won taek lee, m.d., ph.d. basalgangliabasalganglia

42
Won Taek Lee, Won Taek Lee, M.D., Ph.D. M.D., Ph.D. Basal Basal Ganglia Ganglia

Upload: eustace-perkins

Post on 31-Dec-2015

231 views

Category:

Documents


2 download

TRANSCRIPT

Won Taek Lee,Won Taek Lee, M.D., Ph.D. M.D., Ph.D.

Basal Basal Ganglia Ganglia Basal Basal

Ganglia Ganglia

Traditional Concepts of Traditional Concepts of Basal GangliaBasal Ganglia

Corpus StriatumCorpus Striatum

Caudate NucleusCaudate Nucleus

Lenticular Nucleus PutamenLenticular Nucleus Putamen

Globus Pallidus Globus Pallidus PaleostriatumPaleostriatum Pallidum Pallidum

Corpus Amygdaloideum Corpus Amygdaloideum ArchistriatumArchistriatum

NeostriatumNeostriatum Striatum Striatum

Basal Ganglia Introduction Basal Ganglia Introduction Basal Ganglia Introduction Basal Ganglia Introduction

1. Putamen1. Putamen2. Tail of caudate nu2. Tail of caudate nu

cleuscleus3. Caudatolenticular 3. Caudatolenticular

gray bridgegray bridge4. Amygdaloid body4. Amygdaloid body5. thalamus5. thalamus

Lateral surface Lateral surface of basal gangliaof basal ganglia

1. head of 1. head of caudate nuceluscaudate nucelus

2. body of 2. body of caudate nuceluscaudate nucelus

3. caudatolenticular 3. caudatolenticular gray bridgegray bridge

4. putamen4. putamen

5. tail of 5. tail of caudate nucleus caudate nucleus

6. external segment of 6. external segment of globus pallidus globus pallidus

7. internal segment of 7. internal segment of globus pallidusglobus pallidus

8. amygdaloid body8. amygdaloid body

9. nucleus accumbens 9. nucleus accumbens septisepti

Medial surface of basal gangliaMedial surface of basal ganglia

Components of Components of Basal GangliaBasal Ganglia

Corpus StriatumCorpus Striatum

Striatum ----- Caudate Nucleus & PutamenStriatum ----- Caudate Nucleus & Putamen

Pallidum ----- Globus Pallidus (GP)Pallidum ----- Globus Pallidus (GP)

Substantia NigraSubstantia Nigra

Pars Compacta (SNc)Pars Compacta (SNc)

Pars Reticulata (SNr)Pars Reticulata (SNr)

Subthalamic Nucleus (STN)Subthalamic Nucleus (STN)

Ventral Striatum and Ventral PallidumVentral Striatum and Ventral Pallidum

Nucleus Accumbens SeptiNucleus Accumbens Septi

Non cholinergic portion of Substantia InnominataNon cholinergic portion of Substantia Innominata

Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components

STRIATUMSTRIATUM

Caudate NucleusCaudate Nucleus Head, (Corpus), TailHead, (Corpus), Tail

caudatolenticular gray bridgecaudatolenticular gray bridge

PutamenPutamen

Ventral StriatumVentral Striatum: : Nucleus Accumbens (Septi)Nucleus Accumbens (Septi)

Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components

Striatal CompartmentsStriatal Compartments (Mosaic or Modular Organization)(Mosaic or Modular Organization)

1. 1. Striosome (Patches)Striosome (Patches)

- 10-20% of total striatal mass- 10-20% of total striatal mass

- low acetylcholinesterase (AchE) activity- low acetylcholinesterase (AchE) activity

- high substance P (SP), neurotensin (NT), tyrosine hydroxylase- high substance P (SP), neurotensin (NT), tyrosine hydroxylase

- high expression of D- high expression of D11 dopamine receptor dopamine receptor

- high opiate receptor- high opiate receptor

2. 2. MatrixMatrix

- high acetylcholinesterase (AchE) activity- high acetylcholinesterase (AchE) activity

- high somatostatin (SRIF) activity- high somatostatin (SRIF) activity

- high D- high D22 dopamine receptor dopamine receptor

Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components

Spiny I Spiny I neuronneuron

Spiny II Spiny II neuronneuron

Aspiny I Aspiny I neuronneuron

Aspiny II Aspiny II neuronneuron

Aspiny III Aspiny III neuronneuron

Neurogliform Neurogliform cellcell

Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components

Striosome and Striosome and Matrix compartmentMatrix compartment

AchE

Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components

Inputs to the Inputs to the spiny striatal neuronsspiny striatal neurons

distal – extrinsicdistal – extrinsic proximal - intrinsicproximal - intrinsic

PALLIDUMPALLIDUM

Globus Pallidus (Pallidum)Globus Pallidus (Pallidum)

Internal or Medial Segment (GPi)Internal or Medial Segment (GPi) internal medullary laminainternal medullary lamina

External or Lateral Segment (GPe)External or Lateral Segment (GPe)

Ventral PallidumVentral Pallidum

Non-cholinergic portions Non-cholinergic portions

of of substantia innominatasubstantia innominata

Basal Ganglia ComponentsBasal Ganglia ComponentsBasal Ganglia ComponentsBasal Ganglia Components

Substantia NigraSubstantia Nigra

Pars Compacta (SNc)Pars Compacta (SNc)

Dopaminergic Cell Group (ADopaminergic Cell Group (A99))

cf. Ventral Tegmental Area (VTA, Acf. Ventral Tegmental Area (VTA, A1010))

Retrorubral Area (ARetrorubral Area (A88) )

Pars Reticulata (SNr)Pars Reticulata (SNr)

Non-dopaminergic Portion Non-dopaminergic Portion

GABAergic NeuronGABAergic Neuron

Basal Ganglia ComponentsBasal Ganglia ComponentsBasal Ganglia ComponentsBasal Ganglia Components

Subthalamus Subthalamus

Subthalamic Nucleus (STN)Subthalamic Nucleus (STN)zona incertazona incerta

Field of ForelField of Forel H H ansa lenticularisansa lenticularis

H1H1 thalamic fasciculusthalamic fasciculus

H2H2 lenticular fasciculuslenticular fasciculus

Basal Ganglia ComponentsBasal Ganglia ComponentsBasal Ganglia ComponentsBasal Ganglia Components

PutamenPutamenGlobus pallidusGlobus pallidus external segmentexternal segment internal segmentinternal segmentSubthalamic NucleusSubthalamic NucleusSubstantia nigraSubstantia nigra

Internal capsuleInternal capsule

Components ofComponents ofBasal GangliaBasal Ganglia

Basal Ganglia ComponentsBasal Ganglia ComponentsBasal Ganglia ComponentsBasal Ganglia Components

Subthalamic NucleusSubthalamic Nucleus

1. epithalamus2. dorsal thalamus3. subthalamus 3-1. subthalamic nucleus 3-2. zona incerta 3-3. globus pallidus4. hypothalamus5. putamen

arrow: internal capsule

Origin of subthalamic nucleus and putamen (Kuhlenbeck)

Input Portion Input Portion

STRIATUM STRIATUM

(Caudate Nucleus and Putamen)(Caudate Nucleus and Putamen)

Output PortionOutput Portion

1. 1. PALLIDUM PALLIDUM (Globus Pallidus)(Globus Pallidus)

2. 2. SNr SNr (Substantia Nigra, Pars Reticulata)(Substantia Nigra, Pars Reticulata)

Basal Ganglia ConnectionsBasal Ganglia Connections

STRIATUMSTRIATUM

AfferentsAfferents from from 1. 1. Cerebral Cortex Cerebral Cortex [Corticostriatal Projection][Corticostriatal Projection] 2. 2. ThalamusThalamus (CM-PF complex) [Thalamostriatal Projection] (CM-PF complex) [Thalamostriatal Projection] 3. 3. SNcSNc (Substantia Nigra, pars compacta), (Substantia Nigra, pars compacta), Ventral Tegmental Area (VTA, AVentral Tegmental Area (VTA, A1010) )

and Aand A88(Retrorubral Area) [Nigrostriatal Projection](Retrorubral Area) [Nigrostriatal Projection]

4. Dorsal Raphe Nucleus (B4. Dorsal Raphe Nucleus (B66, B, B88) [Raphestriatal Projection]) [Raphestriatal Projection]

5. Amygdaloid Nuclear Complex [Amygdalostriatal Projection]5. Amygdaloid Nuclear Complex [Amygdalostriatal Projection]

EfferentsEfferents to to 1. 1. Pallidum (GPi & GPe) Pallidum (GPi & GPe) [Striopallidal Projection][Striopallidal Projection] 2. 2. SNrSNr [Strionigral Projection] [Strionigral Projection] 3. 3. SNcSNc from from striosomestriosome

Basal Ganglia ConnectionsBasal Ganglia Connections

Afferent Connections of Basal GangliaAfferent Connections of Basal Ganglia

Input-OutputInput-OutputRelationshipRelationshipof Basal Gangliaof Basal Ganglia

1. striopallidal fiber1. striopallidal fiber2. strionigral fiber2. strionigral fiber3. strionigral fiber3. strionigral fiber from striosomefrom striosome to SNcto SNc4. ventrostrio-4. ventrostrio- ventro-pallidal fiberventro-pallidal fiber

PALLIDUM (Globus Pallidus)PALLIDUM (Globus Pallidus)AfferentsAfferents from from

1. 1. Striatum Striatum [Striatopallidal Projection][Striatopallidal Projection]

2. 2. STN <GPi & GPe> STN <GPi & GPe> [Subthalamopallidal Projection][Subthalamopallidal Projection]

EfferentsEfferents to to

1. 1. Thalamus (VLo, VApc, CM) <GPi> Thalamus (VLo, VApc, CM) <GPi> [Pallidothalamic Projection][Pallidothalamic Projection]2. 2. STN <GPe>STN <GPe> [Pallidosubthalamic Projection] [Pallidosubthalamic Projection]

SNr (Substantia Nigra, Pars Reticulata)SNr (Substantia Nigra, Pars Reticulata)Afferents from Afferents from Striatum Striatum [Striatonigral Projection][Striatonigral Projection]

Efferents toEfferents to

1. 1. Thalamus (VLm, VAmc, MD) Thalamus (VLm, VAmc, MD) [Nigrothalamic Projection] [Nigrothalamic Projection]

2. Brain Stem Nucleus: Tectum (Superior Colliculus) &2. Brain Stem Nucleus: Tectum (Superior Colliculus) &

Pedunculopontine Nucleus (PPN)Pedunculopontine Nucleus (PPN)

Basal Ganglia ConnectionsBasal Ganglia Connections

Efferent Connections of Basal GangliaEfferent Connections of Basal Ganglia

Pallidothalamic FibersPallidothalamic Fibers from from GPi GPi to to VLo, VApc, CMVLo, VApc, CM

Ansa LenticularisAnsa Lenticularis from outer (lateral) portion of GPifrom outer (lateral) portion of GPi fibers sweep ventromedially and rostrally around fibers sweep ventromedially and rostrally around the posterior limb of the the posterior limb of the internal capsuleinternal capsule enters enters Forel’s field HForel’s field H

Lenticular FasciculusLenticular Fasciculus from inner (medial) portion of GPifrom inner (medial) portion of GPi perforateperforate internal capsule internal capsule enters enters Forel’s field HForel’s field H22

Thalamic fasciculusThalamic fasciculus ansa lenticularis, lenticular fasciculusansa lenticularis, lenticular fasciculus and cerebellothalamic fibersand cerebellothalamic fibers Forel’s field HForel’s field H11

Basal Ganglia ConnectionsBasal Ganglia Connections

habenularhabenularnucleusnucleus

habenularhabenularnucleusnucleus

tectumtectum(superior colliculus)(superior colliculus)

tectumtectum(superior colliculus)(superior colliculus)

PPNPPN(pedunculopontine nucleus)(pedunculopontine nucleus)

PPNPPN(pedunculopontine nucleus)(pedunculopontine nucleus)

amygdaloid bodyamygdaloid bodyamygdaloid bodyamygdaloid body

rapherapherapheraphe

CerebralCerebralCortexCortex

CerebralCerebralCortexCortex

STNSTNSTNSTN

PallidumPallidum

SNrSNr

PallidumPallidum

SNrSNr

STRIATUMSTRIATUMSTRIATUMSTRIATUM

Connections of the Basal GangliaConnections of the Basal GangliaConnections of the Basal GangliaConnections of the Basal Ganglia

SNcSNcSNcSNcThalamusThalamusThalamusThalamus

Basal Ganglia (Main Motor Circuit) ConnectionsBasal Ganglia (Main Motor Circuit) ConnectionsBasal Ganglia (Main Motor Circuit) ConnectionsBasal Ganglia (Main Motor Circuit) Connections

SupplementarySupplementaryMotor AreaMotor Area

(SMA)(SMA)

PrimaryPrimaryMotor AreaMotor Area

(M I)(M I)

THALAMUSTHALAMUS(VLo, VApc, CM)(VLo, VApc, CM)

STRIATUMSTRIATUM(Putamen)(Putamen)

PALLIDUMPALLIDUM(GPi)(GPi)

pyramidalpyramidal tracttract

LMNLMN

ansaansalenticularislenticularis

lenticularlenticularfasciculusfasciculus

Basal Ganglia (Prefronatal Complex Loop) Connections Basal Ganglia (Prefronatal Complex Loop) Connections Basal Ganglia (Prefronatal Complex Loop) Connections Basal Ganglia (Prefronatal Complex Loop) Connections

PrefrontalPrefrontalAssociationAssociation

CortexCortex

PrimaryPrimaryMotor AreaMotor Area

(M I)(M I)

THALAMUSTHALAMUS(VLm, VAmc, MD)(VLm, VAmc, MD)

STRIATUMSTRIATUM(Caudate (Caudate Nucleus)Nucleus)

SNrSNr(Substantia Nigra,(Substantia Nigra,

pars reticulata)pars reticulata)

pyramidalpyramidal tracttract

LMNLMN

GP, SNrGP, SNr

StriatumStriatumMotorMotorCortexCortex

VA-VL VA-VL complexcomplex

- - GABAGABA

--

GABAGABA

++glutamate ?glutamate ?

glutamateglutamate

++

glutamateglutamate

++

Basal Ganglia (Microcircuitary) Connections Basal Ganglia (Microcircuitary) Connections

Basal Ganglia (Microcircuitary) Connections Basal Ganglia (Microcircuitary) Connections

Basal Ganglia (Limbic Loop) ConnectionsBasal Ganglia (Limbic Loop) ConnectionsBasal Ganglia (Limbic Loop) ConnectionsBasal Ganglia (Limbic Loop) Connections

Orbitofrontal CortexOrbitofrontal CortexAnterior Cingulate GyrusAnterior Cingulate GyrusHippocampal FormationHippocampal Formation

THALAMUSTHALAMUS(VAmc, MD)(VAmc, MD)

Ventral StriatumVentral StriatumCaudate NucleusCaudate Nucleus

Ventral PallidumVentral PallidumGPi, SNrGPi, SNr

Basal Ganglia (Oculomotor Loop) Connections Basal Ganglia (Oculomotor Loop) Connections

Basal Ganglia (Oculomotor Loop) Connections Basal Ganglia (Oculomotor Loop) Connections

FrontalFrontalEye FieldEye Field(area 8)(area 8)

PrimaryPrimaryMotor AreaMotor Area

(M I)(M I)

THALAMUSTHALAMUS(VLm, VAmc, MD)(VLm, VAmc, MD)

STRIATUMSTRIATUM(Caudate (Caudate Nucleus)Nucleus)

SNrSNr(Substantia Nigra,(Substantia Nigra,

pars reticulata)pars reticulata)

pyramidalpyramidal tracttract

LMNLMN TectumTectum

Basal GangliaBasal Ganglia (SNc and CM-PF nuclear complex) Connections (SNc and CM-PF nuclear complex) Connections Basal GangliaBasal Ganglia (SNc and CM-PF nuclear complex) Connections (SNc and CM-PF nuclear complex) Connections

PallidumPallidum

StriatumStriatum

THALAMUSTHALAMUS(CM-PF)(CM-PF)

PallidumPallidum

StriatumStriatum

SNcSNc

Basal Ganglia (Brain Stem Efferents) Phylogeny Basal Ganglia (Brain Stem Efferents) Phylogeny Basal Ganglia (Brain Stem Efferents) Phylogeny Basal Ganglia (Brain Stem Efferents) Phylogeny

GPiGPi

SNrSNrTectumTectum(superior (superior colliculus)colliculus)

SpL SpL nDCPnDCP

DIP (thalamus)DIP (thalamus) NeostriatumNeostriatumIntermedialeIntermediale

(motor cortex)(motor cortex)

aves (birds)aves (birds)

GPiGPi

SNrSNrTectumTectum(superior (superior colliculus)colliculus)

nPCnPC

VA-VL complexVA-VL complex(thalamus)(thalamus)

motormotorcortexcortex

mammalsmammals

Basal Ganglia (STN) Basal Ganglia (STN)

ConnectionsConnections

Basal Ganglia (STN) Basal Ganglia (STN)

ConnectionsConnections

SNrSNrGPiGPi

STNSTN

GPeGPe

subthalamicsubthalamic fasciculusfasciculus

OutputOutputPortionPortionofofBasalBasalGangliaGanglia

Cerebral CoretxCerebral Coretx

Thalamus (CM-PF)Thalamus (CM-PF)

PPNPPN

SubthalamicSubthalamicNucleusNucleus

Basal Ganglia (Ventral Striatum and Ventral Pallidum) ConnectionsBasal Ganglia (Ventral Striatum and Ventral Pallidum) ConnectionsBasal Ganglia (Ventral Striatum and Ventral Pallidum) ConnectionsBasal Ganglia (Ventral Striatum and Ventral Pallidum) Connections

VentralVentralPallidumPallidum

VentralVentralStriatumStriatum

HippocampalHippocampalFormationFormation

BasolateralBasolateralAmygdalaAmygdala

Temporal &Temporal &Frontal CortexFrontal Cortex

SNc, VTA &SNc, VTA &Dorsal RapheDorsal Raphe

ThalamusThalamus(MD)(MD)

BasolateralBasolateralAmygdalaAmygdala

PPN & VTAPPN & VTA

ThalamusThalamus(MD)(MD)

Basal Ganglia (Brain Stem Efferents) ConnectionsBasal Ganglia (Brain Stem Efferents) ConnectionsBasal Ganglia (Brain Stem Efferents) ConnectionsBasal Ganglia (Brain Stem Efferents) Connections

PPNPPN(midbrain(midbrain

locomotorlocomotor region)region)

TectumTectum(superior (superior colliculus)colliculus)

GPi, SNrGPi, SNr

StriatumStriatum(caudate nucleus)(caudate nucleus)

LowerLowerMotorMotor

NeuronNeuron

viaviareticularreticularformationformation

tectospinaltectospinaltracttract

Basal GangliaBasal Ganglia

Brain Stem & Spinal CordBrain Stem & Spinal Cord

SMASMA (supplementary motor area)(supplementary motor area)

SMASMA (supplementary motor area)(supplementary motor area)

Basal Ganglia and Pyramidal TractBasal Ganglia and Pyramidal TractBasal Ganglia and Pyramidal TractBasal Ganglia and Pyramidal Tract

upper motor neuronupper motor neuron

UMNUMN

lower motor neuronlower motor neuron

LMNLMN

pyramidalpyramidal tracttract

BASALBASALGANGLIAGANGLIA CIRCUITCIRCUIT

Basal Forebrain Area Basal Forebrain Area ComponentsComponents

Basal Forebrain Area Basal Forebrain Area ComponentsComponents

BASAL FORBRAIN AREABASAL FORBRAIN AREA (Heimer) (Heimer)

Ventral Striatum, Part ofVentral Striatum, Part of Ventral PallidumVentral Pallidum Basal Nucleus of Meynert (Ch4)Basal Nucleus of Meynert (Ch4) Extended AmygdalaExtended Amygdala

cf. cf. Cholinergic Cell GroupsCholinergic Cell Groups (Mesulam) (Mesulam)(Magnocellular Basomedial Telencephalic Complex(Magnocellular Basomedial Telencephalic Complex ) )

1. Ch1 1. Ch1 (Medial Septal Nucleus)(Medial Septal Nucleus)

2. Ch2 2. Ch2 (Nucleus of Diagonal Band of Broca)(Nucleus of Diagonal Band of Broca)

3. Ch3 3. Ch3 (Nucleus of Diagonal Band of Broca)(Nucleus of Diagonal Band of Broca)

4. 4. Ch4Ch4 (Basal Nucleus of Meynert) (Basal Nucleus of Meynert)

5. Ch5 5. Ch5 (Pedunculopontine Tegmental Nucleus)(Pedunculopontine Tegmental Nucleus)

Basal Ganglia Basal Ganglia Functional Consideration Functional Consideration Basal Ganglia Basal Ganglia Functional Consideration Functional Consideration

Functional ConsiderationFunctional Consideration

1. 1. Selection Selection of “Preprogramed (learned) motor plans”of “Preprogramed (learned) motor plans”

Basal Gangla Circuit ---- Basal Gangla Circuit ---- Selection MechanismSelection Mechanism

Selection Inability -------- Selection Inability -------- Akinesia and HypokinesiaAkinesia and Hypokinesia

Faulty Selection ----------- Faulty Selection ----------- HyperkinesiaHyperkinesia

2. 2. Generation (learning) Generation (learning) of motor programsof motor programs

Programming of several Programming of several motor fragments motor fragments intointo

complex motor routinescomplex motor routines

Cerebral Palsy Cerebral Palsy ------------- Disordered motor program ------------- Disordered motor program

SYDENHAM’S CHOREASYDENHAM’S CHOREASYDENHAM’S CHOREASYDENHAM’S CHOREA

- Complication of- Complication of Rheumatic FeverRheumatic Fever- Fine, disorganized , and - Fine, disorganized , and random movements ofrandom movements of extremities, face andextremities, face and tonguetongue- Accompanied by - Accompanied by Muscular HypotoniaMuscular Hypotonia- Typical exaggeration of- Typical exaggeration of associated movements associated movements during voluntary activityduring voluntary activity- Usually recovers- Usually recovers spontaneously spontaneously in 1 to 4 monthsin 1 to 4 months

Clinical FeatureClinical Feature

Principal Pathologic Lesion: Principal Pathologic Lesion: Corpus StriatumCorpus Striatum

Clinical FeatureClinical Feature

Principal Pathologic Lesion:Principal Pathologic Lesion:

Corpus Striatum (esp. caudate nucleus)Corpus Striatum (esp. caudate nucleus) and Cerebral Cortexand Cerebral Cortex

- Predominantly - Predominantly autosomal dominantlyautosomal dominantly inherited chronic fatal diseaseinherited chronic fatal disease (Gene: chromosome 4)(Gene: chromosome 4)- Insidious onset: Usually 40-50- Insidious onset: Usually 40-50- Choreic movements in onset- Choreic movements in onset- Frequently associated with- Frequently associated with emotional disturbancesemotional disturbances- Ultimately, grotesque gait and sever- Ultimately, grotesque gait and sever dysarthria, progressive dementiadysarthria, progressive dementia ensues.ensues.

HUNTINGTON’S CHOREAHUNTINGTON’S CHOREA

HEMIBALLISMHEMIBALLISMHEMIBALLISMHEMIBALLISM

- Usually results from CVA- Usually results from CVA (Cerebrovascular Accident)(Cerebrovascular Accident) involving subthalamic nucleusinvolving subthalamic nucleus- sudden onset- sudden onset- - Violent, writhing, involuntaryViolent, writhing, involuntary movements of wide excursionmovements of wide excursion confined to confined to one half of the bodyone half of the body- The movements are continuous- The movements are continuous and often exhausting but ceaseand often exhausting but cease during sleepduring sleep- Sometimes fatal due to exhaustion- Sometimes fatal due to exhaustion- Could be controlled by- Could be controlled by phenothiazines and stereotaxicphenothiazines and stereotaxic surgery surgery

Clinical FeatureClinical Feature

Lesion: Lesion: Subthalamic NucleusSubthalamic Nucleus

Muhammad Ali in Alanta OlympicMuhammad Ali in Alanta Olympic

Parkinson’s DiseaseParkinson’s Disease

Disease of mesostriatal Disease of mesostriatal dopaminergic systemdopaminergic system

PDPD

normalnormal

Substantia Nigra, Substantia Nigra, Pars Compacta (SNc)Pars Compacta (SNc)

DOPAminergic NeuronDOPAminergic Neuron

Slowness of MovementSlowness of Movement- - Difficulty in Initiation and Cessation Difficulty in Initiation and Cessation of Movementof Movement

Clinical Feature (1)Clinical Feature (1)

Parkinson’s Disease - Paralysis AgitansParkinson’s Disease - Paralysis Agitans

Clinical Feature (2)Clinical Feature (2)

Resting TremorResting TremorParkinsonian PostureParkinsonian PostureRigidity-Cogwheel RigidityRigidity-Cogwheel Rigidity

Parkinson’s Disease Parkinson’s Disease

Paralysis AgitansParalysis Agitans