Pathophysiology of Extrapyramidal Syndrome

Pyramidal arrangement 
All the motor neuron impulses are channeled directly to the lower motor neuron ( LMN ) or , through its interneurons belonging to the group of upper motor neuron ( UMN ) . These neurons are residents presentralis gyrus . Therefore , it is called the motor cortex gyrus . They are in the fifth layer and each has a relationship with a particular muscle movement . The axons through contacting motoneuron motor cortex neurons that form the motor nucleus of cranial nerve and motoneuron in anterius medulaspinalis horn .

Aksons redact corticobulbar and corticospinal  pathway . As the nerve bundles that they compact down from the motor cortex and in the thalamus and ganglia basalia level they are in between the two buildings , known as the internal capsule .
Throughout the brain stem , the fibers corticobulbar them to leave the area and ended up crossing the center line directly in motorneuron motor cranial nerve or the side contralateral interneurons . Most of the fibers corticobulbar ended in cranial nerve nuclei ipsilateral side of the motor as well .
On the border between the medulla oblongata and spinal cord , fibers mostly corticospinal  pathways intersect and form the lateral corticospinal  running in funiculus posterolateral kontralateralis . Most of them do not cross but went on a trip to the spinal cord in the ventral funiculus ipsilateralis and corticospinal  pathway known as the ventral or ventral pyramidal tract .

The composition of extrapyramidal
The composition consists of extrapyramidal corpus striatum , globus palidus , thalamic nuclei , nucleus subtalamikus , substantia nigra , reticular formatio brain stem , cerebellum following the supplementary motor cortex , the area 4 , area 6 and area 8 . these components are connected to one another by the axons of each component . Thus there is a circular path known as circuits . Therefore, the corpus striatum is a single recipient of all the fibers of the neocortex , the track circuit is called striatal circuits consisting of primary striatal circuits ( principal ) and 3 supporting striatal circuits (accessories ) .
Principal striatal circuits composed of three chains , namely ( a) the entire neocortex relationship with the corpus striatum and globus palidus , ( b ) the relationship of the corpus striatum / globus palidus the thalamus and ( c ) the relationship of the thalamus with the cortex area 4 and 6 . The data arrived throughout the neocortex as if delivered to the corpus striatum / globus palidus / thalamus to be processed and the results of the processing of a material feedback for motor cortex and supplementary motor cortex . Therefore, the composition of components other extrapyramidal construct circuits feeding circuit which is essentially the main striata , the circuits are called asesorik striatal circuits .
First asesorik striatal circuit is a circuit that connects the stratum - globus palidus - thalamus - striatum . Asesorik second - striatal circuit is the path that circles the palidus globus - globus - corpus subtalamikum palidus . And finally the third asesorik circuit , which is formed by the encircling relationship nigra - striatum - substantia striatum .
Generally all neuroleptics cause extrapyramidal dysfunction due to some degree of inhibition of dopaminergic transmission in the basal ganglia . In schizophrenic patients and patients with other psychotic disorders dopamine dysfunction in sitem so typical antipsychotic serves to inhibit the transmission of dopamine in the extrapyramidal pathway inhibition dopaminergic role as the dopamine D2 receptor antagonist . But the use of these substances cause transmission interference in the corpus striatum which contains a lot of D1 and D2 dopamine receptors . Striatonigral dopamine pathway disorders causing depression of motor function that manifests as extrapyramidal syndrome . Some typical neuroleptics ( such as haloperidol , fluphenazine ) is a dopamine inhibitor that is more potent basal ganglia , and causes side effects as a result of the more prominent extrapyramidal symptoms
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