Module 3, Year 1; Module 2, Year 3 - Dr. K Materials Flashcards
*On a CN III test, catch up siccades are controlled by what?
Cerebellum & Pons
*Describe the Prukinje system and function.
Purkinje fibers lie on top of the outer cerebellar covering. They send a “don’t do it” signal to inhibit the deep cerebellar nuclei.
90% of what the brain does is inhibit. The cerebellum has more neurons than the cerebrum.
*What does autophagy do to the brain?
Cleanses brain
Removes metabolic waste
Clears inflammation
*Duel tasking tests what part of the brain?
Frontal lobe
*Describe the D1 and D2 pathways. Which indicate basal ganglia breakdown?
D1 - makes movement, turns on brain, basal ganglia dysfunction is found here
D2 - Inhibits movement
*Caudate regulates _______ movement, and putamen regulates _________ movement.
Caudate… nonmotor
Putamen… motor movement
*Early detectors of Parkinson’s…
Unresolved constipation (Parkinson's start in the gut) Frozen shoulder without trauma Progressive micrography (due to D1 breakdown)
*The substantia nigra compacta is related to which of the following in early Parkinson’s?
D1 - Putamen
*Which cranial nerves feed into the ventral vagal system?
CN V, VII, IX, X
*BJ Palmer was the first to x-ray the spine, which he called a…
Spinography
*What is required for subluxation to manifest in the body?
Time, subluxation unchecked will lead to unwinding dysfunction
*What is the 5th element to subluxation added by BJ Palmer?
3-directional torque misalignment
The other four: misalignment, occlusion, pressure, and interference
*What is the medullary lock?
The innate mechanism that secures the medulla in the center of both the foramen magnum and upper cervical neural canal
*What dysfunction causes the medullary lock to lock?
Dural attachment to the foramen magnum
Dural attachment to posterior arch of C1 and C2
Connective tissue bridge between rectus capitis posterior minor and dura mater
CTB between RCPmaj and dura mater
Dural attachment to ligamentum flavum
CTB between obliquus capitis minor between C1 and C2
Dural attachments between nuchal ligament and dura mater
Vertebrodural ligament
To-be-named-ligament
*Hack’s thought on the RCPmaj.
“…the function of the muscle dural bridge may be to prevent folding on the dura mater during hyperextension of the neck.”
*Distinguish the myelinated from nonmyelinated regions of the vagus nerve.
Unmyelinated - dorsal part, regulated everything below the diaphragm, origin is the dorsal motor nucleus.
Myelinated - ventral part, regulates everything above diaphragm, origin is nucleus ambiguus, social engagement is controlled here (vital for health)
*Which cranial nerves feed into social engagement?
III, V, VII, IX, X, XII
*The ventral vagus system exerts modulatory control over what?
Sympathetic Nervous System
*As part of the polyvagal theory, a main contributor to SIDS is what?
Freeze response
*Dry mouth presentation would be more like a sympathetic or parasympathetic dysfunction?
Parasympathetic dysfunction
*What does the sympathetic system use for body circulation?
Norepinephrine
*Facial symmetry is regulated by what?
CN VII
*Tongue deviation is controlled by what?
CN XII - deviates towards weak side
*Corneal reflex is controlled by what?
CN V
*Which set of muscles have the most muscle spindles? Why?
The suboccipital muscles. The brain derives energy for development based on muscle spindle strength, which is why “tummy time” is so important
*Microglial cells are white blood cells in the brain. If activated, there are big problems in the brain. If aluminum aggravates microglial cells, causing overreaction, which polyvagal stage is affected?
Pruning
*Explain head tilt, eye movement, and the cerebellum.
Left head tilt indicates a weak right cerebellum; eyes will roll to stay balanced
68% of people see a head tilt away from the weak cerebellum
Summarize all the functions of the frontal lobe in a single sentence.
Movement influenced by the cerebellum and basal ganglia
Greatest natural stressor of the brain
Gravity
Inflammation in the brain is flushed out via what?
CSF and glymphatics
Potential choke point in the CSF.
CCJ
How would you describe a concussion as a structural aberrance?
Rotational injury
What up-regulates antioxidant activities in the brain cells after a concussion?
Glutathione
What white blood cell is up-regulated following a concussion?
Microglial cells
How is the frontal lobe affected following a concussion?
Its normal regulation of motivation, emotions, and social behaviors is taken over by the secondary limbic system
Backbone of the ANS
Brain-gut-axis
Three major systems driven by the autonomic nervous system
Immune system via cytokine messengers
Endocrine system via hormone messengers
Nervous system via neurotransmitters
Define health in relation to the ANS
The ability to heal yourself and adapt to your environment
What provides power to the brain?
Dopamine
What provides speed (processing) to the brain?
ACH
If ACH is low, what part of the brain is susceptible?
Hippocampus, low ACH can lead to dementia
What provides synchronicity in brain function?
Serotonin
What relaxes the brain?
GABA
What “turns on” the brain?
Glutamate
What is the primary imbalancer of the brain?
Inflammation
Describe the dorsal vagus system in the context of the polyvagal theory
First system to develop in utero, comes from the DMN, innervates everything under the diaphragm, tied with the Freeze Response
Describe the sympathetic nervous system in the context of the polyvagal theory
Develops around 16th week, movement system, modulates freeze response, system that is always in control
Describe the ventral vagus system in the context of the polyvagal theory
Myelinated, parasympathetic system, begins around third trimester, matures primarily between 6 months to 1 year (same time primary reflexes disappear), innervates everything above the diaphragm, Social Engagement System, modulates the sympathetic nervous system
Describe breathing and heart rate variability within the context of the polyvagal theory
Breathing in - INHIBITS ventral vagal system, increasing heart rate
Breathing out - ACTIVATES ventral vagal system (turning off sympathetic NS), decreasing heart rate
Good HRV requires a good VVS
Functions of the ventral vagus system (parasympathetic) on the GI tract
Blood supply (if low, can lead to leaky gut)
Motility
Enzyme support
How does the ventral vagus system affect arteries?
VVS keeps inhibits the sympathetic nervous system from releasing norepinephrine, which will constrict the arterial walls.
If the VVS is dysfunctional, this will lead to prolonged contraction of the arterial walls.
This nucleus gets information from the body that is sent to another nucleus to control the ventral vagus system. What is this pathway?
Nucleus tractus solitarious –> Nucleus Ambiguus
What is a better measure than blood pressure, but can still be obtained the same way? How is it clinically applied?
Pulse pressure = systolic pressure - diastolic pressure
40 is normal
>50 is bad (indicative of increased sympathetic nervous system activity, thus increased NE)
Used bilaterally can assess brain function; for example, if the right side is >50 and the left side is normal, the right brain/ANS is weaker. A secondary test that can be done is temperature differential from finger to wrist bilaterally, greater temperature side being the weaker brain/ANS side
Number one driver of heart attacks
Low parasympathetic tone
How does the ventral vagus nervous system control heart rate?
The right vagus nerve controls the SA node, and the left vagus nerve controls the AV node
What supplement would help balance a hyper-sympathetic person? What supplement could worsen it?
Magnesium (best taken topically, like epsom salts)
Calcium would up-regulate the sympathetic tone, making things worse.
Explain how orthostatic hypotension works?
Normally, blood pressure will increase when standing. Cortisol modulates blood sugar blood pressure and immune system. Seeing (via superior colliculus) or hearing (via inferior colliculus) danger will trigger the release of EP/NEP from the adrenal medulla and cortisol from the adrenal cortex. These constant fluctuations of blood sugar cause constant trigger to the sympathetic nervous system. If this occurs long term, the neural loop fatigues - less cortisol -, which leads to a decrease in blood pressure. <110/70 is considered hypotension - decreased oxygen to the brain - orthostatic hypotension.
How does a loss of sleep affect the body?
Ultradian rhythm, or fluctuations throughout the cortisol cycle that cause ups and downs in cortisol level (can cause a lot of crashes throughout the day)
This can be tested via adrenal-salivary index or Dutch Test
Factors that affect ANS function
Food sensitivities
Blood sugar
Chronic infections
What are some tricks to stimulate the vagus nerve?
Gargling for 15-20 seconds
Deep breathing exercises
Cold showers 2-3 days, facial emersion in cold water
Smack your lips, blowing lips, humming, coughing, valsalva
Describe what drives brain growth in a baby.
Experience - senses, vision, sound, touch
Gravity-proprioception activate the muscle spindles (highest density in the suboccipital muscles) which communicate that info to the cerebellum, which communicates with the thalamus, which sets the oscillation rate in the brain - right cerebellum sets left brain oscillation rate and vice versa.
T or F: 80% of neurons in your brain are experience dependent genes that activate the growth of neurons.
True
Describe rhomberg’s test and its implication.
Standing with your eyes closed observing a lean - the side leaned towards is the side of cerebellar weakness (vermis)
Briefly discuss the line of thought between vaccines and neuroinflammation.
If you have a primed microglial system exposed to aluminum in vaccine adjuncts, they could react and orbital frontal and hippocampus would experience increased regression/pruning. Pruning is especially common in children between 0-5 years old (around 10 pruning points) for neuron to grow longer and lateralize. If there is a problem or if pruning is prominent, vaccines can tip an adverse reaction - for example, autism.
How does the basal ganglia and cerebellum affect movement?
The basal ganglia turns movement on and off. The cerebellum smooths out the movement in between - conserving energy.
The pons and cerebellum arise from the same tissue
“What fires together, wires together.”
What are the three basic sections of the cerebellum and how they apply to development?
Middle controls eye movement and central balance (which is present at birth)
Intermediate - control shoulder and pelvic girdle movement, baby starts to crawl (7-8 months) and walk (12-13 months)
Lateral - control fingers and toes (role in speech, starts talking around 18 months, too much vocab early is no bueno)
What is the importance of voneconomo cells in development?
Voneconomo cells, or mirror neurons, mimic social cues, such as mom smiling so baby smiles - invoking happiness. If this is not seen at two months, autism should be suspect.
Which side of the brain develops first? What is the time frame for each?
The right side develops first, 2-3 years old, learning social cues.
The left side develops second, 3-6 years old, for language, questions (“why?”)
Name the three functional areas of the cerebellum.
Vestibular cerebellum (middle) - receives input from the vestibular system Spinocerebellum (intermediate and middle) - central balance, but not eye movement, receives input from the body Cerebrocerebellum (lateral) - receives input from the cortex
What are the four major nuclei that drive function?
Fastigual nucleus - in middle cerebellum, central movements and eye movements
Interpose nuclei (globose and ebolifrom) - intermediate cerebellum, spino cerebellar
Dentate nucleus - lateral cerebellum, communicates only with the cortex
What lobe of the cerebellum has no nuclei?
Flocculonodular lobe - contributes to eye movement control, but no nuclei, thus no purkinje system
Describe the purkinje system.
Inhibits the deep cerebellar nuclei, which are directly connect to the limbic system - if this fails, a person may experience anxiety, nausea, and upset stomach (brain-gut axis). This is similar to VVS and SNS.
Muscle fibers feed into the inferior olive via climbing fibers, which speak to the purkinje system, then thalamus, which sets oscillation rate (8-12Hz)
Which cells inhibit the purkinje fibers?
Basket cells
Stellate cells
What two fibers feed into the cerebellum?
Climbing fibers –> inferior olive –> purkinje fibers –> thalamus –> set oscillation rate
Moss fibers bringing all other environmental info
You see someone walk by with shoulders rolled forward and head in an anterior posture. What spinal tract could potentially be weak?
Vestibulospinal system, which is in charge of extension
Which spinal tract includes the red nucleus and rubrospinal tract?
Spinocerebellum system, which is in charge of flexion
Finger to nose test, while looking for end point tremor, and finger/thumb tapping, while looking for unsynchronized taps, are two tests for what tract?
Cerebrocerebellum
What would cause a tremor at end point or intention tremor?
Problem with cerebellum
What would cause a physiologic tremor?
Tremor at rest and with movement at 8-12 cycles/sec could be due to electrolyte imbalance, blood sugar, or ANS imbalance
What are some quick evaluations for assessing the cerebellum?
Look for big sweeping letter in writing
Elbow flexion and internal rotation of the arm is a sign of a weak cerebellum on that side
Heel to shine test
Ataxia
Describe how the brain builds from bottom up.
Posture –> vestibular system –> oculomotor system –> cortex
Once cortex is mature, it will exert top down influence/regulation.
Any kink in this chain runs the risk of trouble with cortical regulation
Describe smooth pursuits when testing CN III.
Controlled by side of cerebellum the eyes are moving away from.
Horizontal pursuits connect with a pons issue.
Vertical pursuits connect with a midbrain issue.
Diagonal pursuits connect with a cerebellar issue.
Describe saccades.
Jumping from one object to the next while your brain fills in the gaps.
Describe a catch up saccade.
Eyes have to catch up when performing a smooth pursuit, indicating weakness in the cerebellum on the side the eyes move AWAY from.
Describe a fast saccade.
When the eyes jump to the end, past following the smooth pursuit break, indicating a weakness in the cerebellum on the side the eyes are moving TOWARDS
Nystagmus associates with a problem in what system?
Vestibular system
How does Parkinson’s start in the gut?
A build-up of alpha synuclein travels up the vagus nerve into the brain, as evidence by reduced Parkinson’s in those with vagotomies
Digestive finding that would make one suspect of Parkinson’s?
Constipation that does not respond to natural products
Describe frontal lobe development.
Primary motor cortex (movement) –> supplemental cortex & premotor cortex (intentioned movements) –> dorsal lateral prefrontal cortex (planning and predicting movement)
What part of the brain mirrors frontal lobe growth?
Cerebellum
90% of the population have this area on the left frontal lobe, which coordinate the motor aspects of speech
Broca’s area
What are the five major networks that drive all human actions?
Supplementary Motor Area - motor movement
Dorsal lateral prefrontal cortex - executive function (planning, predicting)
Orbital frontal - social and emotional skills
Anterior cingulate - motivation
Frontal eye fields - eye movement
Concerning movement, how does the brain conserve energy?
The brain take information from the thinking part of the brain, the frontal lobe, and creates loops, or habits, in the basal ganglia.
Common symptoms of brain inflammation.
Depression
Fatigue when doing mental things
Brain fog
What is the impulse control part of our brain?
Orbital frontal lobe
What are the four big contributors to dementia?
Inflammation
Insulin resistance - when too high, causes body to be sympathetic dominant and autophagy will have to stimulant (increase brain inflammation)
Low hormones
Toxic burdens
What region of the brain controls circadian rhythm?
Hippocampus via HPA axis
What hippocamal nutrient is given before cortisol gets out of control?
Phosphatydal serine
Name the three divisions of the autonomic nervous system
Sympathetic - movement system; acts globally
Parasympathetic
What are the three layers of the ANS according to Steven Porges?
Dorsal vagal complex
Sympathetic nervous system
Ventral Vagal Complex
Describe the dorsal vagal complex.
Primitive ANS, unmyelinated, “Freeze Response”
Innervates viscera below the diaphragm
Originates from the dorsal motor nucleus in medulla
Begins development in the nervous system and matures around 4th month in utero
Describe the sympathetic nervous system, according to Porges
Movement system
Development begins around 16th week in utero and matures in the 3rd trimester; must be developed by birth
Originates at the rostral ventral lateral medulla
Modulates/breaks the dorsal vagal complex
Describe the ventral vagal complex.
Begins development in the 3rd trimester and matures around 6 months to a year in infants
Myelinated
Innervates everything above the diaphragm - does NOT have a direct effect on digestion
Originates at the nucleus ambiguus (medulla
Modulates/breaks the SNS; enriches behavioural and affective responses, i.e. Social Engagement System
Describe where and when most of the development of the social engagement system occurs?
Development predominately happens in the right hemisphere of the brain when the brain is first born; this allows the baby to mirror actions
What is the primary neurotransmitter of the sympathetic nervous system?
Norepinephrine
How does norepinephrine effect the cardiovascular system?
Constricts blood vessels, increasing blood pressure
Your CA takes a HRV on a practice member, 42 pts out of 100, not great. Sympathetics appear low on the graph, and the practice member appears to be breathing shallowly. What system is likely compromised?
Overactive dorsal vagal complex
Describe the clinical application of the Gut-Brain axis
60%-80% of the functioning immune system is in the gut, the second brain that acts independently from the ANS.
Inflammation in the gut can travel via the vagus nerve and influence brain development and function.
What does an under-active parasympathetic nervous system look like?
Dry mouth
Difficulty swallowing (esp. larger items)
Slow bowel movements/constipation
Bowel or bladder incontinence
What does an overactive sympathetic nervous system look like?
Anxiety Easily startled Difficulty relaxing Sensitivity to bright/flashing lights Episodes of racing heart Difficulty sleeping
What does a weakened sympathetic nervous system look like?
Passing out Low blood pressure and pulse rate Low blood sugar Fatigue Low libido Weight gain Frequent colds/sinusitis
Your CA takes a HRV on a practice member, 50 pts out of 100, not great. Practice member seems to be holding breath a lot and appears anxious. What system is likely compromised?
Ventral vagal complex
__________ inhibits the dorsal vagal system.
Sympathetic nervous system
What is the state of the brainstem and brain cortex at birth?
The brainstem is fully formed at birth, and the cortex is only about 25% formed - by age 3, it will be 90% formed.
A practice member has a larger pupil on their right side. You perform a pupillary reflex, but it doesn’t seem to change. What nerve are you trying to test? What is a reasonable clinical conclusion?
CN III
The sympathetic nervous system is overactive, thus the ventral vagal system is weak, particularly on the right side of the brain (right large pupil)
Practice member shows a temperature differential of 3 degrees F lower on the left wrist and fingers. Capillary refill takes about 5 seconds, and you also notice white spots on the left finger nails. Clinically, what is going on?
An overactive sympathetic nervous system, due to a weak ventral vagal system, is bringing blood flow to larger muscles and organs
Orthostatic hypotension is a sign of dysfunction in what system?
Under-active sympathetic nervous system, thus increased activity in the dorsal vagus complex
Practice member has a pulse pressure of 58. What would be contributing to this?
Overactive sympathetic nervous system
Pulse pressure is determined by 1. Stroke volume and 2. Stiffness of the aorta and larger vessels
Which cranial nerves play a role in the social engagement system? Are they all connected to the ventral vagal system?
CN 3, 5, 7, 9, 10, 11, 12 play a role in the social engagement system.
CN 3 is not a part of the ventral vagal system, but the others listed are.
Where are each of the cranial nerves located?
CN 1 & 2 are at the high midbrain. CN 3 & 4 are on the midbrain as well.
CN 5, 6, 7, 8 are located on the pons.
CN 9, 10, 11, 12 are located on the medulla.
Cranial nerve responsible for smell.
CN 1
Using a Snellen chart or performing a fundoscopic exam would be testing which cranial nerve?
CN 2
Pupillary light reflex tests which cranial nerve?
CN 2 & 3
Having your practice member move their eye down and inward is testing which cranial nerve?
CN 4
Having your practice member move their eye laterally is testing which cranial nerve?
CN 6
What is being tested with the corneal reflex?
Sensory, CN 5
Blinking (motor), CN 7
The jaw jerk reflex tests what cranial nerve?
CN 5
When performing the light touch test on the jaw, what clinically should be considered?
Do not test V3 too laterally as the mandible is also innervated by the great auricular nerve (CN 2 & 3) in its lateral aspect
What tests are available for analyzing CN VII?
Facial expression while looking for asymmetry
Taste test for the anterior 2/3rds of the tongue
Visceral gland palpation minus the parotid (CN IX)
What are some ways to test CN VIII?
Rinne/Weber test
Anterior, posterior, horizontal semicircular canals by head position
What are some ways to test CN IX & X?
Gag response Uvula deviation (CN X) Palatal articulation (KA) and Guttural articulation (GO) evaluation?
How would you test CN XI?
Shrug shoulders and turn head - tests upper traps and SCMs
A practice member sticks out their tongue and it swings noticeably to the left. What clinically does this suggest?
Lesion to the left CN XII
Describe the players when it comes to physical movement.
The prefrontal cortex initiates the though of movement and sends the signal to the basal ganglia and the cerebellum.
The basal ganglia turns on the movement via the thalamus. The cerebellum refines and coordinates the movement. These signals communicate back and forth in a loop 8-10 times with the motor cortex/frontal lobe before the execution of a movement.
Describe how cerebellar growth happens and what other parts of the brain it affects.
Cerebellar growth happens primarily with muscular movement (and proprioception), especially by midline structures, the postural muscles. The lateral most part of the cerebellum has a direct connection to the brain’s frontal lobe function - if the cerebellum builds, the brain builds.
What is KISS syndrome? When might you see this condition? Why is addressing this critical for infants?
KISS = kinematic imbalances due to suboccipital strain
Birth trauma is the primary suspect.
Suboccipital imbalance affects postural muscle development, thus it will have adverse affects on the cerebellum and brain.
Common symptoms: torticollis, unilateral facial symmetry, cervical scoliosis, motor asymmetries, unilateral retarded maturation of hip joints, slowed motor development
A practice member with a history of alcohol abuse is having a hard time responding to simple movement tests. What region of the cerebellum may have a problem? How does it tie into the brain?
Fronto-cerebellar dissociation - the left frontal lobe selects stimulus and right cerebellum searches for a given response to a stimulus. An inability to respond would suggest a dissociation.
What are the three lobes of the cerebellum? What nuclei do they hold?
Anterior - houses fastigual and interpose nuclei
Posterior - houses the dentate nucleus
Flocculonodular - houses the vestibular nucleus
Describe the anterior lobe of the cerebellum.
Sits more medial to the cerebellum. Responsible for mediating unconscious proprioception from input coming primarily from the spinal cord.
Describe the posterior lobe of the cerebellum.
More lateral part of the cerebellum. Coordinates fine motor movement with input primarily coming from the brainstem, particularly the inferior olivary nucleus and RF) and cerebral cortex
Describe the flocculonodular lobe of the cerebellum.
Involved with vestibulo-ocular reflex and postural control
What governs the activity of the cerebellum?
Purkinje system by inhibiting the deep nuclei of the cerebellum
What activates the Purkinje system?
Climbing fibers bringing info from the inferior olivary nucleus
What activates the deep nuclei of the cerebellum?
Mossy fibers
What element are Purkinje fibers sensitive to? What happens when this changes?
Decrease in oxygenation leads to decrease in cerebellar function, which is tied into somatosensory, respiratory, and autonomic function. Studies suggest SIDS is tied into decrease in Purkinje system activity.
Describe the best ways to manage cerebellar health.
Core strength (esp. postural muscles)
Balance exercises
Metabolic factors - Purkinje system is highly susceptible to oxidative stress, blood sugar dysregulation, and anemia (the most common causes being iron deficiency, B12 deficiency, folate deficiency, hypothyroid [Hashimoto’s, chronic inflammation], and gluten sensitivity [gluten ataxia]. Other nutritional deficiencies include vitamin E and thiamine (esp. due to alcohol degenerating anterior cerebellar lobe). Medications, such as anticonvulsants, antineoplastic, lithium salts, and amiodarones and other toxic elements can affect metabolic health.
What determines activation of the D1 or D2 pathway?
The basal ganglia communicates with the frontal lobe via the thalamus, either activating it (D1/direct pathway) or inhibiting it (D2/indirect pathway)
What activates the ventral vagal complex?
Frontal lobe of the brain
Where does the ventral vagal system originate?
Nucleus ambiguus (on the medulla, but pons and medulla drive activity)
What drives/activates the sympathetic nervous system?
Midbrain
What are the three main functional areas of the frontal lobe?
Prefrontal - executive function, personality, motivation, social abilities
Motor - supplemental, premotor, and motor cortices
Broca’s - motor for speech
Neurodegeneration is the loss of neurons or connectivity in specific or generalized areas of the brain. Why does this happen or what is neurodegenerative disease?
Build-up of tau proteins, amyloid beta plaques, alpha-synuclein lewy bodies lead to these progressive degenerative changes in the brain. This build-up occurs if there is insufficient autophagy, glymphatic system, cleaning the brain.
Names some things that can affect autophagy in the brain.
Sleep is when most autophagy occurs - get sleep.
High intensity exercise activating fast twitch and super-fast twitch muscle fibers show the most benefit in brain activation.
Gut inflammation affects the brain by activating more microglia cells, which increase risk of neurodegeneration
Most common food sensitivities that may cause gut inflammation.
Gluten Dairy Corn Eggs Soy
Most common symptoms associated with an inflamed brain
Fatigue
Depression
Brain fog
Describe the D1 pathway
Caudate/Putamen –> Globus Pallidus INTERNAL segment –> Thalamus –> Cerebral Cortex –> Movement turned ON
What are symptoms of a dysfunctional D1 pathway?
Hypokinesia - stiff muscles at rest, masked faces, history of frozen shoulder, constipation, micrographia, loss of smell
Describe the D2 pathway
Caudate/putamen –> globus pallidus EXTERNAL segment –> Subthalamic nucleus –> globus pallidus internal segment –> thalamus –> cerebral cortex –> turns movement OFF
Symptoms associated dysfunctional D2 pathway?
Hyperkinesia - unconrolled muscle movement, OCD tendencies, constant nervousness/restless mind, dystonia
Caudate controls…
Learning and memory
Putamen controls…
Regulates movement and influences learning
Globus pallidus controls…
Regulation of voluntary movement
Subthalamic nucleus controls…
Inhibition and movement control
Nucleus accumbens controls…
Reward circuit
Ventral pallidum controls…
Reward, motivation
SN? controls…
DA and GABA production
