Clinical Notes for Basal Ganglia
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| Where is activity of the BG initiated? | Cortical Levels
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| Nigral input to striatum provides what, & why? | Continuous damping effect, so that cortical commands will be focused
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| Striatum integres & feeds info where? This influences activity of what? | Globus Pallidus & SN-Pars Reticulata; Influences thalamus & other targets (superior colliculus, RF)
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| Thalamus projects where? | Appropriate cerebral cortex loci
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| BG responsible for? | Automatic execution of a learned motor plan
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| Damage to BG results in? | Slower, less automatic & less accurate cortical mechanisms for motor behavior
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| During preparation & execution of mvmt, separate neurons within motor loop discharge selectively in relation to what? | Target location in space; Direction of limb mvmt; Mm pattern
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| In oculomotor loop, neurons discharge in relation to? | Visual fixation; Saccadic eye mvmt; Passive visual stimuli
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| Getting Hypothesis | In normals, dopamine (inhibitory) & cortical sensorimotor (excitatory) inputs to striatum are in balance
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| What do cerebellum & BG have in common? | BG= context encoders, info useful in planning & gating of action sent to cerebral cortex; Cerebellum = pattern generator/executor; Both work seamlessly with cerebrum to provide "perfect" automatic mvmt
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| Cerebral cortex does what? | Acts as a repository to receive diverse info via ascending tracts, compute it & share it with BG & cerebellum
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| More cerebral cortex function | Acts in executive fxn to implement action emanating from its collective computation processes for output via the SC
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| Are lesions of the BG & cerebellum UMN? | NO
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| Pre-frontal Loop deals with? | Spatial memory; Different from memory mediated by hippocampus & diencephalon; Appropriate switches in behavior
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| Limbic System | Emotional & Motivational processes
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| Diseases of BG characterized by? | Abnormal involuntary mvmts at rest; Disappear in sleep (non-intention tremor)
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| BG dysfunction can be either ___ or ___? | Hypo- or Hyperkinetic
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| Most common mvmt disorder of the BG? | Dystonia
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| Most common behavioral disturbance of BG? | Abulia
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| What is abulia? | Apathy, loss of initiative, & of spontaneous thought & emotional response
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| Hyperkinetic Disorders | Chorea (Huntington's, Sydenham's); Athetosis; Ballism; Dystonia; Akathasia; Tourette's
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| Chorea | Sudden, Frequent, involuntary, purposeless & quick jerks of trunk, extremities & head associated with facial grimaces
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| Huntington's Disease | Hereditary; Choreiform mvmts beginning @ extremities/face that progress to more mm; Mental deficiency (progressive deterioration); Combination of hyperhypokinetic (pt becomes immobile & unable to speak/swallow)
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| Sydenham's Disease | Childhood; Rapid, irregular, involuntary mvmts of limbs, face, trunk; Associated with rheumatic fever (pretty rare now); Transient results with full recovery
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| Athetosis | slow, writhing, sinuous, continuous, wormlike mvmts of distal parts of extremities which show bizarre posturing; can have choreoathetosis
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| Ballism (Hemiballism) | Vascular lesion, sub-thalamic nucleus (indirect motor loop); Mvmts of limbs, sudden, quick, continuous, unusually violent & flinging (contralateral to lesion usually); Proximal extremity mm usu involved (exaggerated chorea)
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| Dystonia | twisting, slow, contorting, involuntary mvmt that is somewhat sustained & often repetitive; fixed abnormal posture develops in affected part; Focal, segmental, generalized; sometimes discrete lesion can be found
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| Akathasia | Inability to be still, constant motion of limbs; Common SE of many neuroleptic drugs
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| Tourette's | Motor tics (sudden, brief involuntary mvmt preceded by urge to perform, followed by sense of relief; eye blinking/shoulder shrugging); vocal tics; ADD/compulsive behaviors; condition of late childhood, can be outgrown; counseling is important!
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| Hypokinetic Disorders | Parkinson's
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| What are the 3 classic s/sx of Parkinson's? | Tremor, Rigidity, Bradykinesia
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| Parkinsonian Tremor | non-intentional
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| Parkinsonian Rigidity- Plastic | if pt doesn't also have tremor, mvmt to passive resistance is continuous throughout PROM
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| Parkinsonian Rigidity- Cogwheel | if pt also has tremor, mm resistance can be overcome by a series of jerks (like a ratchet)
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| Parkinsonian Bradykinesia | Diminution/loss of assoc mvmts, difficult to initiate mvmt, slow mvmt; Masked face; Slurred & monotonous speech
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| Postural disturbances in Parkinsonism | Festinating gait; Kyphotic posture
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| Is there loss of power of sensation with Parkinson's? | No, should test normal but be aware that patient may be de-conditioned due to sedentary lifestyle
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| What is the most consistent pathology in Parkinson's? | Loss of dopamine; Leads to poverty of mvmt & difficulty in switching to new behaviors
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| What may be used to treat Parkinson's? | Drugs, sometimes surgery
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| Can Parkinson's be cured? | No, only treated. It is ceaselessly progressive, eventually bilateral (even when medicated)
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| Is Parkinson's strictly hypokinetic? | No, inclues both types of motor disturbances (hyper [tremor, too much motion] or hypo [bradykinesia])
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