Anatomy

 6.5   Feb  14,  2012  

   
Basal Ganglia System Dr.  Quijano  

 
OUTLINE  
I.  Motor  Control  
II.  Basal  Ganglia  System   Figure   1.Motor   control   system.   Alpha   motor   neurons   are   the   final  
A.  Components   common  path  for  motor  control.  Peripheral  sensory  input  and  spinal  cord  
B.  Nomenclature  
tract   signals   that   descend   from   the   brainstem   and   cerebral   cortex  
III.  Connections  of  Basal  Ganglia  
IV.  Basal  Ganglia  Feedback  Loops  
influence  the  motor  neurons.  The  cerebellum  and  basal  ganglia  contribute  
V.  Basal  Ganglia  Diseases   to  motor  control  by  modifying  brainstem  and  cortical  activity.  
A.  Parkinson’s  Disease    
B.  Chorea   • Muscular  actvity  by  reflexes  (eg.  knee  jerk  reflex)  is  controlled  at  
the  spinal  level.    
Objectives:  
• Stereotypic   repetitious   movement   (eg.   walking)   is   controlled   by  
• Name  the  3  systems  involved  in  the  suprasegmental  mechanism  of  
spinal  cord,  brainstem  and  cerebellum  
voluntary  motor  control.    
• Describe  the  basal  ganglia    and  its  composition       • Specific,   goal   directed   movement   (fine   motor   movement   like  
• Enumerate  the  sources  of  the  afferent  fibers  to  the  basal  ganglia.         buttoning  your  shirt)  is  initiated  by  cerebral  cortex.    
• State  the  parts  of  the  basal  ganglia  where  almost  all  the  afferent  impulses    
terminate  and  where  almost  all  afferent  fibers  arise.     • There  are  3  Systems  in  Suprasegmental  Control  
• Name  the  efferent  tracts  from  the  globuspallidus   1. Pyramidal  System  
• Trace  the  different  circuitry  within  the  basal  ganglia  and  name  the   o Direct  control  over  the  motor  neurons  
neurotransmitters  involved.     2. Basal  ganglia  –  inhibitory  output  
• Describe  the  common  basal  ganglia  disorders   o Indirect  control  over  motor  neurons  (influences  motor  cortex,  
 
which  in  turn,  brings  down  the  effect  to  the  motor  neuron  
I.MOTOR  CONTROL  
3. Cerebellum  –  excitatory  output  
• Evolution  of  Movement.  Movement  is  a  fundamental  and  
o Also  indirect  control  
essential  property  of  animal  life.    
 Basal  Ganglia  &  Cerebellum  modify  movement  on  a  minute-­‐to-­‐
o In  simple,  unicellular  animals,  motion  depends  on  the  
minute  basis.    
contractility  of  protoplasm  and  the  action  of  accessory  organs:  
 Cortical  Modulation  is  thru  recurrent  circuits.  
cilia,  flagella,  etc  
   
o Rudimentary  multicellular  animals  possess  primitive  
• There  are  2  Circuits  of  Motor  System  
neuromuscular  mechanisms  
o Pyramidal   System   –   the   primary   control   of   voluntary  
o In  more  advanced  forms  of  animal  life,  reflexive  motion  is  
movement  thru  (1)  corticospinal  or  the  pyramidal  tract  and  (2)  
based  on  the  transmission  of  impulses  from  the  receptor  
corticotubular  pathways  
through  the  afferent  neuron  and  ganglion  cell  to  motor  
o Extrapyramidal   System   (EPS)   –   (1)   Basal   Ganglia   is   clinically   the  
neurons  &  muscles  =  which  is  found  in  the  REFLEX  ARC.    
EPS  and  (2)  Cerebellum  
 Reflex  arc  is  seen  in  higher  form  of  animals  with  developed  
Spinal  Cord.  Superimposed  on  these  reflex  circuits,  the  Brain  
is  concerned  with  the  initiation  and  control  of  movement  and  
the  integration  of  complex  motions.    
• Motor  system  in  humans  control  complex  neuromuscular  
network.  Commands  must  be  sent  to  many  muscles,  and  many  
joints  must  be  stabilized.    

 
Figure  2.  Motor  control  and  its  modulation  
   

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 II.  BASAL  GANGLIA  SYSTEM:  Overview   • The  term  STRIATUM  is  used  to  describe  the  Caudate  Nucleus  
• Basal  Ganglia  are  a  collection  of  subcortical  nuclei  of   PLUS  the  Putamen.    
telencephalon,  subthalamus  &  midbrain  that  modulate  motor  and   • Corpus  Striatum  is  striatum  PLUS  Lentiform  Nucleus.    
cognitive  functions  of  motor  complex.  (Gilman  &  Newman)   o “striped  body”  
• The  term  is  applied  to  a  collection  of  masses  of  gray  matter   o lateral  to  the  thalamus  and  divided  by  sheets  of  myelinated  
situated  within  each  cerebral  hemisphere  which  includes  the  (1)   fibers  and  internal  capsule  into:  
corpus  striatum,  (2)  amygdaloid  nucleus,  and  (3)  the  claustrum.    Caudate  nucleus  (tail)  –  C-­‐shaped  mass  of  gray  matter.  This  is  
th
(Snell,  7 ed)   the  largest  nucleus.    
• Movements  influenced  by  the  basal  ganglia  include  those  related   o It  lies  dorsolateral  to  the  thalamus  and  is  closely  related  to  
to:     the  parts  of  the  lateral  ventricles.    
o Posture   o It  has  a  head,  body  and  tail  
o Automatic  movements  (eg.  swinging  of  arms  while  walking)   • Head
o Skilled  volitional  movements  of  the  trunk  and  limbs   o largest part and continuous and bulges at the cephalic
o It  also  participates  in  cognition.     end
  o continuous inferiorly with the putamen of the
A.  Components  of  the  Basal  Ganglia   lentiform nucleus
o caudate nucleus + putamen = neostriatum or striatum
• Telencephalic  Nuclei   o forms the lateral wall of the anterior horn of the
o Caudate  (Tail)   lateral ventricle
o Putamen  (shell)   • Body
o Globus  pallidus  (pale)   o Continuous with the head in the region of the
o Nucleus  accumbens  (leaning)   interventricular foramen
 HISTORICALY,  the  claustrum  and  amygdale   o forms part of the floor of the body of the lateral
  ventricle
• Nontelencephalic  Nuclei   • Tail
o Subthalamic  nucleus   o Continuous with the body in the region of the
o Substantianigra   posterior end of the thalamus
o Terminates anteriorly in the amygdaloid nucleus
o Follows the contour of the lateral ventricle and
continues forward in the roof of the inferior horn of
the lateral ventricle
• Internal  capsule  is  a  small  but  crucial  band  of  projection  fibers  
that  separate  the  lentiform  nucleus  from  the  medial  caudate  
nucleus  and  the  thalamus.    
o Recall  –  3  types  of  fibers:  (1)  commissural  fibers,  (2)  association  
fibers,  and  (3)  projection  fibers  
• Commisural fibers
o Connect corresponding regions of the two hemispheres
(corpus callosum, posterior commisure, fornix, and
habenular commissure)
• Association fibers
o Connect various cortical regions within the same
hemisphere and maybe divided into short and long groups
  o Short association fibers – lie immediately beneath the
Figure  3.  The  components  of  the  basal  ganglia.   cortex and connect adjacent gyri; run transversely to the
  long axis of the sulci
B.  Nomenclature  of  the  Basal  Ganglia   o Long association fibers – collected into named bundles that
can be dissected in a formalin-hardened brain
• Projection fibers
o Afferent and efferent nerve fibers passing to and from the
brainstem to the entire cerebral cortex must travel between
large nuclear masses of gray matter within the cerebral
hemisphere
o At the upper part of the brainstem, these fibers form a
compact band known as the internal capsule
o Afferent  &  efferent  nerve  fibers  passing  to  and  from  the  
brainstem  to  the  entire  cerebral  cortex  must  travel  between  
large  nuclear  masses  of  gray  matter  within  the  cerebral  
hemisphere.  At  the  upper  part  of  the  brainstem,  these  fibers  
form  a  compact  band  –  the  Internal  Capsule.    
o It  is  flanked  medially  by  the  caudate  nucleus  and  the  thalamus.    
o Because  of  the  wedge-­‐shaped  lenticular  nucleus,  the  internal  
  capsule  is  bent  to  form  the  anterior  limb  and  a  posterior  limb  
Figure  4.  Organization  of  basal  ganglia   on  horizontal  section.    

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• Lentiform  Nucleus    
o Thumb-sized mass of gray matter wedged against the internal • Amygdaloid  Nucleus  
capsule o Situated in the temporal close to the uncus
o Wedge-shaped mass of gray matter whose broad convex base is o Considered part of the limbic system
directed laterally and its blade medially o Influences the body’s response to environmental changes  
o Buried deep in the white matter of the cerebral hemisphere and  
o Related medially to the internal capsule which separates it from • Claustrum  
the caudate nucleus and the thalamus o Thin sheet of gray matter that is separated from the lateral
o Related laterally to a thin sheet of white matter, the external surface of the lentiform nucleus by the external capsule
capsule which separates it from a thin sheet of gray matter called o Lateral to the claustrum is the subcortical white matter of the
the the claustrum insula
o Divided into putamen and globus pallidus o Function is still unknown
 Putamen
• Larger and darker lateral portion
• Has the same histological appearance as the caudate
nucleus, with numerous and densely packed small neurons
• Contains granules with Ach that account for its darker color
 Globus Pallidus
• Lighter medial region
• Contains sparsely distributed large cells and traversed by
many myelinated fibers
• Paleness due to the high concentrations of myelinated
fibers
• A cell sparse lamina separates the globus pallidus itself
into: external globus pallidus and internal globus pallidus
NOTES:  
• Almost all efferents from GB arise from GPi (w/c contain the inhibitory
neurotransmitter, GABA
• GPi sends (1) Major inhibitory output from BG back to thalamus and (2)
few projections to area of midbrain to assist in postural control  
Figure  5.  Striatum  (putamen  and  capsule)  
• Both GPe and GPi receive info from caudate and putamen
• They both are in communication with subthalamic nucleus
 
• They also provide output to substantia nigra NON-­‐TELENCEPHALIC  NUCLEUS:  
• Posterior limb of internal capsule: separates lentiform nucleus from • Subthalamic  Nuclei  
thalamus o part  of  diencephalon  
• anterior limb of the internal capsule: separates lentiform from head of o largest  nuclear  mass  in  the  subthalamus  
caudate nucleus. o Shape  of  a  biconvex  lens  between  thalamus  &  tegmentum,  just  
  rostral  to  midbrain  
• Striatum  (aka  Neostriatum,  Dorsal  Striatum)  =  Putamen  +  Caudate   o Has important connections with corpus striatum; as a result
o Acetylcholine  is  the  neurotransmitter  of  interneurons   needed for the integration of smooth movements of different
o An  acetylcholinesterase  (AChE)  stains  for  the  enzyme  that   parts of the body
degrades  acetylcholine  (ACh).     o Disorders:  Ballism/Hemiballism  
o It  receives  major  inputs  to  the  basal  ganglia  provided  by   o Main  mass  of  midbrain  between  cerebral  peduncles  and  
afferents  from  the  cerebral  cortex,  thalamus  and  substantia   cerebral  aqueducts  
nigra.   o Functionally  closely  related  to  the  activities  of  the  basal  nuclei  
o Receives  excitatory  input  from  neurons  in  all  areas  of  the   o Neurons  are  glutaminergic  and  excitatory  
isocortex,  causing  excitation  w  ith  GABA  as  the  neurotrans   o Have  many  connections  to  the  globus  pallidus  and  substantia  
mitter   nigra  
o Stimulation  of  cerebral  cortical  neurons  evoke  sequences  of   • Substantia  Nigra  
excitatory(fromglutamatergiccorticalefferents),followedby   o Non-­‐telencephalic  nucleus  =  lies  in  upper  midbrain;  between  
inhibitory  postsynaptic  potentials  (from  GABA-­‐ergic   the  cerebral  peduncle  &  tegmentum  
interneurons  in  striatum)   o The nucleus is composed of medium-size multipolar neurons
o Projections  have  a  topographic  organization  that  is  continued   that possess inclusion granules of melanin pigment within their
by  neurons  that  project  from  the  substantia  nigra  pars   cytoplasm
reticulate  and  to  the  internal  and  external  globus  pallidus   o In  a  brain  specimen,  SN  neurons  appear  brownish-­‐black  due  to  
o Neurons  from  the  striatum  to  the  external  pallidum  provide   neuromelanin  
inhibition  using  GABA  and  encephalin   o The  SN  neurons  are  dopaminergic  and  inhibitory  (  +  ;  -­‐  )  
o Neurons  from  striatum  to  the  internal  pallidum  also  inhibit   o It is concerned with muscle tone and is connected to the cerebral
using  GABA  and  Substance  P   cortex, spinal cord, hypothalamus, and basal nuclei
  o Neuromelanin gives its color: “black substance”
o Have many connections to the corpus striatum
Projection   Areas  
o It has 2 superior and 2 inferior colliculi
Putamen   Areas  4,  6  (lateral  and  medial)  and  3,1,2  
o 2  parts  of  the  Substantia  Nigra  
Caudate  nucleus   Frontal  eye  fields  and  association  areas  of  the  
frontal  and  parietal  lobes  

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  Substancia  Nigra  pars  compacta  (SNc)  –    this  is  the  part  that  
degenerates  in  Parkinson’s  disease.  It  is  treated  by  giving  oral  
dopamine  precursors.  
o Receives  input  from  striatum  and  sends  it  back  to  striatum  
or  sends  it  to  the  outside  of  the  basal  ganglia  to  control  
head  and  eye  movement  
 SubstanciaNIgra  pars  reticulata  (SNr)  –  porjects  to  superior  
colliculi  and  uses  GABA  as  a  neurotransmitter  
 
III.    CONNECTIONS  OF  BASAL  GANGLIA  
Generalization  (REMEMBER!)  
ALMOST  ALL  of  the  input  or  afferent  fibers  are  received  by  the  
STRIATUM.  The  GLOBUS  PALLIDUS  (mainly  the  interna,  or  medial  
part)  forms  the  major  site  from  which  the  output  or  efferent  fibers  
leave  the  basal  nuclei.  
 
• Afferent  fibers  TO  the  striatum  or  basal  ganglia:    
1.  Cerebral  cortex  –  the  corticostriate  fibers   Figure  7.  Some  of  the  major  connections  between  the  cerebral  cortex,  the  
 Preferentially:  From  the  cerebral  cortex  to  the  putamen   basal  nuclei,  the  thalamic  nuclei,  the  brainstem,  and  the  spinal  cord.  
 Only  some  fibers  (from  Area  8)  will  go  to  caudate  nucleus  
 Primary  Motor  cortex  (MI)  =  Area  4  
 Supplementary  Motor  Cortex  (MII)  =  Area  6  
 Pre  Motor  Area  =  Area  6  
 Somotosensory  cortices  =  Area  3,1,2  
 Uses  Glutamate  as  its  neurotransmitter  (strongly  excitatory)  
 

   
Figure  8.  Basal  nuclei  pathways  showing  the  known  neurotransmitters.    
 
• Efferent  fibers  FROM  the  Striatum:  
1. Striatopallidal  fibers  
 GPE  =  strong  inhibitory  input  
 GPI  
2. Stiratonigral  fibers  –  inhibitory  
 
• Efferent  fibers  FROM  the  Globus  Pallidus  =  Pallidofugal  fibers  
1. Fasciculus  Lenticularis  –  to  subthalamus  (across  posterior  limb  
  of  internal  capsule)  
Figure  6.  Schematic  diagram  of  prinicipal  connections  of  basal  ganglia.     2. Ansa  Lenticularis  –  to  thalamic  nuclei  (loop  around  the  ventral  
  aspect  of  posterior  limb  of  internal  capsule;  ansa=”loop”)  
2.  Thalamus  (only  from  intralaminar  nuclei/centromedian)  –   3. Pallidosubthalamic  fibers  –  to  subthalamic  nucleus  (STN)  
thalamostriate  fibers   4. Pallidotegmental  fibers  –  to  caudal  tegmentum  (from  ansa  
3.  Substantia  nigra  –  nigrostriate  fibers  using  dopamine  as  its   lenticularis,  it  could  go  down  to  tegmentum  and  form  the  
neurotransmitter.  Overall  effect  is  inhibitory.  Involved  in   pallidotegmental  fibers)  
Parkinson’s  disease.    Fasciculus  lenticularis  +  Ansalenticularis  =  Thalamic  fasciculus  
4.  Brainstem  striatal  fibers  using  serotonin.  Inhibitory.  
 
 ALMOST  all  impulses  terminate  in  the  Striatum  are  excitatory  
 Interneurons  within  the  striatum  are  excitatory  and  use  Ach.    

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• Basal  Ganglia  efferent  fibers  TO  the  brainstem:   (e.g.  striatum  inhibits  GPI/SNr  which  is  an  inhibitor  of  thalamus,  so  
o Superior  colliculus  –  regulation  of  saccadic  eye  movements   thalamus  will  be  released  from  the  inhibiting  effect  of  GPI/SNr)  
 
o Pedunculopontinetegemental  neuron  (PPTN)  –  coordinates  
status  of  arousal  with  fundamental  motor  patterns  (REM)   3. Indirect  loop  (nigrostriatal  fibers)  –  the  subthalamic  nucleus  
influence  the  outflow  of  the  globus  pallidus  interna.    
o Cortico  +  striato  –  pallido  ext  –  stn  +  pallido  int/snr  –  thalamo  
–  cortical  pathway  
o D2  receptors  are  stimulated,  which  are  inhibitory  
o Cortex→  striatum→  SNr-­‐SNc→  striatum(D2)  →  G  
pallidus(ext.)→    subthalamic  nucleus→  G  pallidus  (int.)→  
thalamus→  cortex  
o The  striatal  efferent  fibers  reach  the  external  segment  of  the  
GP  and  after  synspases,  pallidal  efferent  fibers  cross  the  
posterior  limb  of  the  internal  capsule  to  reach  the  subthalamic  
nucleus  (STN).    
o Neurons  of  the  STN  project  excitatory  glutamatergic  fibers  back  
to  both  GP,  but  primarily  to  the  internal  segment,  and  to  the  
substantia  nigra  reticulate  (SNr)  where  they  excite  GABAergic  
projections  to  the  thalamus  and  thereby  inhibit  it.    
o The  STN  also  receive  direct  input  from  the  cerebral  cortex.    
  Memory  trick  for  Neurotransmitters:    
Figure  9.  Principal  physiologic  circuitry  and  neurotransmitters  in  the  basal   • All  excitatory  stimulus  uses  glutamate  
ganglia.  
• All  inhibitory  stimulus  uses  GABA  
 
• EXCEPT  for  Dopamine  from  SNCompacta  
IV.  BASAL  GANGLIA  FEEDBACK  LOOPS   o Dopamine  in  INdirect  loop  (D2)  is  Inhibitory  (IN-­‐IN)  
1. Cortico  +  striato  –  pallido  –  thalamo  +  cortical  pathway     o Dopamine  in  direct  loop  (D1)  is  excitatory  
o It  is  the  long  loop   OVERALL  basal  ganglia  effect:  INHIBITORY  
o From  cortex  to  striatum,  and  thalamus  to  cortex,  it  is  excitatory  
The  Basal  ganglia  function  is  described  as  the  “brake  hypothesis.”    
o From  striatum  to  globus  pallidus,  and  pallidus  to  thalamus,  it  is  
Ex:  To  sit  still,  put  the  brakes  on  and  all  movements  except  those  
inhibitory  
reflexes  that  maintain  an  upright  posture.  To  move,  apply  a  brake  to  
2. Direct  loop  (nigrostriatal  fibers)  
some  postural  reflexes  and  release  brake  on  voluntary  movement.    
o Cortico  +  striato  –  pallido/snr  –  thalamo  +  cortical  pathway  
The  disturbances  could  lead  to:  
o D1  receptors  on  striatum  are  stimulated,  which  are  excitatory  
1.  Presence  of  extraneous  unwanted  movements  
o Cortex→  striatum→  SNr-­‐SNc→  striatum(D1)→  G  pallidus→  
2.  Absence  or  difficulty  with  intended  movements  
thalamus→  back  to  cortex  
 
V.  BASAL  GANGLIA  DISEASES  
• The  are  three  functional  categories  (Manter&Gatz):  
o Parkinsonism  –  degeneration  of  the  substantia  nigra  
o Hyperkinetic  movement  (Ballism,  chorea,  athetosis)  –  from  
striatal  or  subthalamic  dysfunction  
o Dystonia  –  from  pallidal  dysfunction  
 
• Two  General  Types  (Snell):  
o Hypokinetic  disorders  –  lack  or  slowness  of  movement  
o Hyperkinetic  movemnt  –  excessive  and  abnormal  movements  
(ballism,  chorea,  athetosis)  
 Parkinson’s  disease  includes  both  types  
 
A.  Parkinson’s  Disease  
• Results  from  slow  and  steady  loss  of  dopaminergic  neurons  in  
SNc.    
• Aka  Paralysis  Agitans  
• Concerned  with  lesions  on  the  basal  ganglia  
• Symptoms  usually  include  the  ff:  
  o Tremors  when  at  rest  (pin-­‐rolling  movement)  
Figure  10.  Direct  and  indirect  Loop  
Black  arrows  represents  excitatory  effect,  red  arrows  represents  inhibitory   o Rigidity  due  to  simultaneous  contraction  of  flexors  and  
effect.   extensors  (cogwheel  rigidity)  
REMEMBER:     o Bradykinesia  or  slow  movement  
st
• excitatory  stimulus  to  an  inhibitor,  will  increase  its  ability  to  inhibit  (e.g.   o Festinating  gait  –  difficulty  initiating  1  steps,  but  once  under  
cortex  to  striatum)   way,  pace  becomes  more  rapid  (short,  shuffling  steps)  and  has  
• inhibitory  stimulus  to  an  inhibitor,  will  decrease  its  ability  to  inhibit,  thus   trouble  stopping  
releasing/exicitng/stimulating  the  succeeding  nuclei  

Group  2  |  Agustin  B,  Al-­‐Qaseer,  Alegre,  Almario,  Almazan,  Almodiente,  Altabano,  Alvarez   Page  5  of  6  
 
 o Postural  disturbances  –  stooped  posture  with  loss  of  arm  swing    Basal  ganglia  affects  final  common  path  or  LMN  INDIRECTLY  
when  walking    Basal  ganglia  effects  are  contralateral  to  the  side  of  the  lesion  
o Masked  face  –  expressionless    Strength  persists  in  muscles  but  there  is  emergence  of  involuntary  
o Depression  and  anxiety  problems  with  memory  loss  and   movement.  
dementia  
o No  loss  of  muscle  power  nor  sensiblities  
• Parkinson’s  usually  develop  late  in  life.    
• REMEMBER:  Parkinson’s  disease  involves  the  nigrostriatal  
dopaminergic  pathway  

 
Figure  11.  Section  of  the  brain  affected  by  Parkinson’s  disease  
 
B.  Chorea  
 
• A  form  of  striatal  disorder   Figure   12.   A.   Conceptual   model   of   activity   in   the   basal   ganglia   and  
• Exhibits  involuntary,  quick,  jerky,  irregular  nonrepetitive   associated   and   associated   thalamocortical   regions   under   normal  
movements.  Ex:  swift  grimaces  and  sudden  movements  of  limbs   circumstances.   Dark   arrows   indicate   inhibitory   connections,   and   open  
and  head.     arrows   indicate   excitatory   connections.   B.   Changes   in   activity   in  
Parkinson’s   disease.   As   a   result   of   degeneration   of   the   pars   compacta   of  
• May  affect  limbs  (refers  more  to  distal  movements),  face,  tongue   the   substantia   nigra,   differential   changes   occur   in   the   two   striatopallidal  
  projections   (as   indicated   by   altered   thickness   of   the   arrows),   including  
• Huntington’s  disease  –  hereditary,  defect  on  chromosome  4   increased  output  from  GPi  to  the  thalamus.  D,  direct  pathway;  I,  indirect  
(protein  huntingtin).     pathway;  GPe,  external  segment  of  globus  pallidus;  GPi,  internal  segment  
o Degeneration  of  neurons  of  caudate  nucleus   of   globus   pallidus;   SNr,   substantia   nigra   (pars   reticulate);   SNc,   subsantia  
o Disease  is  characterized  by  chorea  and  progressive  dementia   nigra   (pars   compacta);   STN,   subthalamic   nucleus;   VL,   ventrolateral  
  thalamus.    
• Sydenham’s  Chorea  aka  St.  Vitus  Dance    
o Disease  of  childhood  
o Associated  with  rheumatic  fever  (streptococcal  antigens  have  
same  membrane  proteins  of  striatal  neurons)  
o Choreic  movements  
o Disease  is  transient  and  with  full  recovery  
 
• Athetosis  
o Characterized  by  slow  writhing  worm-­‐like  involuntary  
movement  of  extremities,  trunk,  and  neck  
o Involves  the  cerebral  cortex  and  the  basal  ganglia  
o Ex:  TICS,  Tourette’ssyndrom  
o Aka  choreoathetosis  
 
• Dystonia  
o Fixed  posture  or  sustained  postural  contraction  of  limb,  neck  
and  facial  muscles  
o Most  commonly  secondary  to  cerebral  palsy  
 
• Ballism  or  Hemiballismus  
o Involuntary  flailing  movements  of  arm/s  and  leg/s  
o Caused  by  damage  (i.e.  stroke)  of  opposite  subthalamic  
nucleus.    
 

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