Spontaneous hemiballism and disappearance of parksinsonism following contralateral lenticular lacunar infarct

Changing views of the pathophysiology of Parkinsonism

Studies of the pathophysiology of parkinsonism (specifically akinesia and bradykinesia) have a long history and primarily model the consequences of dopamine loss in the basal ganglia on the function of the basal ganglia/thalamocortical circuit(s). Changes of firing rates of individual nodes within these circuits were originally considered central to parkinsonism. However, this view has now given way to the belief that changes in firing patterns within the basal ganglia and related nuclei are more important, including the emergence of burst discharges, greater synchrony of firing between neighboring neurons, oscillatory activity patterns, and the excessive coupling of oscillatory activities at different frequencies. Primarily focusing on studies obtained in nonhuman primates and human patients with Parkinson's disease, this review summarizes the current state of this field and highlights several emerging areas of research, including studies of the impact of the heterogeneity of external pallidal neurons on parkinsonism, the importance of extrastriatal dopamine loss, parkinsonism-associated synaptic and morphologic plasticity, and the potential role(s) of the cerebellum and brainstem in the motor dysfunction of Parkinson's disease. © 2019 International Parkinson and Movement Disorder Society.

GABAergic circuits in the basal ganglia and movement disorders

GABA is the major inhibitory neurotransmitter in the basal ganglia, and GABAergic pathways dominate information processing in most areas of these structures. It is therefore not surprising that abnormalities of GABAergic transmission are key elements in pathophysiologic models of movement disorders involving the basal ganglia. These include hypokinetic diseases such as Parkinson's disease, and hyperkinetic diseases, such as Huntington's disease or hemiballism. In this chapter, we will briefly review the major anatomic features of the GABAergic pathways in the basal ganglia, and then describe in greater detail the changes of GABAergic transmission, which are known to occur in movement disorders.

Unchanged basal ganglia N-acetylaspartate and glutamate in idiopathic Parkinson's disease measured by proton magnetic resonance spectroscopy

The lentiform nucleus of five patients with idiopathic Parkinson's disease (IPD) was studied by quantitative magnetic resonance spectroscopy (MRS), both before and after administration of apomorphine, and the spectra were compared with those from a group of age-matched normal subjects. The concentrations of the three major metabolites, choline, creatine, and N-acetylaspartate (NAA), were quantified using tissue water content as an internal concentration reference. Glutamate concentration was assessed as the (glutamate + glutamine; GLX)/creatine peak area ratio. In normal subjects, the mean +/- SD concentrations of the the three metabolites were 2.4 +/- 0.4 mumol/g wet wt for choline, 11.5 +/- 0.8 mumol/g for creatine, and 14.7 +/- 2.8 mumol/g for NAA. The Glx/creatine ratio was 1.26 +/- 0.12. There was no significant difference in these parameters in the lentiform nucleus of patients with IPD either before or after apomorphine. The absence of detectable differences in IPD in this study implies that the changes in glutamate metabolism in the basal ganglia predicted by animal work are more subtle than those currently observable by MRS.