiththalamicandbrainstemac.vity
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Earlydevelopment
• 3-4months:ChoreiformMan(Riverdance)– Trunksymmetricallystraightposture,armsandlegshyperac.ve(physiologicalchorea)
• 6-8months:Kung-FuMan– Directedandtargetedswagngandkickingofarmsandlegs(prelocomotorequipoten.alphaseofallfourlimbs)–striataltoes
• 6-10months:Ballerina– Holdinglegsstraightplayingwiththefeet–dissipateswhenlegsarecommi9edtolocomotortask
Earlydevelopment
• 24months:maturegait– Firsthallmark:heel-strike– Secondhallmark:asynchronoushipflexion-knee-extension-ankledorsiflec.on
– Thirdhallmark:contralateralarmswing
Earlydevelopment
• Ini.alclumsy,goal-directedmotorbehavioursandmovementstransi.ontohabitualmovements(internalized,semi-automa.c)
• Ini.alco-contrac.onofmosttrunkandlimbmusclegroupsarerequired
• Willgraduallydevelopmorefluentandeconomicalmovementsreplacingco-contrac.onwithagracefulinterplayofagonist-antagonistmuscles
Developmentofpathology
• Lackofselec.vecontrolandsurroundinhibi.onproducesunwantedsynergies(CP)
• Lackofselec.vemotorcontrol,excessiveplas.city(dystonia)
• Knowledgeofdiversepathwaysandcircuitsadvantageouswhenassessingneonatalbraininjury
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JPLin,NNardocci,2016
Summary
• Understandingbasalgangliaanatomy,circuitry,neurotransmi9ers,developmentofmovementininfancy,helpsin:– diagnosisandtreatmentof
• developmentalmovementdisorders,suchasCP• primarygene.cmovementdisordersinchildren
References• www.neuroanatomy.wisc.edu/coursebook/motor2.pdf• ANelson,AKreitzer.Reassessingmodelsofbasalgangliafunc.onand
dysfunc.on.AnnuRevNeurosci.2014;37:117• LBrichta,PGreengard,MFlajolet.Advancesinthepharmacological
treatmentofParkinson’sdisease:targe.ngneurotransmi9ersystems.TrendsinNeurosci.2013:36;9
• GLeisman,OBraun-Benjamin,RMelillo.Cogni.ve-motorinterac.onsofthebasalgangliaindevelopment.FrontSystNeurosci.2014;8:16
• JPLin,NNardocci.Recognizingthecommonoriginsofdystoniaandthedevelopmentofhumanmovement:Amanifestoofunmetneedsinisolatedchildhooddystonias