Black substance. Midbrain Neurons in the substantia nigra of the midbrain produce
Not a single animal suffers from this disease - you will not see a cat or a mouse with a trembling paw. And since the origins of the disease are unclear, there is no complete cure. You asked about the starting point, the very first "call" that marked trouble. Once, on the way to the country house, we stopped at the market. I remember choosing a melon, the seller suddenly became rude. My husband's hand suddenly trembled - and it has been trembling for 11 years. The hospital said, "Parkinson's disease." We opened medical books, reference books and made sure that such patients are long-lived and that this disease is incurable throughout the world."
There are not many specialists in Russia who are closely "familiar" with the disease, which has become a personal enemy for Margarita Vasilievna and her husband. Nikolai Nikolayevich YAKHNO is the head of the Clinic of Nervous Diseases of the I. Sechenov Moscow Medical Academy. He has been dealing with the problem of Parkinson's disease for many years.
- Nikolai Nikolaevich, this disease remains a mystery to medical science in many respects. But lately it has received a lot of attention all over the world. What is the reason for this interest?
- Parkinson's disease is a fairly common disease. There are about four million such patients in the world, in Russia about 300 thousand people suffer from this disease. Indeed, in different countries, the most active research into the causes of the disease and the search for ways to treat it are being conducted. This is partly due to the fact that the proportion of older people in society is growing, which means that there are more and more patients with Parkinson's disease, because most often people get sick with Parkinson's disease over the age of 60 years.
Its study began at the beginning of the twentieth century. Then for the first time it was shown what happens with this disease. In the human brain there is a certain nucleus of nerve cells. It is called substantia nigra because it actually looks like a dark spot when cut. So, in Parkinson's disease, the number of these cells decreases dramatically. Why this happens is not fully understood. But there are ways to at least partially correct the defect. In the 1950s, it was discovered that this disease affects a chemical that is essential for the brain to function properly: dopamine. The search began for a drug that could replace it. So the drug appeared: levodopa. When it was created, the newspapers wrote: "Insulin for parkinsonism found." It seemed that the situation is similar to the situation with diabetes - after all, insulin allows you to live with the disease for a very long time and relatively fully. Unfortunately, it soon became clear that this was not the case. First, like all medications, levodopa has side effects. But most importantly, after a few years of using the drug, very serious complications can occur. The disease itself gives rise to a lot of suffering: both trembling of the hands, and slowness of movements, stiffness and pain, instability. When we prescribe the drug, the patient becomes much better. And a few years later he felt bad again, only "in a different way." And these complications are even more difficult to treat than the disease itself. What does it look like? The patient takes a pill - and can move normally. And in half an hour he is again "shackled". Such "switching on" and "switching off" motor abilities occurs many times during the day.
Listening to the professor, I tried to imagine what the life of a person suddenly deprived of the ability to move becomes. Margarita Vasilievna describes it this way:
- After examinations, it became clear that my husband had a brain area that is responsible for all movements, speech, swallowing. Only the thought is still clear. This disease pulls out of the usual life rapidly and, it seems, forever. At first, such a tremor appeared that the husband could not even sign - and was forced to quit his job. Then there was a gradual loss of the simplest life skills: putting a handkerchief in your pocket, fastening a button, tying your shoelaces, shaving - all this becomes impossible. For seven years, the husband had difficulty leaving the house five or six times. He was tormented by a tremor of all the muscles of his face, arms, legs (almost like "withdrawal" in drug addicts), it was difficult to walk and talk. All this drove me into such a depression that I did not want to live. And so - months, years... And now we are LIVING again. I get up at six in the morning - there is already light in his room: he sits and writes - he works. Once the husband realized that he was able to go out alone - that day he left and returned six times, he still could not believe in his happiness.
How did this miracle happen?
- A year and a half ago, we were lucky: my husband was in a group of patients who were taken for testing the Mirapex drug. At first, no one really believed in the success of the treatment. The doses given were very small. And about a week later, the husband suddenly began to smile, to joke. This was the beginning of his and our return to normal life.
The suffering patients and their relatives today are confident in the effectiveness of the new drug. Nikolai Nikolayevich Yakhno, like any serious scientist, prefers to be as careful as possible in his wording and not to add any emotions to his assessments.
- In addition to levodopa, we also use other drugs, including mirapex. The goal is either to delay the use of levodopa and its associated complications, or to reduce its dose. Unfortunately, in most patients, Parkinson's disease also provokes deep depression. So, the "substitutes" for levodopa, which we are talking about (they are called by the medical term "dopamine agonists"), help to partially relieve depression. Today we have reason to say that of all the dopamine agonists that we have, Mirapex is indeed the most effective and has the fewest side effects.
- Reviews of patients and their relatives about the drug are full of rave reviews. But if this medicine is not given to them at a discount or free of charge, there is practically no chance of acquiring it on their own - the price is too high. In your opinion, how justified are the requests of patients to include Mirapex in the list of subsidized medicines that are provided free of charge for health reasons?
- The logic here is quite simple. If there is no drug, it is difficult to provide a person with a full life. Levodopa improves the patient's condition, but may contribute to the development of complications. In fact, this new medicine, of course, is necessary for our patients for health reasons. Yes, it is quite expensive. But here, I think, a pharmaco-economic study is needed. It is necessary to calculate all the losses from the disability of patients, all the costs of caring for them, for disability benefits. And then it may well turn out that it is much more profitable to provide the patient with a drug, not to mention the moral side of the matter. Now there are a lot of expensive medicines. But many of them can cut society's costs.
Little remains to be added to this opinion. A group of patients with Parkinson's disease turned to the Ministry of Health of the Russian Federation with a request for help in providing them with medicine, on which the future of these people literally depends. The Ministry of Health replied that, by law, these issues are the responsibility of local authorities. In this case, the decision of the issue depends on the Moscow Health Committee. From there, the patients received an explanation that the drug they were interested in was not used in city medical institutions, that it could be included in the "preferential" list of drugs dispensed to patients free of charge or at a discount only after appropriate tests were carried out on the basis of Moscow clinics. Perhaps I am unaware of some legal subtleties of the entire process of drug provision. But it seems strange that the authority of the clinic of nervous diseases, which is headed by N. Yakhno, and the clinical hospital named after S. Botkin, where the drug was also tested, is insufficient to resolve the issue of this drug. By the way, it has long been approved by all relevant authorities and is freely sold in Moscow pharmacies.
Margarita Vasilievna has her own view on the relationship between society and a sick person:
- My husband worked in civil aviation for forty-six years, he was a leading specialist in the industry. His pension is 900 rubles. And the cost of the drug for a month is about four and a half thousand rubles. Yes, treatment is expensive, but people are returning to work! By the way, Parkinson's disease often affects people of mental labor. As a rule, these are professionals with extensive experience. Are their knowledge, their qualifications worth nothing? And don't they deserve a decent pension? We are ready to spend all of it on buying a medicine that returns us to the joy of life. Understand, there was an absolutely helpless invalid, doomed to crawl along the long, hopeless tunnel of life. Now the medicine for him is like a door from a tunnel, there the star shines, there is a full-fledged life, as before, before the illness. And what now - to slam this door?
The human brain is a complex structure, an organ of the human body that controls all processes in the body. The midbrain is part of its middle section, belongs to the oldest visual center, acquired new functions in the process of evolution, and occupied a significant place in the life of the human body.
The midbrain is a small (only 2 cm) part of the brain, one of the elements of the brain stem. It is located between the subcortex and the posterior part of the brain, located in the very center of the organ. It is a connecting segment between the upper and lower structures, since the nerve brain tracts pass through it. Anatomically, it is not as complicated as the rest of the departments, but in order to understand the structure and functions of the midbrain, it is better to consider it in cross section. Then 3 of its parts will be clearly visible.
Roof
In the posterior (dorsal) area there is a plate of the quadrigemina, consisting of two pairs of hemispherical hillocks. It is a roof, placed above the water supply, and its cerebral hemispheres cover it. Above is a pair of optic hillocks. They are larger in size than the lower elevations. Those mounds that lie below are called auditory. The system communicates with the geniculate bodies (elements of the diencephalon), the upper ones with the lateral ones, and the lower ones with the medial ones.
Tire
The site follows the roof, includes the ascending pathways of nerve fibers, the reticular formation, the nuclei of the cranial nerves, the medial and lateral (auditory) loop, and specific formations.
Legs of the brain
In the ventral region lie the legs of the brain, represented by a pair of ridges. Their main part includes the structure of nerve fibers belonging to the pyramidal system, which diverges to the cerebral hemispheres. The legs cross the longitudinal medial bundles, they include the roots of the oculomotor nerve. In the depths there is a perforated substance. At the base is white matter, descending pathways stretch along it. In the space between the legs there is a hole where the blood vessels pass.
The midbrain is a continuation of the bridge, the fibers of which stretch transversely. This makes it possible to clearly see the boundaries of the departments on the basal (main) surface of the brain. From the dorsal region, the restriction occurs from the auditory hills and the transition of the fourth ventricle to the aqueduct.
midbrain nuclei
In the midbrain, gray matter is located in the form of a concentration of nerve cells, forming the nuclei of the nerves of the skull:
- The nuclei of the oculomotor nerve are located in the tire, closer to the middle, ventral to the water supply. They form a layered structure, participate in the occurrence of reflexes and visual reactions in response to signals. Also, during the formation of visual stimuli, the nuclei control the movement of the eyes, body, head, and facial expressions. The complex of the system includes the main nucleus, consisting of large cells, and small-cell nuclei (central and outer).
- The nucleus of the trochlear nerve is a pair of elements, located in the segment of the tire in the region of the lower hillocks directly under the water supply. Represented by a homogeneous mass of large isodiametric cells. Neurons are responsible for hearing and complex reflexes, with their help a person reacts to sound stimuli.
- The reticular formation is represented by a cluster of reticular nuclei and a network of neurons, located in the thickness of the gray matter. In addition to the middle center, it captures the diencephalon and medulla oblongata, education is associated with all parts of the central nervous system. It affects motor activity, endocrine processes, affects behavior, attention, memory, inhibition.
Specific formations
The structure of the midbrain includes important structural formations. The centers of the extrapyramidal system of the subcortex (a set of structures responsible for movement, body position and muscle activity) include:
Red cores
In the tire, ventral to the gray matter and dorsal to the substantia nigra, red nuclei are located. Their color is provided by iron, which acts in the form of ferritin and hemoglobin. Cone-shaped elements stretch from the level of the lower colliculi to the hypothalamus. They are connected by nerve fibers with the cerebral cortex, cerebellum, subcortical nuclei. Having received information from these structures about the position of the body, the cone-shaped elements send a signal to the spinal cord and correct muscle tone, preparing the body for the upcoming movement.
If the connection with the reticular formation is broken, decerebrate rigidity develops. It is characterized by a strong tension of the extensor muscles of the back, neck and limbs.
black matter
If we consider the anatomy of the midbrain in section, from the bridge to the diencephalon in the stalk, two continuous bands of black substance are clearly visible. These are clusters of neurons richly supplied with blood. The dark color is provided by the melanin pigment. The degree of pigmentation is directly related to the development of structure functions. It appears in a person by 6 months of life, reaches a maximum concentration by 16 years. The black substance divides the leg into sections:
- dorsal is a tire;
- the ventral section is the base of the leg.
The substance is divided into 2 parts, one of which - pars compacta - receives signals in the basal ganglia chain, delivering the hormone dopamine to the telencephalon to the striatum. The second - pars reticulata - transmits signals to other parts of the brain. In the substantia nigra, the nigrostriatal tract originates, which is one of the main nerve pathways of the brain that initiates motor activity. This section mainly performs conductor functions.
When the substantia nigra is damaged, a person develops involuntary movements of the limbs and head, difficulty in walking. With the death of dopamine neurons, the activity of this pathway decreases, Parkinson's disease develops. There is an opinion that with an increase in the production of dopamine, schizophrenia develops.
The cavity of the midbrain is the salvian aqueduct, the length of which is about one and a half centimeters. The narrow canal runs ventral to the quadrigemina and is surrounded by gray matter. This remnant of the primary cerebral bladder connects the cavities of the third and fourth ventricles. It contains cerebrospinal fluid.
Functions
All parts of the brain work interconnectedly, together creating a unique system for ensuring human life. The main functions of the midbrain are designed to perform the following role:
- Touch functions. The load for sensory sensations is carried by the neurons of the nuclei of the quadrigemina. They receive signals from the organs of vision and hearing, the cortex of the hemispheres, the thalamus and from other brain structures along the conducting paths. They provide accommodation of vision to the degree of illumination by changing the size of the pupil; his movement and turns of the head towards the irritating factor.
- Conductor. The midbrain plays the role of a conductor. Basically, the base of the legs, the nucleus and the substantia nigra are responsible for this function. Their nerve fibers are connected to the cortex and underlying brain regions.
- Integrative and motor. Receiving commands from sensory systems, the nuclei convert signals into active actions. Motor commands are given by the stem generator. They enter the spinal cord, due to which not only muscle contraction is possible, but also the formation of a body posture. A person is able to maintain balance in various positions. Also, reflex movements are made when the body moves in space, helping to adapt so as not to lose orientation.
In the midbrain there is a center that regulates the degree of pain. Receiving a signal from the cerebral cortex and nerve fibers, the gray matter begins to produce endogenous opiates that determine the pain threshold, raising or lowering it.
Reflex functions
The midbrain performs its functions through reflexes. With the help of the medulla oblongata, complex movements of the eyes, head, torso, and fingers are performed. Reflexes are divided into:
- visual;
- auditory;
- watchdog (indicative, answering the question "what is it?").
They also provide a redistribution of skeletal muscle tone. The following types of reactions are distinguished:
- Static reflexes include two groups - postural reflexes, which are responsible for maintaining a person's posture, and rectifying ones, which help to return to their normal position if it has been violated. This type of reflex regulates the medulla oblongata and spinal cord, reading data from the vestibular apparatus, with tension in the neck muscles, organs of vision, and skin receptors.
- Statokinetic. Their goal is to maintain balance and orientation in space while moving. A striking example: a cat falling from a height will land on its paws anyway.
The statokinetic group of reflexes is also divided into types.
- With linear acceleration, the lift reflex appears. When a person rises quickly, the flexor muscles tense up, while lowering increases the tone of the extensor muscles.
- During angular acceleration, for example, during rotation to maintain visual orientation, nystagmus of the eyes and head occurs: they are facing in the opposite direction.
All reflexes of the midbrain are classified as congenital, that is, unconditioned types. An important role in the integration processes is assigned to the red core. Its nerve cells activate the muscles of the skeleton, help to maintain the usual position of the body and take a pose to perform any manipulations.
The substantia nigra is involved in controlling muscle tone and restoring normal posture. The structure is responsible for the sequence of acts of chewing and swallowing, the work of fine motor skills of the hands and eye movements depend on it. The substance is involved in the work of the autonomic system: it regulates the tone of blood vessels, heart rate, respiration.
Age features and prevention
The brain is a complex structure. It functions with close interaction of all segments. The center that controls the middle section is the cerebral cortex. With age, connections become weaker, the activity of reflexes weakens. Since the site is responsible for motor function, even minor disruptions in this tiny segment lead to the loss of this important ability. It is more difficult for a person to move, and serious violations lead to diseases of the nervous system and complete paralysis. How to prevent disturbances in the work of the brain department in order to remain healthy until old age?
First of all, you should avoid hitting your head. If this happens, it is necessary to begin treatment immediately after the injury. It is possible to preserve the functions of the midbrain and the entire organ until old age if you train it with regular exercises:
- For physical and mental health, it is important what lifestyle a person leads. Drinking alcohol and smoking destroy neurons, which gradually leads to a decrease in mental and reflex activity. Therefore, bad habits should be abandoned, and the sooner this is done, the better.
- Moderate physical activity, walks in nature supply the brain with oxygen, which has a beneficial effect on its activity.
- Do not give up reading, solving charades and puzzles: intellectual activity keeps the brain active.
- An important aspect of the functioning of brain structures is nutrition: fiber, protein, greens must be present in the diet. The midbrain responds positively to the intake of antioxidants and vitamin C.
- It is necessary to control blood pressure: the health of the vascular system affects the general condition of a person.
The brain is a flexible system that can be successfully developed. Therefore, by constantly improving your mind and body, you can maintain clarity of thought and motor activity until a very old age.
The midbrain, its structure and functions are determined by the location of the structure, provide movement, auditory and visual reactions. If there are difficulties with maintaining balance, lethargy, you should consult a doctor and undergo an examination to find the cause of the violations and eliminate the problem.
. Pars reticulata serves mainly as a transmitter (transmitter), transmitting signals from basal ganglia to numerous other brain structures.
It is a collection of nerve cells. It is located in the dorsal part of the leg on the border with the basal part of the midbrain. Substantia nigra extends along the entire length of the brain stem from bridge before diencephalon. people have two Substantiae nigrae, one on each side (left and right) of the midline of the brain.
The cells of this substance are rich in one of the forms of the natural pigment melanin - neuromelanin which gives it its characteristic dark color. In the substantia nigra, a dorsally located compact layer is distinguished ( pars compacta) and ventral ( pars reticulata) - mesh layer. Pars compacta lies more medially pars reticulata. Sometimes the third lateral layer is also mentioned - pars lateralis, although it is usually classified as part of pars reticulata. Pars reticulata and interior pale ball separated by an internal capsule.
Pars reticulata bears a strong resemblance, both structural and functional, to the interior of the globus pallidus. The neurons of the globus pallidum, as in pars reticulata mostly GABAergic.
The pars compacta substantia nigra consists of dopaminergic neurons. These neurons are afferent and communicate with other brain structures: caudate nucleus and shells, which are part of a group called striatum. This allows you to release dopamine in these structures.
The black substance plays an important role, thanks to it the following functions are carried out: eye movements, it regulates and coordinates small and precise movements, in particular fingers; coordinates processes chewing And swallowing. There is evidence of the role of substantia nigra in the regulation of many autonomic functions: breathing , cardiac activity, tone of blood vessels. Electrical stimulation of the substantia nigra causes an increase blood pressure, heart rate, respiratory rate.
Substance nigra is an essential component of the dopaminergic reward system. She also plays a very important role in the motivation and emotional regulation of maternal behavior.
Pars reticulata substantia nigra is an important process center in the basal ganglia. GABAergic neurons V Pars reticulata transmit final processed signals from the basal ganglia to thalamus and quadruple. Besides, Pars reticulata inhibits dopaminergic activity in Pars compacta through collaterals axons, although the functional organization of these relationships remains unclear.
Most famous feature Pars compacta is - movement control, however, the role of the black substance in controlling body movements is indirect; electrical stimulation this area of the black substance does not lead to the occurrence of body movements. Also, this core is responsible for providing synthesis dopamine, which is supplied to other structures of the head brain through dopaminergic neurons. The function of dopamine neurons in Pars compacta black substance is complex.
The substantia nigra plays a very significant role in the development of many diseases, including Parkinson's disease. The bodies of neurons are located in the substantia nigra, the axons of which, constituting nigrostriatal pathway, go through legs of the brain , internal capsule and terminate in the neostriatum in the form of a wide plexus of terminal microvesicles with a high content of dopamine. It is this pathway that is the place in the brain, the defeat of which leads to the formation of the syndrome parkinsonism.
Parkinson's disease is a neurodegenerative disease characterized by the death of dopaminergic neurons in pars compacta black substance, the cause of which is still unknown. Parkinson's disease is characterized by movement disorders: tremor , hypokinesia , muscle rigidity , postural instability, as well as vegetative and mental disorders- the result of reducing the inhibitory effect pale ball (Globus pallidus) located in the anterior part of the brain striatum (striatum). Neuronal damage pallidum leads to "inhibition of inhibition" of peripheral motor neurons ( motor neurons of the spinal cord). At the moment, the disease is incurable, however, the existing methods of conservative and surgical treatment can significantly improve the quality of life of patients. By using positron emission tomography it has been proven that the pace degeneration substantia nigra neurons parkinson's disease much higher than during normal aging.
An increase in dopamine levels is known to be involved in the development of schizophrenia. However, much discussion continues to this day around this theory, which is commonly known as " dopamine theory of schizophrenia". Despite controversy, dopamine antagonists remain the standard treatment for schizophrenia. These antagonists include first generation drugs (typical) antipsychotics, such as derivatives butyrophenone , phenothiazine And thioxanthene. These drugs have been largely replaced by second generation drugs (atypical antipsychotics) such as clozapine And risperidone. It should be noted that these drugs generally do not act on dopamine-producing neurons, nor on the receptors of postsynaptic neurons.
Other, non-drug evidence to support the hypothesis dopamine associated with the substantia nigra include structural changes in the pars compacta, such as reduction in the size of the synaptic endings. Other changes in the substantia nigra include increased expression of NMDA receptors in the structure and decreased expression dysbindin. Disbindin, which has been (controversially) associated with schizophrenia, may regulate dopamine release, and a measure of low dysbindin expression in substantia nigra may be important in the etiology of schizophrenia.
With inhibition of dopaminergic transmission in the nigrostriatal system (blockade of dopamine D2 receptors) when using antipsychotics, they associate the development extrapyramidal side effects : parkinsonism , dystonia , akathisia , tardive dyskinesia and etc.
Various independent studies have shown that many individuals with schizophrenia have an increased flow dopamine And serotonin entering the postsynaptic neurons of the brain. These neurotransmitters are part of the so-called reward systems” and are produced in large quantities during positive experiences, according to the patient, such as sex, drugs, alcohol, delicious food, as well as stimulants associated with them. neurobiological experiments have shown that even remembering positive experiences can increase dopamine levels, so this neurotransmitter used by the brain for evaluation and motivation, reinforcing actions important for survival and procreation. For example, the brain of laboratory mice produced dopamine already even during anticipation of the expected pleasure. However, some patients deliberately overexert this reward system by artificially evoking pleasant memories and thoughts over and over again, as the neurotransmitters good mood, while losing self-control. It is similar to drug addiction, because almost all drugs directly or indirectly target the reward system of the brain and saturate its structures. dopamine. If the patient continues to overstimulate their reward system, then gradually the brain will adapt to the excessive flow. dopamine, producing less of the hormone and reducing the number of receptors in the reward system. As a result, the chemical effect on the brain is reduced, reducing the patient's ability to enjoy things they used to enjoy. This lowering makes the patient dependent on dopamine, strengthen their "mental activity" trying to bring the level neurotransmitters to its normal state - this effect is known in pharmacology as tolerance. Further addiction can gradually lead to very severe changes in neurons and other brain structures, and can potentially cause serious damage to brain health in the long term. Modern antipsychotic drugs aimed at blocking functions dopamine. But, unfortunately, this blockage sometimes also causes bouts of depression, which can exacerbate the patient's addictive behavior. Cognitive Behavioral Psychotherapy(CBT) performed by a professional psychologist can also help patients effectively control their persistent thoughts, improve self-esteem, understand the causes of depression, and explain to them the long-term negative effects of dopamine addiction. The "dopamine theory" of schizophrenia has become very popular in psychiatry due to the effectiveness of atypical antipsychotics that block neurotransmitters, however, many psychologists do not support this theory, considering it "simplified", there are also several different currents within the supporters of the theory.
So when cutting the bilateral pathways coming from the substantia nigra to striatum, cause immobility in animals, refusal to eat and drink, lack of responses to irritation from the outside world. Damage to the substantia nigra of a person leads to voluntary movements of the head and hands when the patient sits quietly ( Parkinson's disease), as well as many other drugs affect substantia nigra.
The substantia nigra is the main target of chemotherapy in the treatment parkinson's disease. Levodopa(L-DOPA), a dopamine precursor, is the most commonly prescribed antiparkinsonian drug. Levodopa is especially effective in treating patients in the early stages of Parkinson's disease, although the drug does not lose its effectiveness over time. Through passing through GEB, levodopa increases the level of the necessary dopamine in the substantia nigra, thus alleviating the symptoms of Parkinson's disease. The disadvantage of levodopa treatment is that it eliminates the symptoms of Parkinson's disease, in which low dopamine levels are recorded, and not the cause - the death of substantia nigra dopaminergic neurons.
BLACK SUBSTANCE - an integral part of the pallidar system, which is part of the striopallidum in the extrapyramic system. Ch. s. located in the legs of the brain, has close connections with various parts of the cerebral cortex, with the striatum, globus pallidus and reticular formation; together with the red nuclei and the reticular formation, it is involved in the regulation of muscle tone, incl. voice and articulatory apparatus, in performing precise and subtle movements of the fingers; has to do with the coordination of swallowing and chewing. Ch.'s defeat with. causes an increase in plastic muscle tone
Psychomotor: dictionary-reference book.- M.: VLADOS. V.P. Dudiev. 2008 .
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