The direct pathway originates in the cortex, projecting to the striatum of the BG which consists of the caudate and putamen nuclei.1,2 The striatum projects to and inhibits the GPi which has tonic inhibitory connections to the VA/VL nuclei of the thalamus and finally back to the motor and premotor cortex.1
Activation of the direct pathway initiates voluntary movement, by releasing upper motor neurons in the cortex from inhibition.1,2 The globus pallidus, internal and …show more content…
Huntington’s disease is a hyperkinetic genetic disorder characterised by degradation of the tonic inhibitory medium spiny neurons of the striatum which project to the GPe in the indirect pathway.1,3 The loss of inhibitory input from these neurons results in enhanced activity of the GPe.1,3 As a result, the GPe inhibits the STN and reduces its excitatory input to the GPi.1,2 The GPi’s inhibitory effects on the VA/VL thalamic nuclei is not enhanced and the inhibitory outflow of the BG is reduced.1,3 Upper motor neurons are not adequately inhibited, there is increased excitation to the motor cortex and inappropriate, ‘ballistic’ movement results.1,3
Hemiballismus is characterised by violent, involuntary movements of the limbs, usually on one side of the body, and occurs due to damage to the STN involved in the indirect pathway.1,3 Damage to the STN removes or reduces its excitatory input to the GPi, which normally enhances its inhibitory effects.1,3 The inhibitory connections from the GPi to the VA/VL thalamic nuclei are not enhanced.1,3 Thus, the upper motor neurons discharge abnormally as they are not adequately inhibited when movements are