Nsp Week 4: Basal Ganglia Control Of Movement (Blair)

Front 1

List the anatomic "dorsal" basal ganglia

Back 1

1. Caudate nucleus
2. Globus pallidus
3. Putamen

Front 2

Which basal ganglia make up the "neostriatum"?

Back 2

Caudate and putamen

Front 3

Which basal ganglia make up the lenticular nucleus?

Back 3

Globus pallidus + putamen

Front 4

Other than the dorsal basal ganglia, which structures are considered to be part of the dorsal basal ganglia "system"?

Back 4

1. Subthalamic nucleus
2. Motor parts of the thalamus
3. Substantia nigra
4. Pedunculopontine nucleus
5. Superior colliculus

Front 5

Which 3 structures make up the "ventral" basal ganglia?

Back 5

1. Nucleus accumbens
2. Olfactory tubercle (ventral striatum; anterior perforated substance)
3. Substantia innomina (ventral pallidum

Front 6

Which artery supplies the putamen, globus pallidus, and internal capsule?

Back 6

Lenticulostriate branches of M1 segment of Middle cerebral A

Front 7

Which artery mainly supplies the caudate nucleus?

Back 7

Medial striate artery

Front 8

Which artery supplies the basal ganglai and the telencephalon?

Back 8

Anterior choroidal A

Front 9

Which arteries supply thalamic and mesencephalic regions of basal ganglia?

Back 9

1. Thalamoperforating arteries
2. Thalamogeniculate arteries
3. Posterior choroidal

Front 10

There are 4 parallel circuits through the basal ganglia, where do each of these circuits begin?

Back 10

1. Sensorimotor cortex
2. Prefrontal cortex
3. Oculomotor cortex
4. Limbic regions

Front 11

Describe the parallel circuit through the basal ganglia beginning in the Sensorimotor cortex

Back 11

1. Sensorimotor cortex
2. Putamen
3. Posterior regions of globus pallidus
4. Ventral lateral thalamic nuclei

Front 12

Describe the parallel circuit through the basal ganglia beginning in the prefrontal cortex

Back 12

1. Prefrontal cortex
2. Anterior portion of caudate
3. Lateral dorsomedial region of globus pallidus
4. Ventral anterior thalamic nuclei

Front 13

Describe the parallel circuit through the basal ganglia beginning in the frontal eye field

Back 13

1. Frontal eye field
2. Body of caudate
3. Caudal dorsomedial region of globus pallidus
4. Dorsomedial and ventral anterior thalamic nuclei

Front 14

Describe the parallel circuit through the basal ganglia beginning with limbic regions

Back 14

1. Limbic regions of cerebral cortex
2. ventral striatum
3. ventral pallidum
4. dorsomedial nucleus

Front 15

List 5 functions of the basal ganglia.

Back 15

1. Facilitation of desired movements, and suppression of opposing movements
2. Initiation and cessation of movements
3. Sequencing
4. Scaling
5. Adjust motor set (or posture)

*Only have indirect affect on movements

Front 16

The globus pallidus is divided into which 2 regions?

Back 16

1. External (lateral)
2. Internal (medial)

Front 17

Which structure provides the major output of the basal ganglia circuit?

Back 17

Internal (medial) division of globus pallidus

Front 18

What are the two major components of the substantia nigra?

Back 18

1. Pars compacta
2. Pars reticulata

Front 19

Which neurons of the pedunculopontine nucleus are the primary ones that interconnect with the basal ganglia?

Back 19

Glutamatergic neurons

(PPn also contains high concentration of cholinergic neurons)

Front 20

The superior colliculus receives input from which nucleus?
What kind of movements does it influence?

Back 20

Reticulated substantia nigra

*Eye movements
(saccadic movements to contralateral side)

Front 21

Which structures of the basal ganglia produce inhibition of the thalamocortical output, and which produce disinhibition?

Back 21

Globus pallidus --> inhibition
Neostriatum --> disinhibition (of globus pallidus)

Front 22

What is the function of the direct pathway?

Back 22

Disinhibits thalamus, thereby increasing thalamocortical activity.
Thalamocortical neurons (glutamate) EXCITE cortical neurons

Front 23

What is the function of the indirect pathway?

Back 23

Excites pallidothalamic neurons, which inhibit thalamus, thereby decreasing thalamocortical activity

Front 24

What is the consequence of the action of the striatopallidal fibers on the pallidothalamic and pallidosubthalamic neurons?

Back 24

Striatopallidal fibers are inhibitory neurons (GABA)
*Inhibition of PALLIDOTHALAMIC neurons --> DISINHIBITION of thalamocortical neurons

*Inhibition of PALLIDOSUBTHALAMIC neurons --> Excitation of Pallidothalamic fibers--> INHIBITION of thalamocortical neurons

Front 25

Describe the influence of the substantia nigra on the striatopallidal neurons in the direct and indirect pathways.

*What is the net effect of these two actions?

Back 25

Dopamine is released from the nigrostriatal pathways, which has 2 different effects:

1. EXCITES striatopallidal neurons projecting to the MEDIAL globus pallidus in the DIRECT pathway

2. INHIBITS striatopallidal neurons projecting to the LATERAL globus pallidus in the INDIRECT PATHWAY

*Movement is ENHANCED

Front 26

What is the activity of the nigrostriatal pathway dependent on?

Back 26

The behavior context of the movement
*The activity is enhanced when the movement is behaviorally important (goal-directed movements)

Front 27

What is the term used to describe problems with initiation of movements?

Back 27

Akinesia

Front 28

Reduction in speed and amplitude of movements is called..?

Back 28

Bradykinesia

Front 29

What is the general cause of Parkinson disease?

Back 29

Loss of dopaminergic neurons in the nigrostriatal pathway

Front 30

List 3 signs/symptoms associated with Parkinson disease

Back 30

1. Akinesia, bradykinesia
2. Resting tremor
3. Plastic, or lead-pipe rigidity; cogwheel rigidity

Front 31

What is the ultimate result of damage to the nigrostriatal pathway in Parkinson disease?

Back 31

Reduced thalamocortical activity

Front 32

What is the general MOA of all of the treatments for Parkinson disease?

Back 32

Increase dopamine levels in the striatum

Front 33

What can dopamine not be give to treat Parkinson disease?

What medication is given instead?

Back 33

It is rapidly metabolized and does not cross the blood brain barrier

Levodopa (L-DOPA)-- precursor to dopamine. Rapdily absorbed from the GI and can cross the blood-brain barrier, where it is metabolized to dopamine

Front 34

L-DOPA is commonly given with which other medication? Why?

Back 34

Carbidopa
*This is an inhibitor of dopa-decarboxylase, so it increases the availability of dopa to the brain

Front 35

What is the combination of L-DOPA and Carbidopa called?

Back 35

Sinemet

Front 36

What is the most common type of dyskinesia that occurs as a result of long-term use of L-DOPA?

Back 36

Choreothetosis of the face and extremities

Front 37

List 6 adverse side effects of L-DOPA.

Back 37

1. *Cardiovascular effects (tachycardia, ventricular extrasystoles, and atrial fibrillations)
2. *Dyskinesias (choreoathetosis of face/extremities)
3. *On-off phenomenon
4. Anorexia, nausea, vomiting
5. Mood changes
6. Mydriasis --> glaucoma

Front 38

L-DOPA is contraindicated in which patients?

Back 38

1. Psychotic patients
2. Closed-angle glaucoma

Front 39

What is the MOA of Bromocriptine?

Back 39

(D2 receptor agonist)

*Inhibits activity in the indirect pathway, making it more likely that the already reduced activity in the direct pathway is high enough to elicit movement

Front 40

List 3 dopamine-agonists used for the treatment of Parkinson disease

Back 40

1. Bromocriptine
2. Pramipexole
3. Ropinirole

Front 41

What are the adverse effects of selegiline and rasagiline?

Back 41

Similar to L-DOPA if dopamine levels are too high

Front 42

Dopamine agonists are contraindicated in which patients?

Back 42

1. Psychosis
2. Recent MI
3. Active peptic ulcer

Front 43

Which type of MAO metabolizes only dopamine?

Back 43

MAO-B

Front 44

List 2 monoamine oxidase inhibitors?

Back 44

1. Selegiline
2. Rasagiline

Front 45

What is pramipexole?

Back 45

D3-agonist

Front 46

What is ropinirole?

Back 46

D2-agonist

Front 47

What is bromocriptine?

Back 47

D2-agonist

Front 48

What is selegiline?

Back 48

MAO inhibitor

Front 49

What is rasagiline?

Back 49

MAO inhibitor

Front 50

Selegiline and rasagiline are contraindicated in what patients?

Back 50

Those taking mepiridine

Front 51

What is the MOA of Selegiline and rasagiline?

Back 51

Block MAO-B to increase the level of dopamine

Front 52

List 2 COMT inhibitors

Back 52

1. Tolcapone
2. Entacapone

Front 53

What is the MOA of tolcapone and entacapone?

Back 53

Enhance the level of L-DOPA by inhibiting COMT

Front 54

A combination of L-DOPA, carbidopa, and entacapone is known as...?

Back 54

Stalevo

Front 55

What are the adverse effects of the COMT inhibitiors?

Back 55

(tolcapone and entacapone)

1. Effects similar to L-DOPA
2. Liver failure

Front 56

Which drug is a dopamine agonist and is used for the temporary relief of the off phenomenon?

Back 56

Apomorphine

Front 57

What is the major adverse effect of apomorphine?

Back 57

Nausea

Front 58

Which antiviral drug has a beneficial effect in Parkinson disease?

Back 58

Amantadine

Front 59

What symptoms are the antimuscarinic drugs useful for treating?

Back 59

Tremor and rigidity
(not very useful for bradykinesia)

Front 60

List 2 antimuscarinic drugs used for treating Parkinson disease

Back 60

1. Benztropine
2. Biperiden

Front 61

List 4 examples of hyperkinetic movements

Back 61

1. Chorea
2. Athetosis
3. Ballism
4. Tics

Front 62

Rapid, jerky, alternating movements superimposed on a hypotonic background of motor activity is known as?

Back 62

Chorea

*Hyperkinetic movement

Front 63

Slow writhing, ceaseless movements that usually involves the hands is know as?

Back 63

Athetosis

*Hyperkinetic movement

Front 64

Sudden violent flinging motions of limbs is known as..?

Back 64

Ballism

*Hyperkinetic movement

Front 65

Rapid, stereotyped, coordinated, repetitive movements are known as..?

Back 65

Tics

*Hyperkinetic movement

Front 66

What is the general pathology of Huntington disease?

Back 66

Loss of medium spiny output neurons of the striatum
(those projecting to the globus pallidus and substantia nigra)

Front 67

Describe the characteristic MRI sightings associated with Huntington disease

Back 67

Loss of mass in the caudate nucleus, with a resultant increase in size of the lateral ventricle

Front 68

List 3 characteristics of Huntington disease

Back 68

1. Chorea
2. Dementia
3. Inherited (AD), adult onset

Front 69

What is the ultimate result of Huntington disease on thalamocortical neurons?

Back 69

ENHANCED thalamocortical activity

*Loss of striatopallidal neurons projecting to the LATERAL globus pallidus (indirect pathway) --> loss of inhibition of pallidosubthalamic neurons --> ---> excitation of thalamocortical neurons