The sensory receptors and

Somatic sensation
The sensory receptors
▪ Definition : specialized structure at the end of Affrent .
▪ Functions :
1. Detectors : detect changes in the external or internal environment of the body.
2. Transducers : covert the energy of the detected change into electrical impulses.
▪ Classification of receptors according to the type of stimulus: :
1) Mechanoreceptors (stimulated by mechanical stimuli):
 Touch, pressure and vibration receptors (the skin).
 Proprioceptors (muscles, and tendons) and relay formation about length and tension.
 Baroreceptors (the aortic arch and carotid sinus).
 Stretch receptors (alveoli of the lungs and right atrium).
2. Thermoreceptors (stimulated by changes in temperature):
 Cold and Warm receptors.
3. Nociceptors (pain receptor): (stimulated by tissue damage).
4. Chemoreceptors (stimulated by chemical composition of the environment):
 Taste and smell receptors.
 Glucoreceptors and Osmoreceptors (the hypothalamus).
5.Electromagnetic receptors (stimulated by electromagnetic waves of light):
 Rods & cons (retina of the eye).
▪ Properties of receptors :
① specificity (Differential sensitivity )
 Muller’s law : Each receptor is most sensitive to one specific type of stimulus called
adequate stimulus giving rise to one type of sensation regardless method of stimulation
 modality of sensation : The sensation perceived as a result of stimulation of a receptor
It depends on the area in the brain ultimately activated.
 Some receptors can be stimulated by stimuli other than their adequate stimulus provided
the intensity of stimulation is sufficiently high, but will still be giving its own specific
modality of sensation.
② Excitability (receptor or generator potential ):
 Definition : the ability of the receptor to respond to stimuli.
a. In the resting condition :
- the receptor is in a polarized state (outer surface : +ve , inner surface : -ve )
- resting membrane potential (RMP) = -70 mv.

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 b. On stimulation:
1. receptor or generator potential : it is local, graded potential
+ +
- Cause : opening of Na channels in the receptor membrane lead to Na inflow .
2. When the receptor potential reaches the threshold value, action potentials are
generated in the first node of Ranvier of the afferent sensory fiber.
3. increase in the amplitude of the receptor potential produced by increased stimulus
intensity causes increase in the action potential frequency in the afferent sensory fiber
 comparison between the Properties of receptor potential & action potential :

③ Adaptation
 Definition : the decrease in number of nerve impulses (action potential) due to decline
in the amplitude of the receptor potential by a constant maintained stimulus .
 Types of adapting receptor according to the rate of adaptation :

 Mechanisms of adaptation due to one or more of the following mechanisms :

1. Loss of the stimulus energy in the surrounding tissues in the surrounding tissue by
constant stimulation
2. Gradual decrease of the excitability of the first node of Ranvier.
3. Accommodation of the afferent nerve fiber to the receptor potential this probably
due to Progressive "inactivation“ of the sodium channels in the nerve fiber membrane

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▪ Coding of sensory information:
 Definition : the ability of the brain to discriminate the modality, locality and intensity of
different stimuli although all sensations reach the brain in the form of nerve impulses.
a. Modality discrimination depends on :
1. the differential sensitivity of the receptors.
2. adequate stimulus to which the receptor is specialized
3. the area of the brain ultimately activated.
b. Locality discrimination (projection ):
- each receptor has specific pathway to the sensory cortex where different parts of body
are represented
- Stimulation of a sensory pathway anywhere along its course to the sensory cortex produces
sensation referred to the location of the receptor.
c. Intensity discrimination
 depends on :
1-

1. the frequency of discharge of action potentials (nerve impulses) in the sensory fiber.
2. the number of receptors stimulated
 stronger stimuli tend to :
Increase action potential frequency and stimulate a greater number of receptors

The Somatic sensation

① Tactile Mechanoreceptive sensation include

a. Touch sensation : the ability to localize physical contact with skin while the eyes are closed.
 2 type :
I. Light touch: touch sensation that is not sharply localized
- results from stimulation of tactile receptors in the superficial layers of the skin.
- tested using a piece of cotton wool on different dermatomes.
II. Tactile discrimination (2 point discrimination):
the ability to perceive, with closed eyes, two touch stimuli applied to the skin at the same
time as two separate points of touch provided that the distance between the two points
is more than a certain threshold variable in different areas of the body.
B. Pressure sensation : the ability to discriminate different weights
- results from stimulation of tactile receptors in deeper layers of the skin. .
C. vibration sensation : results from rapidly repetitive sensory signals from tactile receptors

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② Proprioceptive (kinaesthetic) sensations
A. Conscious proprioception:
- includes : the sense of joint (position & movement).
- Site of receptors : in the joints provide sensory Information to the cerebral cortex which in
turn ,uses this information to generate conscious awareness of the orientation of different
parts of the body to each other.
B. Unconscious proprioception:
- includes : the senses of muscle ( length and tension).
- The impulses arising from the proprioceptors are relayed to cerebellum & serve
information about the momentary state of muscles contraction, degree of tension &
length of muscles.

 Cutaneous thermoreceptors :
 definition : specialized free nerve endings
 Site : found with highest density in the skin of the hands and face.
 include :
a. Cold receptors (cool receptors) :
- respond to temperatures between 10- 35C° and are normally silent above 40 C°
- at 45°C , may give a brisk discharge producing false cold sensation (paradoxical cold).
b. warmth receptors
- respond to temperatures between 35- 45C°
 Function : monitor skin temperature not body temperature .
(useful in detecting changes in external environmental temperature).
 innervated by Aδ and C fibres that travel to the brain together with pain sensation
 This information reaches the hypothalamus (the heat regulating center) to initiate
nervous and humoral mechanisms for maintaining constant body temperature
 N.B :
- cold-pain respond to temperatures between 0°C - 10°C
- hot-pain respond to temperatures between above 45° C
- At 0°C all receptors stop discharging, a fact made use of cold for local anaesthesia

‫ﺳوف ﯾﺗم ﺷرﺣﮫ ﻓﻲ ﻣﺣﺎﺿرة ﻣﻧﻔﺻﻠﺔ‬

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 Ascending tracts for Somatic
sensation
▪ Common Features within each somatosensory pathway :
 Sensory (afferent) fibers from the receptors enter the CNS via :
1. the spinal dorsal nerve roots (for sensations from the body)
2. the trigeminal root (for sensations from the face) .
- with the nervous pathways conducting impulses to the higher levels of the CNS referred
to as the ascending tracts.
 the first order neuron for all sensations being the cell bodies in the dorsal root ganglia or
the trigeminal ganglion which have their sensory afferent nerves.
▪ Ascending tracts for Somatic sensation :

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◼ transmits the following sensations:
1. Light touch.
2. Two-point discrimination.
3. Pressure & Vibration sense.
4. Conscious proprioceptive sensations (limb and joint position).
◼ Pathway
a) First order neuron (dorsal root ganglion)
 Aα and Aβ fibres mediating the sensations enter the spinal cord via the dorsal nerve roots
and pass to the dorsal white column on the same side giving off collaterals that pass into
the dorsal horn of grey matter and then ascend in the white matter tracts without relay : -
1. Fibres from the lower half of the body (below T6) :
- ascend ipsilaterally in the most medial part of the dorsal column till relaying in the gracile
nucleus in the medulla oblongata forming the fasciculus gracilis .
- These fiber found in all spinal levels & carry sensation from the skin and muscles of the
lower limbs and inferior aspect of the trunk
2. fibres from the upper part of the body (above T6)
- ascend ipsilaterally in the lateral part of the dorsal column till relaying in the cuneate
nucleus in the medulla oblongata forming the fasciculus cuneatus.
- These fiber found only at upper thoracic and cervical spinal cord levels and conveys
sensation from the skin and muscles of upper trunk, upper limb, neck and posterior scalp.
b) Second order neuron (gracile and cuneate nuclei)
- Axons of gracile & cuneate nuclei cross to the opposite side as the internal arcuate fibers
- then ascend as the medial lemniscus to relay in the ventral posterolateral nucleus (VPL)
of the thalamus .
c) Third order neuron (VPL nucleus of the thalamus)
- Axons of these cells ascend as the sensory radiation and terminate in the sensory area of
cerebral cortex in postcentral gyrus of the parietal lobe.
◼ Deficits after lesions in the dorsal column pathway may lead to :
1. sensory ataxia:
loss of proprioceptive sensation → unable to identify the position of their limbs in space
when their eyes are closed do not know if one of their joints is in flexion or extension .
2. paresthesia (abnormal sensation in the form of tingling or numbness)
3. loss of tow-point discrimination, vibration and pressure sensations
4. astereognosis : can’t identify the shape, size or texture of objects in their hands by touch .

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◼ transmits the following sensations:
1. Pain and temperature.
2. Itch (produced by stimulation of pain receptors due to tissue irritation).
◼ The second order neuron of the anterolateral system forms the following pathway :
 Pathway of spinothalamic tract & spinoreticular tract :-
a) First order neuron (dorsal root ganglion)
I. the burning or aching or slow pain is transmitted by slowly conducting C fibres.
II. The fast pricking pain is transmitted by Aδ fibres
 These fibers enter the spinal cord along the dorsal nerve roots to relay in the dorsal
horn cells.
b) Second order neuron (dorsal horn cells)
 From the dorsal horn cells , the fibers cross to the opposite side close to the central
canal at all levels of the spinal cord and ascend to the brainstem.
I. The spinoreticular tract (paleospinothalamic): Fibres carrying slow pain & temperature
pass to the reticular formation then to the intra- laminar thalamic nuclei in directly .
Some Fibres carrying slow pain terminate in different brain stem areas
II. The spinothalamic tract (neospinothalamic) : fibers carrying fast pain pass to the ventral
posterolateral nucleus of the thalamus directly.

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 c) Third order neuron.
I. The fibers from the intralaminar thalamic nuclei :
- associated with arousal they project to insular cortex which keeps memory of the
stimulus that resulted in pain.
- the anterior cingulate gyrus & other parts of limbic system which process emotional
content of pain.
II. The fibers from the ventral posterolateral nucleus of the thalamus :
project to the somatic sensory area in the post central gyrus which is responsible for the
discriminative aspect of pain.
 Pathway of The spinomesencephalic tract :-
this pathway activates neurons in the periaqueductal grey which suppress pain.

◼ transmits the following sensations: unconscious proprioceptive sensations.

◼ They include :
 Pathway of Dorsal spinocerebellar tract :-
a) First order neuron (dorsal root ganglion)
- The thick myelinated Aβ fibers of the dorsal root ganglia enter the spinal cord along the
dorsal nerve roots fibers to convey information from the muscle spindles and Golgi
tendon organs in the skeletal muscles in the lower limbs.
- This fiber relay in Clarke's nucleus at the base of the dorsal horn from T1 through L3
spinal segments .

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 b) Second order neuron (Clarke's column neurons)
- Fibers ascend from Clarke's column neurons on the same side of the spinal cord in the
posterolateral column of white matter up to the medulla.
- Then pass through the inferior cerebellar peduncle to terminate in the cerebellar cortex.
 Pathway of Cuneocerebellar tract :-
a) First order neuron (dorsal root ganglion)
- The thick myelinated Aβ fibers of the dorsal root ganglia enter the spinal cord along the
dorsal nerve roots fibers to convey information from the muscle spindles and Golgi
tendon organs in the skeletal muscles in the upper limbs.
b) Second order neuron
- Fibers ascend on the same side of the spinal cord in the posterolateral column of white
matter to relays in the accessory cuneate nucleus in the medulla .
- Then pass through the inferior cerebellar peduncle to terminate in the cerebellar cortex.
 Pathway of Ventral spinocerebellar tract :-
⚫ it conveys information to the cerebellum about activity occurring in the motor tracts
a) First order neuron (dorsal root ganglion)
The thick myelinated Aβ fibers of the dorsal root ganglia enter the spinal cord along the
dorsal nerve roots.
b) Second order neuron
- The second order neurons of this pathway arise from the grey matter of the spinal cord
and receive a diverse input from proprioceptors and the descending tracts.
- The fibers travel anterior to the dorsal spinocerebellar tract with :
1. some fibers (from upper limb) ascending on the same side to midbrain through the
superior peduncle to terminate in cerebellar cortex.
2. others fiber (from lower limb) crossing to the opposite side & ascend to the midbrain,
where re-cross and pass with the uncrossed fibers through the superior peduncle to
terminate in the cerebellar cortex.

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 a) First order neuron (trigeminal ganglion )
Carries the touch, proprioception and pain and temperature sensation from the face.
b) Second order neuron (trigeminal sensory nuclei )
- These fibers relay in the 3 trigeminal sensory nuclei in the brainstem .
- Each receives a different type of sensory information.
- The fibers Carries fast pain and temperature information from the face relay in the spinal
trigeminal nucleus then cross and ascend in the trigeminal lemniscus to the thalamus.
c) Third order neuron (thalamus)
- terminate in the sensory area of the cerebral cortex in postcentral gyrus of parietal lobe.

 Spino-olivary tract
 ascends from the cervical cord to the tectum of the midbrain. .
 function : motor learning and modifying motor actions
 Spino-tectal tract
 ascends from the spinal cord to the inferior olivary nucleus in the medulla.
 function : integration of spinal (head /neck reflexes) with visual and auditory stimuli

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 Sensation
Pain sensation
- un pleasant sensory and emotional experience associated with actual or potential tissue damage
[ Pain receptors (Nociceptors) ]

- sensory receptors in the free nerve endings, Detect signals from damaged tissue (stimulus).

Mechanosensitive Thermosensitive Chemically sensitive Polymodal pain

pain receptors pain receptors pain receptors receptors
0 stimulus: intensive 0 StimUlUS 1 Various ’ stimulus: high
pressure applied to skin . _ chemicals e.g. intensity mechanical,
hOt Pam cold pain — bradykinin thermal (hot and cold)
~_ “S. recfaplors reCEptorS - histamine or chemical stimuli.
5"“ ° “mums: 0 stimulus : -lactic acid (high acidity)
if?) temp. ’ 45°C temp. (0 ' 10°C) -proteolytic enzymes
A -serotonin
\ - prostaglandins
P environmental irritants

[ Types of pain ]

Neuropathic pain Nociceptor pain

Due to disease of peripheral.
cranial nerve or CNS. Somatic pain

1—
0 Types

- Site of pain receptor : the skin and subcutaneous tissue

- types:

[ Fast pain (epicritic pain Slow pain (protopothic pain ) ]

skin & parietal coverings layer source Skin . deep tissue and viscera
short duration Duration long duration
pricking Property burning or dull aching
immediate pain onset delayed pain
well localized localization poorly localized
Myelinated A5 fibers Affrent unmyelinated C fibers
neospinothalamic tract tracts paleospinothalamic tract
Cerebral cortex centre thalamus
glutamate neurotransmitter substance P

- Site of pain receptor : muscles. ligaments. tendons and periosteum of bones

- properties:
1. poorly localized. dull aching
2. commonly associated with parasympathetic effects such as bradycardia. hypotension.
nausea & vomiting

11 CNS physiofogy
0 Reactions (effects) of somatic pain :
1
Fast pain initiates the withdrawal reflex which takes the body away from the noxious stimulus.

—Cutaneous pain : associated with sympathetic effects (e.g. vasoconstriction. tachycardia &’LTABP)
— Severe cutaneous pain and deep pain: associated with parasympathetic effects
(e.g. vasodilatation. bradycardia and hypotension).

3
e.g. crying, restlessness and anxiety due to stimulation of the limbic system

4
') Hyperalgesia: fifisensitivity to pain
- Causes: often accompanies various inflammatory conditions of skin.
- Types : try and 2ry hyperalgesia

[ 1ry hyperalgesia 2ry hyperalgesia ]

in area of red inflamed or injured (flare) in the healthy skin around injured (flare)
skin area. area

1. painthreshold is lowered 1. painthreshold is not lowered

2. non- painful stimulus e.g. touch is felt changes 2. painful stimulus is felt as severe pain
as painful and prolonged than normal.

. the diffusion of pain producing substances ) Convergence facilitation theory

e.g. histamine, proteolytic enzymes, kinins (D Convergence: afferent from both area skin
Mechanism

from injured skin area to neighboring health injury and area of secondary hyperalgesia
5km converge on the same dorsal horn neurons
. . <2) Facilitation: fit) excitability of dorsal horn
Resulting In cells following tissue injury (central
1 asod'latat'on redness
) v I
2) lowering theI threshold
( ) pain receptors
of sensitization) 9 (postsynaptic facilitation).
in this area (sensitized nocicept'orsi);i
’ Resulting in : exaggerated pain sensation

Mechanism of hyperalgesia
- - _ - ~ -7. a -: - ainful Pain
\ : -:"—‘-
a; ~. Fa :;1
_ —4-‘_ sltjimulus threshold
-
-_
-
-
-_ ~~ .1 :' .1‘ ‘ Site oftissue injury

“'
{J (I) k ‘ ‘ ‘ I
P""""“ sensitized nociceptors
Br.- lagla din
\1asl crll or _ _
"eunuphu non- painful stimulus
diffusion of pain \-[ Pain
Substances \ threshold
rom injured area
area of 1ry hyperalgesia
Blood
v rsxvl
/ central sensitization at"? .d
, t res a

Su l‘~l.In-;e I'

l)()r\.ll rtnnl .
ganglinn Pain
7‘ “K . _ ' painful
«a II I I\ \\: .v . < / stimulus threshold
Spiq ‘1)rxi
area of 2ry hyperalgesia

12 CNS physiofogy
2—
. Types :
[ true visceral pain A ‘ parietalvisceral pain ]
in the viscera itself Site of in the parietal coverings layer
i‘empm" (pleura, peritoneum and pericardium)
Few pain receptor
richly supplied with pain receptors
Some viscera contain no pain receptor
msenSItIyerEa pam l‘v-ltm‘iber of
.\
’ receptor

5/
brain lung‘s alveoli liver parenchyma

autonomic visceral afferents (C-fibers) somatic afferent (A6 fibers )

o sympathetic nerves (thoraco—lumbar): e.g. the phrenic and thoracic intercostals
- thoracic and upper lumbar dorsal roots. nerves
(The cell bodies are located in dorsal root ganglia)
e parasympathetic nerves (cranio-sacral): Atlre m
a. cranial nerve : facial, glossopharyngeal, and
vagus nerves
(cell bodies are located in cranial nerve ganglia)
b. sacral dorsal roots
(cell bodies are located in the dorsal root ganglia)
dull aching and poorly localized Pain sensation sharp, severe and better localized

0 Causes of visceral pain:

1;

0 Causes of ischemic pain:

0 compression of blood vessels supplying the viscera as in case of:
1. Spasmodic contraction of hollow viscera as the uterus or intestine
2. overdistension e.g. urinary bladder over filling.
a thrombosis of blood vessels supplying the viscera as in case of
coronary thrombosis.
O mechanism of ischemic pain:
Insufficient blood supply to a viscus

accumulation of metabolites as lactic acid releases paIn-producmg substances

due to tissue damage
L————> Excite nociceptor and produce pain {—4

.1 '

0 Characters of visceral pain :

‘1
contraction of muscles of the anterior abdominal wall, which
helps to protect the underlying visceral structures.

— associated with parasympathetic effects a

(e.g. bradycardia, hypotension, nausea and vomiting).

13 CNS physiofogy
l Definition:
Irritation of the visceral organs frequently produces pain that is felt not at that site but in some
somatic structures that may be a considerable distani
l Examples : 0's "\

- Cardiac pain is felt at the inner part of left arm ‘ 4;

and left shoulder. ' ‘
Liver and \
gallbladder —, Heart
\ .4 .
P . . . f dt b-‘l l fl Stomach
- am in ovary IS re erre o um I ICUS . / pancreas
l
l
. . . Appendix— -
- Pain from testis IS felt In abdomen. 7- , 7 lea-”4*" (”was
.
fi—r §/—-V , (iemale)

/ .. \,_‘ ——Kidney
. / L \

f / v , vUnnary
. , Q i.‘ ' bladder
' i
Ureter—/ ‘1

l Mechanism of referred pain:

0 dermatomal rule :
- when pain is referred, it is usually to a structure that developed from the same embryonic segment
or dermatome as the structure in which the pain originates.
'dermatome includes all the structures or parts of the body which are innervated by afferent nerve
fibers of one dorsal root.
- For example:
a. the heart and arm have the same segmental origin.
b. the testicle migrated with its nerve supply from the primitive urogenital ridge from which the
kidney and ureter also developed.
9 convergence-facilitation theory ( central sensitization) :
- The afferent fibers from both somatic structure and viscera converge on same second-order
neurons in the dorsal horn that project to the thalamus & then to somatosensory cortex.
- The somatic nociceptive fibers are normally not activated, but when the visceral stimulus facilitates
the same second order neuron, the somatic fiber activity is transmitted as well to brain
- the brain cannot determine whether the stimulus came from viscera or from the area of referral
- The brain refers the pain to the somatic structure, since, it is accustomed to perceive pain from

body surface
Pain interpreted as
originating In distrlbmion
of somatic sensory nerves

Convergence theory

x t. viscera

3 "mo/q /
E J

Somuk
body surface

Facilitation theory
Patient perceives
iffusepaln In
1" 4 dermatome

viscera
dermatomal rule | | convergence-facilitationtheory(centralsensitization) l

14
CNS physiofogy
a Neuropathic pain )
l Definition:
- persistent pain not due to stimulation of pain receptors
l Mechanism :
- persistent pain that arises from functional changes occurring in CNS secondary to peripheral nerve injury
- After chronic nerve injury, there is redistribution and alteration of compositions of sodium and calcium
channels in peripheralnerves resulting in sensitivity and spontaneous firing of neurons.
l Characters of neuropathic pain:
1. shooting, stabbing often devastating pain
2. Common qualities include "pins and needles" sensations and numbness.
3. severe and difficult to treat.
I Causes of neuropathic pain:
1. Diseases of peripheral nervous system:
a. Diabetes mellitus (diabetic neuropathy).
b. Herpes zoster infection.
c. Side effect of chemotherapy.

2. Diseases of the central nervous system:

- strokes and injuries of the spinal cord.

1-

15
—O CNS physiofogy
 pain control mechanisms
- The transmission of information from pain afferents to secondary neurons in the spinal cord is
not a passive process but is dynamic involving excitation, Inhibition and modulation
- Neurons in dorsal horn are subjected to modulation that gates the flow of information to CNS
Gating (Pain control) occurs at 2 levels

at the spinal cord level At a higher level using the descending

pathways from the brainstem
ž this explains the analgesia produced by : ž this explains :
a. rubbing or shaking an injured area a. stress analgesia
b. counter-irritants. b. morphine-induced analgesia
c. acupuncture

- The gate theory suggests : § Opiate analgesia (OA):

non-noxious (cutaneous) input suppresses pain
or "closes the gate to noxious Input.
- Cutaneous stimulation by rubbing the skin →
activates large diameter myelinated afferents
(AB) associated with mechanoreceptors →
increasing inhibitory interneuron activity →
close the gate to noxious input
- The most effective clinically used drugs for
producing temporary analgesia and relief
from pain are the opioid family.
- The brain has neuronal circuit & endogenous
opioid system (endorphins and enkephalins)
to modulate pain.
These substances act on opioid receptors.

interneuron

16
 Cerebral cortex

17
 motor homunculus Sensory homunculus

SOMATOSENSORY AREAS
1) Somatosensory area I (S1)

18
2) Somatosensory area II (S2)

3) Somatosensory association area (areas 5 and 7)

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 MOTOR AREAS
1) Primary motor area (area 4)
◼ Site: precentral gyrus (Brodmann's areas 4).
◼ Characteristics:
1) It contains large highly excitable cells (Betz cells)
2) Body representation :
- Crossed inverted with same somatotopic map similar to sensory cortex
- Upper part of face, respiratory muscles & abdominal wall muscles are bilaterally represented
- The size: directly proportional to complexity of its function not to its size
{ Trunk and legs (small) < hands & muscles of speech (large) }
◼ Function:
1. Initiation of fine isolated (discrete) movements of distal
part of the limb (hands, fingers) opposite side of body
2. Facilitatory to superficial & deep spinal reflexes (e.g.
stretch reflex).

2) Premotor area 6
◼ Site: anterior to the precentral gyrus
◼ Characteristics:
1. Contains a somatotopic map of the body.
2. The body representation is roughly the same as that of primary motor area.
◼ Function:
1. Initiates gross movements on the contralateral limbs &
concerned with control of posture.
2. Shares together with the basal ganglia and cerebellum in
initiation of automatic associated subconscious
movements like, swinging of the arms during walking.
3. Involved in planning of voluntary movements.

3) Supplementary motor area (SMA)

◼ Site: anterior and superior to area 6 on the medial surface of the frontal lobe.
◼ Characteristics:
1. The body representation is bilateral and horizontal.
2. Less excitable than area 4.
◼ Function:
1. Coordinates contraction of many muscles to provide background for performance of fine
movements.
2. Involved in bilateral movements.
3. Involved in planning of voluntary movements.

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 Prefrontal Association Area
◼ Site: Anterior part of the frontal lobe; in front of area 6.
(Brodmann's areas 8, 9, 10, 11, 12, 13, 44, 45, 46, 47)
◼ Characteristics:
- Not involved directly with sensory perception or execution
of motor actions
- Receives, analyses &integrates signals from (motor,
sensory cortex & subcortical structures) therefore it is
considered as one of the cortical integrative areas.

Areas Involved In Language

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22
 MOTOR DESCENDING TRACT

MOTOR DESCENDING TRACT

- Origin : the cerebral cortex.

- Carrying : motor fibers to the spinal cord and brainstem.
- termination: ventral horn cells (AHCS) of the spinal cord either directly or indirectly
through interneurons
- Function : voluntary control of the muscles of the body and face.
- N.B :
1. The cells controlling the distal portions of the limbs represented most laterally.
2. The cells controlling the proximal portions represented more medially.
- Effect of lesion of pyramidal tract:
 Strokes of the motor cortex or corticospinal tracts are common.
 Their immediate consequences are paralysis of fine movements on contralateral side.

- TYPES :

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1) The Corticospinal Tract
▪ Originate in : cerebral cortex
a. 60 % of fibers: their cell bodies in primary motor
cortex (in precentral gyrus) & premotor area.
b. 40 % of fibers : their cell bodies in Primary and
secondary somatosensory cortical areas
▪ Axons of the corticospinal tract leave the
cerebral cortex in corona radiata → then they
narrow as they descend to pass through the
internal capsule → Descent through ventral part
of the midbrain, pons and medulla → In medulla
the fibers collect forming the medullary pyramid.
▪ Terminate in the ventral horn anterior horn cells
(AHCS) of spinal cord either directly or indirectly

A. Lateral (crossed) corticospinal tract :

- 80 % of fibers cross to contralateral side
(motor decussation) → continue in the
contralateral side of the spinal cord →
terminating on the alpha motor neurons
- Function : controlling skilled movements.

B. Ventral (uncrossed) corticospinal tract :

① 14 % of fibers cross to contralateral side
Function : supplying proximal and axial muscles on contralateral side
② 6% of the fibers continues on the same side
Function : supplying proximal and axial muscles on the same side .

2) Corticobulbar tracts
▪ Origin : face motor area .
▪ Descend as collaterals from corticospinal tract
▪ Terminate on the brainstem motor nuclei bilaterally
except the lower part of facial nucleus & hypoglossal
nucleus which receive fibers only from the opposite side.
▪ Function : supply muscles of the face, head & neck except
extraocular muscles

3) Corticonuclear tract
▪ Origin: frontal eye field area
▪ Terminate on motor cranial nerve nuclei III, IV & VI cranial nerve.
▪ Function : supply the extraocular muscles

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- Origin : brainstem.
- Receive input from premotor areas, basal ganglia & cerebellum
- Carrying : motor fibers to the spinal cord .
- Termination : ventral horn cells (AHCS) of the spinal cord either directly or indirectly
through interneurons
- Function :
1. Automatic (subconscious) muscle control to support muscle tone, balance, posture
& equilibrium.
2. Controlling the gross coordinated movements involving groups of muscles.

- TYPES:

25
26
• Communication between neurons in the CNS occurs through Synapses.
• DEFINATION:
Specialized functional junction between two neurons
(axon terminal of presynaptic and postsynaptic)

• TYPES OF SYNAPSES:
1) Electrical synapse → extremely rare in nervous system.
- the membranes of the presynaptic and postsynaptic neurons come close together
forming areas of fusion called gap junction.
- In these junctions the opposing membranes are held in position by connecting protein
channels called connexon, which contain pores that permit ions to pas directly from one
cell to the other.
- Importance: allows rapid direct conduction of electrical potential from one neuron to
the next as if no membrane barrier exists.
2) Chemical synapse → Almost all synapses in CNS are chemical synapses.
The impulses in the presynaptic axon causes secretion of a chemical transmitter at the
synapse which act on receptors located in the membrane of post-synaptic neuron →
modify its activity either exciting or inhibiting it depending upon the nature of
postsynaptic receptors.

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 Mechanism Of Neurotransmitter Release From Synapse
- When action potential arrives at the synaptic knob Opening of voltage-gated Ca+2
channels Ca+2 influx into synapse due to  permeability of the knob to Ca+2
Depolarization occurs Release of the neurotransmitter by exocytosis at the
synapse Neurotransmitter diffuses through the synaptic cleft and binds to receptor
molecules on the postsynaptic membrane This binding lead to opening of chemical-
gated channels for specific ions which are allowed to pass the membrane causing local
change in membrane potential of post synaptic neuron (polarized state) [ RMP = -70mv].
- The neurotransmitter released at the synapse will lead to either:
1) Excitatory neurotransmitter e.g. acetylcholine, noradrenaline , serotonin , glutamate
, aspartate.
2) Inhibitory neurotransmitter e.g. GABA , glutamate & glycine .

✓ Electrical events in excitatory synapses :

- Binding of the excitatory transmitter to postsynaptic receptors increases the
permeability of the postsynaptic membrane to all ions, Especially Na+ .
- The Na+ influx results in slight depolarization of the postsynaptic neuron, which will
increase excitability and bring it closer to threshold ( -59 mv).
- This change in voltage above RMP is called excitatory postsynaptic potential (EPSP).
✓ Electrical events in inhibitory synapses :
❶ Postsynaptic inhibition:
- Binding of the inhibitory transmitter to postsynaptic receptors increases the permeability
of the post-synaptic membrane to K+ and Cl-.
- The K+ outflux & Cl- influx increases the intracellular negativity  state of
hyperpolarization at the postsynaptic neuron causing its inhibition.
- This hyperpolarization state is called the inhibitory postsynaptic potential (IPSP).
❷ Presynaptic inhibition:
- Special interneurons terminate on excitatory presynaptic terminals of other neurons
forming axo-axonic synapses to inhibit the presynaptic terminals by :
- Release the inhibitory neurotransmitter GABA which inhibits the release of the excitatory
transmitter from the excitatory presynaptic fiber  decreasing the postsynaptic response.

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CENTRAL EXCITATORY AND INHIBITORY STATE
- Most postsynaptic neurons are covered with thousands of synaptic knobs derived
from a large number of presynaptic neurons.
- Some of presynaptic inputs are excitatory while others are inhibitory to
postsynaptic neuron.
- If a neuron, at a given instant, receives excitatory
impulses > inhibitory impulses , there will be central
excitatory state , in which the neuron is depolarized.
- If a neuron receives inhibitory impulses > excitatory
impulses, there will be central inhibitory state, in
which the neuron is hyperpolarized.

FACTORS AFFECTING SYNAPTIC TRANSMISSION:

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 CHARACTERISTICS OF SYNAPTIC TRANSMISSION:
❶ Forward conduction:
The impulses are conducted only in one direction from the presynaptic to the
post- synaptic neuron
❷ Summation :
- Single EPSP is not sufficient to stimulate the postsynaptic neuron.
- The effects of Several EPSP must add up or summate to increase the excitability
of the postsynaptic neuron to the threshold level to propagated action potential.

o There are two types of summation:

1. Temporal summation:
Stimulation of a single presynaptic fiber
repetitively, provided the interval between
stimuli does not exceed 15 msec .
2. Spatial summation:
Stimulation of several presynaptic fibers that
converge postsynaptic neuron simultaneously
❸ Synaptic delay :
• When impulse reaches the presynaptic terminals, there is an interval of, at least,
0.5 millisecond before the response is obtained in the postsynaptic neuron.
• This time is needed for :
1. Release of the neurotransmitter
2. Diffusion of neurotransmitter across the synaptic cleft.
3. Binding of neurotransmitter to the post-synaptic receptors.
4. Na+ influx to produce the EPSP and summation of the EPSPS to threshold value.

❹ Synaptic fatigue:
• Mechanism: Repetitive stimulation of the presynaptic fibers at a rapid rate, leads at first
to maximal discharge from postsynaptic neuron then gradually decreases.
• Causes: exhaustion of the neurotransmitter stores in the synaptic knobs.
• Importance: protective mechanism for preventing excess neuronal activity e.g. cessation
of an epileptic fit which would otherwise be fatal.
❺ Synaptic plasticity:
• The ability of the synapse to change in strength in to either use (strengthened) or
disuse (weakened) on the basis of past experience.
• These changes are of great interest because they represent forms of learning and
memory.

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• TYPE OF CHANGES OF SYNAPTIC PLASTICITY

❶ Habituation:
- Decrease in response to a stimulus when that stimulus is presented repeatedly.
- it is a form of negative memory.
- Mechanism of habituation:
repeated presynaptic stimulation intracellular calcium less release of
neurotransmitters from the presynaptic terminals gradual decrease in the
postsynaptic response .
❷ Sensitization:
- Enhanced response to stimulus after the presentation of another intense or noxious
stimulus E.g. animal responds more vigorously to mild tactile stimulus after it has
received painful pinch.
- Mechanism of sensitization:

❸ Long term potentiation (LPT): (converting short memory into long memory)
- Enhancement of the postsynaptic potential response to rapidly repeated stimulation
of the presynaptic neuron for a brief period
- Site : occurs in many parts of the nervous system but has been studied in greatest
detail in the hippocampus where the excitatory neurotransmitter is glutamate.
- Glutamate has 2 types of ionotropic receptors:
a. NMDA receptors which typically allow small amount of Ca+2 influx & blocked by Mg+2.
b. AMPA receptors which typically allows Na+ influx & depolarizes postsynaptic cell

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Mechanism of LPT :
- During induction of LTP , strong stimulation occurs at the synapse which opens a large
number of AMPA receptors  Generating an EPSP that is sufficient to trigger a
postsynaptic action potential.
- The action potential generates large depolarization that is able to expel Mg+2 from the
pore of the NMDA receptor .
- Permitting Ca+2 influx in postsynaptic which activates several signaling pathways
which allows :
▪ Insertion more AMPA receptors in postsynaptic membrane (more sensitive to glutamate)
▪ Sends signal to presynaptic membrane asking presynaptic cell to release more glutamate.
- These changes enhance response of the postsynaptic cell to glutamate and increase
the amount of glutamate released from the presynaptic cell.

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