Intro-CNS Pathophys-Pharmaco 2024

Intro.
CNS Pathophysiology & Pharmacology
Content/Objectives:
1. Introduction: Emphasize terminology.
2. Review of NS structure-concepts, functions and terminology.
3. Describe NS cell types and Communication.
4. List examples of classes of neurological disorders.
5. List diagnostic aids and examinations.
6. Discuss why we study CNS drugs.
7. Describe a simple functional organization of the CNS.
8. Discuss neuronal communication- Action Potential and Synaptic
Transmission.
9. Discuss neurotransmission and neuromodulation.
10. List sites for action of neuro-active drugs.
Prof SBK …Intro CNS-2024

Intro. CNS Pathophysiology & Pharmacology
Outcome/Expectations:
1. Familiar with terminology in CNS diseases and pharmacology.
2. Know basic nervous system (NS) structure & function.
3. Know NS cell types and how they communicate.
4. Know examples of neurological/psychiatric disorders.
5. Know basic diagnostic aids/examinations in CNS disorders.
6. Know a simple functional organization of the CNS.
7. Know how neurones communicate- action potential and synaptic
transmission/neuromodulation
8. Know the sites for action of neuro-active drugs.
Prof SBK …Intro CNS-2024

Male
Female
…, suggest that male brains may be optimized for motor skills and female brains may
be optimized for combining analytical and intuitive thinking. R. Verma et al., PNAS, Dec 2,
2013
1: Introduction: Concepts and terminology:
• Nervous system: comprises the brain, spinal cord and nerves.
• Subdivided into central and peripheral nervous systems
• Central Nervous Systems (CNS): structural and functional center

of the entire nervous system: brain and spinal cord.
• Peripheral Nervous System (PNS): consist of nerve tissue that lie

in the “outer regions”-periphery. Originating from brain: cranial
nerves and from spinal cord: spinal nerves.
• Enteric Nervous System- controls activity of the GIT

•Brain:-communication and control center of body.
•Receives inputs (afferents-sensory), processes and evaluates it, decides

on response or action, then initiates the response (via efferents-motor)
•Responses are either involuntary for homeostasis (Autonomic Nervous

System) or voluntary (Somatic Nervous System). Both ANS and SNS
include elements of the CNS and PNS.
•ANS: information from CNS to autonomic or visceral effectors: smooth

muscle, cardiac muscle and glands. Usually independent, functions
without our conscious knowledge, but can be influenced by our
conscious mind.
•Efferent system of ANS: sympathetic and parasympathetic.
•Sympathetic-efferent (motor)nerves exit in the thoraco-lumbar
(spinal) region: prepares body to deal with immediate threats to the
internal environment… “fight or flight” or stress response.
•Parasympathetic-efferent nerves exit from the brainstem and lower
spinal cord (cranio-sacral) regions: coordinates the body’s normal
resting activities.
•Afferent pathways from the visceral sensory division, carry feedback to
integrating centers in CNS.
•Somatic Nervous System (SNS): efferents (motor) from somatic

integrating centers (CNS) carry information TO somatic effectors
(skeletal muscles). Somatic sensory (afferent) bring feedback FROM
effectors.
2: The Brain: Protected by:
•Bony skull
•Three membranes or meninges
•Cerebrospinal fluid (CSF)
•All provide protection to the brain.
•Skull-cranial and facial bones connected by sutures (immovable joints)
in adults. Fusion occurs later after birth.
•Meninges-continuous connective tissue covering the brain and spinal
cord.
•Outer layer (dura mater)-tough, fibrous double layer membrane.
Beneath is the subdura space
•Middle layer(arachnoid) -loose web-like covering, beneath is the
subarachnoid space-contains CSF and cerebral arteries and veins
•Inner layer (pia mater) very delicate tissue that adheres closely to the
brain. Many small blood vessels found here.
•CSF-provides a cushion for brain and spinal cord. It is clear, colourless

and contains different concentrations of electrolyte and proteins.
•Formed constantly in the choroid plexuses in the ventricles, flows into
subarachnoid space, where it circulates around the brain and back into
the venous blood.
•CSF pressure within the skull is constant i.e. production= re-
absorption.
•Ventricles: canals in the brain through which CSF circulates-lateral Vs
(left & right), 3rd V, aqueduct, 4th V.
•Blood Supply to the Brain:
•Blood supplied to the brain by internal carotid arteries (ICA) and
vertebral arteries (VA).
•Each ICA is a branch of the common carotid artery (left & right)
•Immediately after branch is the carotid sinus, the location of
baroreceptors and chemoreceptors to monitor BP and blood pH.
•ICA supplies most of the cerebrum (some contribution from VA)
•VA supplies most of the brainstem, cerebellum and some cerebrum.
•Anastomoses (communication between vessels by collateral
channels) occurs between ICA and VA (via branches) at base of brain
to form Circle of Willis. This arrangement provides an alternative
source of blood to the brain if either the ICA or the VA is blocked.
•Blood flow to the brain is relatively constant to supply O2 and glucose
constantly as brain has little storage capacity. Baroreceptors and
chemoreceptors play a KEY role in maintaining this flow.
•Blood Brain Barrier (BBB): Helps maintain stable environment in

brain. Poorly developed in neonates. RE: Rh factor, bilirubin and
neonatal jaundice. Dr SBK Pathophysiology
332/Pharmacol334-2010
•Due to relatively 1:impermeable blood capillaries in brain resulting
from tight junctions between capillary epithelial cells, 2:presence of
glia cells (astrocytes) and 3: special pumps (e.g. p-glycoproteins).
•Regulates passage of most ions (Na+, K+ , Ca2+) from blood to brain
•Permeable to oxygen, carbon dioxide, water and glucose, also small
lipid soluble substances e.g. alcohol but not M.wt >60,000
•Important in development of CNS active drugs e.g. dopamine vs L-
DOPA
•No BBB in some(few) brain areas e.g. area prostrema, preoptic area
etc
•Functional areas of the Brain:

a: Cerebrum: largest part of brain, outer surface covered by elevations
(gyri) separated by grooves (sulci)- lissencephaly? Longitudinal fissure
separates the two cerebral hemispheres.
•Outer surface of cerebrum is called the cortex consists of “grey matter”
which is mainly nerve cell bodies .
•Beneath the grey matter is the “white matter” composed of myelinated
nerve fibres.
•These myelinated nerve fibres are bundled into tracts: 1:corpus
callosum which connect the hemispheres, 2: projection fibres connecting
cortex to e.g. the spinal cord etc or 3: association fibres, connecting
different grey mater areas.
•Each hemisphere is divided into 4 lobes (parietal, occipital, temporal
and frontal) with specific functions (see physiology).
•Complex functions often involve many areas (network!).
•Each hemisphere involved in voluntary movement and sensory function
on the opposite side (contralateral side) of the body (same side is
ipsilateral)
•Voluntary movement initiated in motor cortex (upper motor neurons,
UMN), axons travel to spinal cord (corticospinal or pyramidal tracts)
•Most of these fibres crossover in the medulla damage in the left
motor cortex causes paralysis of the right side.
•Different parts of the motor cortex control different parts of the body
(somatotopic mapping or arrangement)
•Sensory cortex is also somatopically mapped e.g the visual cortex
(primary and association).
•Left and right hemispheres are generally structurally similar but NOT
functionally similar. RE: dominant hemisphere refers to side of brain
that controls language (LEFT hemisphere in most people)-Broca’s area
and Wernicke’s area. The left hemisphere also appears to dominate or is
responsible for mathematical ability, problem solving and logical
reasoning.
•The right hemisphere dominant in artistic ability, creativity, spatial
relationships, emotional and other behavioral characteristics.
•b: Basal ganglia: Deep inside the tracts of the cerebral hemispheres are
located clusters of nerve cell bodies called the basal nuclei or basal
ganglia (BG).
•BG form part of the extrapyramidal system (EPS) of motor control.
•Controls and coordinates skeletal muscle activity, preventing excessive
movement, initiating accessory, involuntary movement e.g arm swinging
when walking. Two other nuclei in the midbrain, substantia nigra and
red nucleus form part of the EPS.
c: Limbic system: include several nuclei in the cerebral hemispheres
•Responsible for emotional reaction or feelings e.g. anger, fear, sexual
feelings, pleasure and sorrow. Part of hypothalamus is involved with the
limbic system-provides link for autonomic responses associated with
emotion e.g. altered BP, heart rate, nausea when one experiences fear,
excitement or an unpleasant sight or odor. Limbic activity is modulated
by other cortical areas to prevent excesses
The central portion of the brain (surrounded by the hemispheres)
contains several nuclei (collection of nerve cell bodies)
•Important structures include thalamus and hypothalamus
•Thalamus: many different sub-nuclei- main function-serves as
integrating &relay station for incoming sensory impulses, from here
they are transmitted to the cerebral cortex and other areas of the brain.
•Hypothalamus: several sub-nuclei:-responsible for maintenance of
homeostasis, controlling the autonomic nervous system and much of the
endocrine system (hypophysis or pituitary gland)-neurohypophysis.
•Responsible for temperature regulation, food and fluid intake and sleep
cycles. See also limbic involvement.
d: Brainstem: Links the rest of the brain to the spinal cord-divisions:
•Pons-bundles of afferent and efferent fibres
•Several nuclei (cell bodies) of cranial nerves (ANS) located here.
•Medulla oblongata: a: vital control centers regulating respiration
and cardiovascular function b: centers controlling the cough,
swallowing and vomiting reflexes c: nuclei of several cranial nerves
and d: crossing point of the corticospinal tracts (RE: left side
controlling right side and vice versa)
•The reticular formation: several nuclei. Main one is the Reticular-
Activating System (RAS)-responsible for arousal or awareness.
Decides which sensory inputs the brain (mainly cortex) ignores and
the ones it notices. Site of action of many drugs.
e: Cerebellum: Functions to coordinate movement & maintain posture
and equilibrium by continuously assessing & adjusting inputs from the
pyramidal system, proprioceptors in joints and muscles, the visual
pathways and the vestibular pathways in the inner ear.
f: Spinal cord: protected by the vertebral column, meninges and CSF.
•Continuous with the medulla oblongata and ends in the first/second
lumbar vertebrae (L1 or L2). No risk of damage to SC when needle
inserted into the subarachnoid space below the first lumbar level (L3-
L4) to obtain a sample of CSF for diagnosis (lumbar puncture).
•SC consists of nerve fibres or tracts (white matter) that surrounds an
internal grey matter (cell bodies). Anterior horns contain motor neurons
which send axons out of the SC via the ventral root to innervate skeletal
muscles (lower motor neurons-LMN). Posterior horns contain
association neurons. Dorsal horn receives sensory inputs e.g. pain from
from nociceptors in the periphery.
•SC also contains pyramidal tracts (from UMN) & extra-pyramidal
tracts that initiate & maintain voluntary movement: reticulospinal,
rubrospinal & vestibulospinal tracts.
•Sensory information passes via the SC (dorsal root/horn) en route to the
CNS.
•SC is the main source of preganglionic fibres of the ANS and the
fibres of the SNS.
•SC also involved in reflexes-automatic rapid involuntary response to
a stimulus.
3: Cells of the NS: Two main types- neurons and glia.
Cells of the NS: Two main types- neurons and glia.
•Neurons: excitable cells that generate, and conduct the impulses

that enable the brain to communicate (function) i.e they form the
wiring of the NS~ 100 billion cells (10% ).
•Glia (neuroglia): do not usually conduct but support the functions

of neurons in several ways.
•Large quantities(~900 billion-90% ), retain their capacity to divide
(unlike neurons!!)
• can replace themselves but subject to abnormalities of cell
division- neoplasia
•Types of neuroglia: 5 types-
•Astrocytes: form part of the BBB by wrapping around brain blood
capillaries, synaptic remodeling, structural & neurotrophic support.
•Microglia: phagocytic during inflammation and degeneration (
synaptic pruning, apoptosis.
•Ependymal cells: CSF production and circulation(cilia)
•Oligodendrocytes: Provide support (helps hold nerve fibres
together) and also forms myelin sheath in the brain.
•Schwann cells: Found only in PNS, form myelin sheath and provide
support.
•Structure of Nerve cell (neuron)
•Cell body called soma or perikaryon and at least two processes: one
axon and one or more dendrites
•Soma: resembles most cell bodies
•Dendrites: threadlike extensions from soma, extensive branching.
Form receptor field of neuron (contain receptors)
•Axon: single prominent process extending from soma (no branching
at this point). Conducts impulses away from soma
•Initial segment is called axon hillock. After this portion, the axon
may be covered with myelin and called myelinated fibres (white
fibres) or not and are non-myelinated fibres(grey fibres).
•Presence of myelin is segmented leaving axon regions without
myelin(Nodes of Ranvier). Arrangement allows for fast conduction of
impulses.
•Axon may branch after the hillock region (branch called axon
collateral)
Page 18
•Functional Classification: According to direction in which they
conduct impulses:
•Afferent (sensory) neurons: conduct impulses TO SC and/or

brain
•Efferent (motor) neurons: conduct impulse AWAY from SC
and/or brain to or toward muscles or glands
•Interneurons: conduct impulses from afferent neurons to or
toward efferent (motor) neurons.
•Neuronal communication: Electrochemical

•Starts as electrical(soma & axon) and becomes chemical at the
synapse.
http://www.bbc.com/news/av/stories-41949254/the-7-year-old-neuroscientist-wowing-the-internet
•Synapse: junction or point where presynaptic neuron communicates
with the postsynaptic neuron.
•Two main types:
•Chemical synapse -presynaptic neuron releases a chemical
(neurotransmitter) that crosses the synaptic cleft or junction to
act on postsynaptic receptors. NO direct contact. Most synapses
in brain and SC
•Electrical synapses: electrical flow between two or several
somas in direct contact. Also called gap junction. Important in
synchronous firing of neurons. RE: epileptic focus??
•Neurotransmitters: Two general categories:
•Fast transmitter: e.g. glutamate, GABA and Acetylcholine
•Slow transmitters (neuromodulators)-actions relatively slow
compared to fast and mainly modulate (increase or decrease) the
actions of fast transmitters e.g. dopamine, norepinephrine, serotonin
(5-HT) and neuropeptides.
Electrical synapse Chemical synapse
Connexon = 6 Connexins
•Fast transmitters can also act as neuromodulators by their actions at
different receptor subtypes.
•A neurotransmitter may be excitatory –cause postsynaptic cell to
move towards or fire an action potential (AP) or inhibitory prevent
the postsynaptic cell from firing APs.
4: Neurological Diseases: can result from:

•A: cell death or loss (acute or chronic)-(movement disorders)
•B. conduction failure (epilepsy)
•C: circulatory abnormality (cerebrovascular diseases)
•D: neuronal structural defects(neuromuscular diseases)
•E: over- or under- activity of neurones (psychiatric)
•F: Neoplasm (mainly glia-gliomas).
•G: Others (congenital, infections, acute trauma)
5: Diagnostic aids or tests.
•Electroencephalogram (EEG) –Used to localize areas of brain
dysfunction, identify altered state of consciousness and to establish
death based on different wave patterns(a, b, t, d waves)
•X-ray photography e.g. tumors or Acute injuries (skull)
•Computed or computerized tomography (CT scan)-radiographic
imaging using x-rays. Provide 3-D image of brain. Detects
hemorrhage, tumors, ischemia etc. commonest is CA(axial)T scan
•Positron-emission tomography (PET scan). Similar to CT scanning
but with radioactive substance used. Useful in determining functional
characteristics of different brain regions.
•Single photon emission computed tomography (SPECT). Similar to
PET scan but more powerful-e.g visualize blood flow patterns in
brain.
•Ultrasonography- using sound to bounce off structures
•Diagnostic aids or tests: contn’d
•No harmful radiation & useful in diagnosing tumours or
hydrocephalus in children. Also called echoencephalography.
•Magnetic Resonance Imaging (MRI) or Nuclear Magnetic
Resonance (NMR). No harmful radiation, uses magnetic field to
induce generation of radiowaves by brain tissue. Sharper images than
PET.
•Magnetoencephalography(MEG). Measures brain activity using
biomagnetometer. New technique, very sensitive and accurate.
•Evoked Potential (EP)-similar to EEG but response is induced or
evoked by the clinician and the EEG recorded.
•Psychological Testing or examinations
•Motor tests-EMG
6. Why study CNS drugs?
• Humans most commonly self-administer CNS drugs e.g alcohol,

coffee, nicotine
• Numerous therapeutically important drugs are neuroactive e.g

• a: Anesthetics for surgery
• b: Analgesics for pain
• c: Antipyretics for fever
• d: Anticonvulsants for epilepsy
• e: Drugs for movement disorders & muscle spasms.
• f: Drugs for sleep and arousal.
• g: Drugs for improving or suppressing appetite.
• h: Drugs to induce or suppress vomiting (emetics and anti-
emetics).
• i: Drugs for psychiatric disorders- schizophrenia, mania,
depression, anxiety etc.
• Functionally most complex organ of body. Effect on basic functional

unit  organ or human response understanding the fundamentals is
very IMPORTANT!
Page 25
7. Functional organization:
• Microanatomy: Cellular organization of CNS
• Nuclei: aggregate of neurons performing identical function.
• Three types of arrangements:
• A: Long hierarchical neuronal connectivity e.g. primary

sensory and motor pathways e.g.:
• Visual pathway: retina  primary relay center(lateral
geniculate nucleus) secondary relay center (superior
colliculus)  visual cortex- sequential!
• Auditory system more complicated with up to 5 relays before
reaching the auditory cortex.
• Reverse sequence for motor.
Page 26
• Chain of neurons provides precise flow of information
• Long axons, action potentials and neurotransmission required.
Some transmitters known, others unknown
• B: Local networks- connectivity within nucleus

• Neurons are small and called interneurons
• Regulate activity in microdomains
• May use action potentials and neurotransmitters or NOT (gap
junctions)
• Transmitter mainly GABA and glycine but also glutamate and
neuropeptides
• C: Non-specific or Diffuse systems e.g. include clusters of

neurons in the brainstem (Medulla/Pons). Project to several
regions of brain with relatively little pattern, hierarchy or
sequence.
• Mainly monoaminergic-noradrenergic, dopaminergic and
serotoninergic, also some peptides e.g. vasopressin and
oxytocin.
8. Neuronal communication- Electrochemical

• Action Potential:
• At rest main extracellular ion-Na+ and main intracellular ion
is K+. Cl- follows Na+ and K+ passively to balance charge
• resting membrane potential negative due to preferential
permeability of neuronal membrane to K+ at rest.
Depolarization of membrane Na+ permeability.
• At threshold,  Na+ permeabilityNa+ rushes into the cell
through voltage activated sodium channels moving membrane
potential past 0mV to positive.
• Huge voltage change quickly shuts down Na+ channels  
Na+ permeability. Also activates voltage activated K+ channels
letting OUT K+  decrease in membrane potential –moving
towards rest. Potential overshoots resting potential-AHP
(afterhyperpolarization). Closure of K+ channels & Na+/K+
ATPase activated to help re-equilibrate and establish original
RMP.
• AP spreads from one region of axon to another after initiation
in axon hillock-non-myelinated fibres-SLOW.
• In myelinated fibres, it jumps from node of Ranvier to node of
Ranvier- saltatory-FAST.
• At the synapse a transmitter is released that crosses the synaptic
cleft to act on receptors on the postsynaptic neuron.
• Synaptic Transmission: One or more transmitters may be
released at any one time on arrival of an action potential to the
terminal-co-transmission, co-localization.
• Released transmitter may act on postsynaptic receptors to
activate ligand-activated channels. Cations (Na+, K+, Ca2+) from
outside (extracellular) move into the neuron to cause
depolarization (see AP initiation & threshold). Channel may select
to pass one type of ion.
Neuron Glia
Astrocyte
Ependymal
Synapse
Dr SBK Pathophysiology
332/Pharmacol334-2010
• Transmitters that do this are Excitatory-excite cells
• Classical e.g. are glutamate and acetylcholine
• Transmitters may also act on channels to cause anions (Cl-) to
enter the neuron increasing negativity of potential-
hyperpolarization. Cells are less likely to fire APs
• Such transmitters are called Inhibitory-prevent cell from firing
APs e.g. GABA and glycine.
• When transmission is in 10s of millisecond range (10-3 sec)-fast
transmitter e.g. glutamate, GABA or glycine etc. Responsible
for most synaptic transmission.
• When in 100s of ms-slow transmitter-neuromodulation e.g.
GABA, Glu, dopamine, noradrenaline, serotonin, Acetylcholine
(Ach).
9. Neurotransmitters/neuromodulators:
• Conventional transmitters: ACh, Norepinephrine (NE),
dopamine(DA), Glutamate, GABA/Glycine, serotonin(5-HT).
• All these (except NE & DA) can engage in fast synaptic
transmission when they activate certain receptors (receptor-
ion channels complexes)
• Neuromodulators: Engage in slow transmission e.g. ACh,
Norepinephrine (NE), dopamine(DA), Glutamate, GABA,
serotonin(5-HT), peptides, Adenosine, NO etc.
• Act on another set of receptors (second messenger-coupled
receptors). May employ G-proteins (cyclic guanine
nucleotide binding proteins).
• Act mainly to increase (depolarize excite) or decrease
(hyperpolarize  inhibit) membrane potential.
Page 32
• Summary of general functions of receptors:
• NE ( a & b adrenoceptors)
• Reward system and mood.
• Arousal state-RAS
• Blood pressure regulation
• DA (D1-D5)
• motor control of nigrostriatal pathway
• Complex behavior/cognition-mesolimbic pathway
• Endocrine control-tuberoinfundibular pathway
• 5-HT( 5-HT1-7)
• Hallucinations
• Sleep, wakefulness and mood
• Control of sensory transmission
• Autonomic and endocrine function
• ACh ( nicotinic & muscarinic [1-5])
• Motor control-basal ganglia
• Arousal, learning and memory
• Excitatory amino acids: Glutamate

• N-methyl-D-aspartate (NMDA receptors)
• AMPA/Kainate (non-NMDA receptors)
• Metabotropic receptors (mGLUR1-8).
• Fast synaptic transmission in all brain regions
• Involved in learning and memory (long term potentiation),
excitatotoxicity, pathogenesis of epilepsy.
• Inhibitory amino acids: GABA and Glycine

» GABAA, GABAB, GABAC
• Main inhibitory transmitter in CNS (supraspinal region).
Glycine main inhibitor in spinal cord.
• Pathogenesis of epilepsy, site of action of many CNS
drugs-alcohol, BDZ, antiepileptics, sedatives etc.
10: Sites of action of neuro-active drugs

• Electrical conduction (LA, anticonvulsants)
• Synthesis & Storage (reserpine, amphetamine etc)
• Active uptake( TCA, SSRI)
• Degradation (MAOI, COMT I)
• Release (amphetamines, amantadine)
• Postsynaptic receptors
Page 35
» Antagonists-antipsychotic
» Agonists (bromocriptine)
• Presynaptic (baclofen)
• Autoreceptors- clonidine at a2.
Sources:
1: From Neuron to Brain by Kueffler, Nicholls and Martin
2: The Biochemical Basis of Therapeutics by Cooper, Bloom,
Roth.
3: Pharmacology by Rang, Dale, Ritter & Gardner.
4: The Pharmacological Basis of Therapeutics by Goodman &
Gilman.
5: Fundamentals of Psychopharmacology by B. Leonard.
6: From Molecules to Networks by Byrne and Roberts
Page 36

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Intro.

CNS Pathophysiology & Pharmacology

Prof SBK …Intro CNS-2024

Prof SBK …Intro CNS-2024

• Central Nervous Systems (CNS): structural and functional center

• Peripheral Nervous System (PNS): consist of nerve tissue that lie

• Enteric Nervous System- controls activity of the GIT

•Receives inputs (afferents-sensory), processes and evaluates it, decides

•Responses are either involuntary for homeostasis (Autonomic Nervous

•ANS: information from CNS to autonomic or visceral effectors: smooth

•Somatic Nervous System (SNS): efferents (motor) from somatic

•CSF-provides a cushion for brain and spinal cord. It is clear, colourless

•Blood Brain Barrier (BBB): Helps maintain stable environment in

•Functional areas of the Brain:

•Neurons: excitable cells that generate, and conduct the impulses

•Glia (neuroglia): do not usually conduct but support the functions

•Afferent (sensory) neurons: conduct impulses TO SC and/or

•Neuronal communication: Electrochemical

4: Neurological Diseases: can result from:

• Humans most commonly self-administer CNS drugs e.g alcohol,

• Numerous therapeutically important drugs are neuroactive e.g

• Functionally most complex organ of body. Effect on basic functional

• A: Long hierarchical neuronal connectivity e.g. primary

• B: Local networks- connectivity within nucleus

• C: Non-specific or Diffuse systems e.g. include clusters of

8. Neuronal communication- Electrochemical

• Excitatory amino acids: Glutamate

• Inhibitory amino acids: GABA and Glycine

10: Sites of action of neuro-active drugs

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