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Neuroanatomy for the Movement Disorder Specialist 

Neuroanatomy for the Movement Disorder Specialist
Chapter:
Neuroanatomy for the Movement Disorder Specialist
Author(s):

Glenda M. Halliday

, Rachel Tan

, and Heidi Cartwright

DOI:
10.1093/med/9780199609536.003.0003
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date: 27 October 2021

Normal voluntary movement is achieved by the coordination and refinement of neural activity from many interconnected brain regions onto populations of motor neurons. Conscious neural control is achieved through activation of corticospinal neurons in frontal motor cortical regions. These regions have diverse functions, with the primary motor cortex directly innervating motor neurons and other motor cortices mainly innervating excitatory and inhibitory spinal interneurons. Interconnections between the cortex and thalamus determine cortical activity, facilitating information transfer from one cortical region to another through feedforward and feedback mechanisms. These thalamocortical relays are regulated by two major subcortical systems—the basal ganglia and the cerebellum. The basal ganglia process cortical information to inhibit thalamocortical motor activity through three intersecting pathways (hyperdirect, direct, and indirect). The cerebellum processes cortical, brainstem, and spinal information to excite thalamocortical and bulbospinal motor activity. In order to automate some purposeful movements, networks of brainstem and spinal neurons (called central pattern generators) interact relatively independently, following appropriate cortical stimuli. In addition, muscles require a certain level of tone to be able to move body parts and a great deal of coordination to maintain postural control during movement. This is achieved involuntarily through a network of excitatory and inhibitory reticulospinal and spinal interneurons. Disruption to different parts of this complex neuroanatomical network produces very diverse movement abnormalities.

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