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20-September-2008 10:08:30 - Extrapyramidal system Redirected from Extrapyramidal Brain: Extrapyramidal system Medulla spinalis. Extrapyramidal tracts are labeled 2 in red, at left. NeuroNames ancil-623 MeSH Extrapyramidal+tracts Dorlands/Elsevier s_33/12787420 In human anatomy, the extrapyramidal system is a neural network located in the brain that is part of the motor system involved in the coordination of movement. The system is called extrapyramidal to distinguish it from the tracts of the motor cortex that reach their targets by traveling through the pyramids of the medulla. The pyramidal pathways corticospinal and some corticobulbar tracts may directly innervate motor neurons of the spinal cord or brainstem anterior horn cells or certain cranial nerve nuclei, whereas the extrapyramidal system centers around the modulation and regulation indirect control of anterior horn cells. Extrapyramidal tracts are chiefly found in the reticular formation of the pons and medulla, and target neurons in the spinal cord involved in reflexes, locomotion, complex movements, and postural control. These tracts are in turn modulated by various parts of the central nervous system, including the nigrostriatal pathway, the basal ganglia, the cerebellum, the vestibular nuclei, and different sensory areas of the cerebral cortex. All of these regulatory components can be considered part of the extrapyramidal system, in that they modulate motor activity without directly innervating motor neurons. Contents 1 Extrapyramidal symptoms 1.1 Disorders 1.2 Treatment for extrapyramidal symptoms 2 See also Extrapyramidal symptoms The extrapyramidal system can be affected in a number of ways, which are revealed in a range of extrapyramidal symptoms such as akinesia inability to initiate movement and akathisia inability to remain motionless. Extrapyramidal symptoms EPS are the various movement disorders such as tardive dyskinesia suffered as a result of taking dopamine antagonists, usually antipsychotic neuroleptic drugs, which are often used to control psychosis, especially schizophrenia. Other antidopaminergic drugs like the antiemetic metoclopramide or the tricyclic antidepressant amoxapine can also cause extrapyramidal side effects. Disorders The best known EPS is tardive dyskinesia involuntary, irregular muscle movements, usually in the face. Other common EPS include akathisia restlessness, dystonia muscular spasms of neck - torticollis, eyes - oculogyric crisis, tongue, or jaw; more frequent in children, drug-induced parkinsonism muscular lead-pipe rigidity, bradykinesia/akinesia, resting tremor, postural instability; more frequent in adults and the elderly, Although Parkinson's Disease is primarily a disease of the nigrostriatal pathway and not the extrapyramidal system, loss of dopaminergic neurons in the substantia nigra leads to dysregulation of the extrapyramidal system. Since this system regulates posture and skeletal muscle tone, a result is the characteristic bradykinesia of Parkinson's. Extrapyramidal symptoms can also be caused by brain damage, as in athetotic cerebral palsy, which is involuntary writhing movements caused by prenatal or perinatal brain damage. Treatment for extrapyramidal symptoms Anticholinergic drugs are used to control neuroleptic-induced EPS, although akathisia may require beta blockers or even benzodiazepines. If the EPS are induced by a typical antipsychotic, EPS may be reduced by dose titration or by switching to an atypical antipsychotic, such as aripiprazole, ziprasidone, quetiapine, olanzapine, risperidone or clozapine. These medications possess an additional mode of action that is believed to negate their effect on the nigrostriatal pathway, which means they are associated with fewer extrapyramidal side effects than conventional antipsychotics chlorpromazine, haloperidol, etc.. Commonly used medications for EPS are benztropine Cogentin, diphenhydramine Benadryl, and trihexyphenidyl Artane. See also List of regions in the human brain v d e Anatomy of torso primarily: the spinal cord Spinal nerve Dorsal Root, Ganglion, Ramus Ventral Root, Ramus Sympathetic trunk rami communicantes Gray, White Gray matter/Rexed laminae Posterior horn Posteromarginal nucleus, Column of Clarke, Substantia gelatinosa of Rolando, Nucleus proprius Lateral horn/Anterior horn Intermediolateral nucleus Central canal/Substantia gelatinosa centralis - Gray commissure White matter somatic/ascending blue Posterior/PCML: touch: Gracilis Cuneatus Lateral: proprioception: Spinocerebellar Dorsal, Ventral pain/temp: Spinothalamic Lateral, Anterior Posterolateral Lissauer Spinotectal motor/descending red Lateral: Corticospinal Lateral Ep Rubrospinal, Olivospinal Anterior: Corticospinal Anterior Ep Vestibulospinal, Reticulospinal, Tectospinal Layers Epidural space Dura mater Subdural space Arachnoid mater Subarachnoid space Pia mater Other structures Denticulate ligaments Conus medullaris Cauda equina Filum terminale Cervical enlargement Lumbar enlargement Anterior median fissure Posterior median sulcus Anterior white commissure v d e Brain and spinal cord: neural tracts and fasciculi Sensory/ascending: PCML Pacinian corpuscle/Meissner's corpuscle → PCML → arcuate fibers Posterior external arcuate fibers, Internal arcuate fibers - Medial lemniscus → Thalamus → Postcentral gyrus Sensory/ascending: anterolateral system Free nerve ending → Spinothalamic tract Lateral, Anterior → Spinal lemniscus → Postcentral gyrus Spinoreticular tract → Reticular formation Spinotectal tract → Midbrain tectum Motor/descending: pyramidal and extrapyramidal flexion: Primary motor cortex → Posterior limb of internal capsule → Decussation of the pyramids → Corticospinal tract Lateral, Anterior → Neuromuscular junction flexion: Red nucleus → Rubrospinal tract extension: Vestibulocerebellum → Vestibular nuclei → Vestibulospinal tract extension: Vestibulocerebellum → Reticular formation → Reticulospinal tract Midbrain tectum → Tectospinal tract → muscles of neck Bidirectional: Spinocerebellar Unconscious proprioception: Golgi tendon organ → Spinocerebellar Dorsal/Dorsal nucleus of Clarke/Column of Clarke, Cuneocerebellar → Cerebellum Reflex arc: Ventral - Rostral Brain only Medial longitudinal fasciculus Vestibular nucleus → Vestibulocerebellar tract → Cerebellum Pontine nuclei → Pontocerebellar fibers → Deep cerebellar nuclei Inferior olivary nucleus → Olivocerebellar tract → Cerebellar hemisphere Primary motor cortex → Genu of internal capsule → Corticobulbar tract → brainstem see also white matter fibers Retrieved from http://en..org/wiki/Extrapyramidal_system Categories: Antipsychotics | Central nervous systemHidden category: All articles with statements Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français Italiano Lietuvių Polski Português РуÑ?Ñ?кий Suomi This page was last modified on 3 June 2008, at 21:25
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