Central Integration of Visceral Sensory and Motor Signals, part 1

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Medical Neuroscience

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Duke University

Medical Neuroscience

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Medical Neuroscience explores the functional organization and neurophysiology of the human central nervous system, while providing a neurobiological framework for understanding human behavior. In this course, you will discover the organization of the neural systems in the brain and spinal cord that mediate sensation, motivate bodily action, and integrate sensorimotor signals with memory, emotion and related faculties of cognition. The overall goal of this course is to provide the foundation for understanding the impairments of sensation, action and cognition that accompany injury, disease or dysfunction in the central nervous system. The course will build upon knowledge acquired through prior studies of cell and molecular biology, general physiology and human anatomy, as we focus primarily on the central nervous system. This online course is designed to include all of the core concepts in neurophysiology and clinical neuroanatomy that would be presented in most first-year neuroscience courses in schools of medicine. However, there are some topics (e.g., biological psychiatry) and several learning experiences (e.g., hands-on brain dissection) that we provide in the corresponding course offered in the Duke University School of Medicine on campus that we are not attempting to reproduce in Medical Neuroscience online. Nevertheless, our aim is to faithfully present in scope and rigor a medical school caliber course experience. This course comprises six units of content organized into 12 weeks, with an additional week for a comprehensive final exam: - Unit 1 Neuroanatomy (weeks 1-2). This unit covers the surface anatomy of the human brain, its internal structure, and the overall organization of sensory and motor systems in the brainstem and spinal cord. - Unit 2 Neural signaling (weeks 3-4). This unit addresses the fundamental mechanisms of neuronal excitability, signal generation and propagation, synaptic transmission, post synaptic mechanisms of signal integration, and neural plasticity. - Unit 3 Sensory systems (weeks 5-7). Here, you will learn the overall organization and function of the sensory systems that contribute to our sense of self relative to the world around us: somatic sensory systems, proprioception, vision, audition, and balance senses. - Unit 4 Motor systems (weeks 8-9). In this unit, we will examine the organization and function of the brain and spinal mechanisms that govern bodily movement. - Unit 5 Brain Development (week 10). Next, we turn our attention to the neurobiological mechanisms for building the nervous system in embryonic development and in early postnatal life; we will also consider how the brain changes across the lifespan. - Unit 6 Cognition (weeks 11-12). The course concludes with a survey of the association systems of the cerebral hemispheres, with an emphasis on cortical networks that integrate perception, memory and emotion in organizing behavior and planning for the future; we will also consider brain systems for maintaining homeostasis and regulating brain state.

À partir de la leçon

Movement and Motor Control: Visceral Motor Control

We conclude our survey of movement and motor control by considering the visceral motor system, perhaps better known as the autonomic nervous system. As you study this lesson, consider how the disparate physiology of the viscera has impact not only on the internal state of the body, but also on implicit processing in the forebrain. We will return to this matter when we consider the neurobiology of emotions near the conclusion of Medical Neuroscience

Functional and Anatomical Divisions of the Visceral Motor System, part 111:18

Functional and Anatomical Divisions of the Visceral Motor System, part 213:45

Functional and Anatomical Divisions of the Visceral Motor System, part 310:33

Central Integration of Visceral Sensory and Motor Signals, part 113:30

Central Integration of Visceral Sensory and Motor Signals, part 27:40

Hypothalamus, part 114:05

Hypothalamus, part 216:53

Micturition19:11

Rencontrer les enseignants

Leonard E. White, Ph.D.
Associate Professor
Department of Neurology, Department of Neurobiology, Duke University School of Medicine; Department of Psychology & Neuroscience, Trinity College of Arts & Sciences; Director of Education, Duke Institute for Brain Sciences; Duke University

So here again in a view of the intermediate grey matter of the Sacral

cord we find the location of these neurons.

Now as I mentioned in broader view, what these neurons actually do is they exit

the spinal cord through the ventral roots.

They bypass our Paravertebral Sympathetic trunk.

And rather they make their way to ganglia that are associated with the viscera.

And that's where we find our synapse with our post-ganglionic neuron.

And the post-ganglionic neuron then supplies, the visceral tissue, whatever

that target organ happens to be. Now, before we move on and consider more

central aspects of visceral motor integration, I want to suggest, make a

couple of, of points of emphasis here. Now, I want you to understand that,

there's always coordination of activity, in our sympathetic outflow and our

parasympathetic outflow. Yes, they do represent, rather, extreme

ends of a continuum of function, but that function is a continuum, and there is

tone in the outflow of each division all the time.

So, while sometimes it's helpful to emphasize, for example, that our

sympathetic division is about fight or flight, or the mobilization of resources

for action, I want you to understand that that's not the only circumstance in which

there is outflow from our sympathetic division.

And likewise. For our parasympathetic division

sometimes we consider this to be a division that is restoring resources in

times of resting and digesting. And it's perfectly fine to use those

kinds of monikers as a way of understanding the principle actions of

these divisions. But what I really want you to get is the

idea that there is a continuum of action here where there's tone in each side of

this visceral motor outflow. And, the, a couple of points that I want

you to take away from this are that the functions are complementary, but they're

coordinated. There's always some tonic activity in

both divisions of the visceral motor outflow, and while it's possible to

increase activation in, a wholesale fashion across multiple visceral organs.

That is not necessarily how these functions are coordinated.

Rather, there can be local coordination of sympathetic and parasympathetic

outflow that can serve to coordinate the activity of just one organ system without

necessarily engaging the entire visceral effector system, in an all-or-none

fashion. Well one important context in which this

ongoing coordination of parasympathetic and sympathetic activity is played out at

the organ-specific level reflects the operation of reflex activity.

So I want us to now begin to move into higher levels of processing in the

central nervous system, but before we get there.

I want you to appreciate the fact that there is a rich source of sensory

information that is coming into the central nervous system, and this

information is integrated at various levels.

at one level of input, there is integration and an important nucleus of

the brain stem that I'll talk about in a little bit more detail in just a moment

called the nucleus of the solitary tract. There is also integration in the spinal

cord for the viscera of the abdomen especially.

And then there is outflow. From this network that's integrating

these sensory signals to preganglionic neurons that then can engage in visceral

motor response. So this kind of reflex activity is not

unlike our segmental reflexes that organize the output of our alpha motor

neurons. As we've talked about when we discuss the

myotatic reflex, for example. So, there's sensory signals that are

integrated at a very local level and that can influence the output of our

preganglionic neurons, both parasympathetic and sympathetic.

In this way, the activity in a visceral effector system.

Can be regulated in a moment to moment basis with adjustments in the tone of our

sympathetic or parasympathetic outflow, depending on the organ system in

question. Well, I want to say a little bit more

about, the sources of this visceral sensory input.

So this visceral sensory input essentially comes, through two cranial

nerves, and through collaterals of our anterolateral pathway.

So, in this illustration, we see those two cranial nerves.

They are the glossopharyngeal nerve, cranial nerve nine, and the vagus nerve,

cranial nerve ten. So this sensory information comes via the

neurons that are associated with the ganglia of these two cranial nerves.

And their peripheral process, is very much like our somatic sensory elements

that we've already discussed, mechano-sensory axons.

no susceptive axons free nerve endings. But in the case of our visceral motor

afferents, there are also specialized tissues in certain regions of the body

that are sensitive to the chemistry of the blood that's flowing past the

structures. Or the chemistry of the extra cellular

fluids. And so there are chemoreceptors that are

sensitive to changes in pH, in carbon dioxide, in oxygen tensions for example.

So there are mechano-sensory afferents, there are nociceptive afferents and there

are chemo-sensory afferents, all supplying information that is fed into

the central nervous system. So as I mentioned, an important

integrator of this incoming information, is this nucleus of the solitary tract.

An we've already talked about, this nucleus when we talked about, our

gustatory system. As you'll recall, this nucleus really has

two principle divisions to it. There's a rostral division which is

receiving this incoming special visceral sensory information about taste.

And then there is a caudal division and that's the part that I want to focus on

here. It's this caudal division that's

receiving this input from these cranial nerves and from collaterals of our

anterolateral system. So this nucleus of the solitary tract,

then, is really a key center that integrates incoming visceral sensory

signals. So just to give you a view in a brain

stem cross section. This nucleus is really quite distinct.

It's found in the upper part of the medulla.

And we recognize it. As something that looks sort of like a

bull's eye. there is a dark milinated spot right in

the middle of the nucleus, so that spot, that is actually the axons of these

afferents that are entering this nucleus and its dark because these afferents are

well milinated. And the gray matter of the nucleus of the

solitary tract surrounds this tract. So, hence, you can understand why this is

called the solitary tract. Because it's sort of sitting there by

itself in isolation. And it's isolated then by the gray matter

of the nucleus that surrounds the solitary tract.

[INAUDIBLE]. Well, that's where you would find, this

nucleus. The upper part of the medulla.

The dorsal aspect of the tegmentum. Now, I want to make just one other

comment about visceral sensory afferents. And it's reflecting some fairly recent

discoveries about. the way that visceral pain is processed

in the central nervous system. There is now a, a well understood pathway

that runs through the medial part of the dorsal columns of the spinal cord that

conveys visceral pain information. Now this is

In addition to the pathways that run through our anterolateral system.

So I don't want you to hear me saying that this conflicts with what I just said

about the anterolateral afferent supplying the nucleus of the solitary

tract. Rather this is an additional pathway that

was discovered in the late 80s and the early part of the 90s.

And what we think is happening here is a pathway that connects especially the

lower GI system. from the first order afferent, which

would be a nociceptive element in the appropriate spinal root, to a set of

second order neurons that are found near the central canal of the spinal cord.

And these neurons send an axon, not to the anterolateral system as we might've

anticipated. But rather up along the medial edge of

the dorsal columns. And there they synapse with neurons in

the dorsal column nuclei. That grow an axon that appears to enter

the medial lemniscal pathway and make synapses on neurons in the ventral

posterior complex that project not up to the postcentral gyrus, but rather into

the insular cortex where representation of.

Visceral sensory information, seems to be elaborated at the level of the cerebral

cortex. Well, this pathway is worth mentioning

because it highlights an important clinical phenomenon that I should

mention, and that is referred pain. Now, referred pain is often considered a

phenomenon involving a crosstalk between dorsal root ganglion neurons that supply,

let's say, skin tissue and dorsal root ganglion neurons that might supply

visceral tissue. So, here I'll just indicate that this is

maybe the lumen of the gut and there is some kind of a visceral sensory axon

innervating that tissue. Well, the central processes of, of these

neurons might very well converge upon the same cell in the dorsal horn of the

spinal cord. So here is the, spinal cord.

Let's just say this is the dorsal horn and somewhere in here is a second-order

neuron of the anterolateral pathway. So one might imagine that the pain

associated with this pathological process in the viscera might actually get

referred to the more peripheral structure.

And the fact that these patterns are so predictable, suggest that they actually

do align with the organization of the body map, in the dorsal horn of the

spinal cord according to the segments of the spinal nerves.

So, illustrated here, for example, are visceral pain patterns associated with

the esophagus, with the heart, and with the left ureter.

So, this dorsal horn cross-talk hypothesis provides a reasonable

framework for explaining these referred pain patterns.

Well it has occurred to me certainly, and others, that this newly discovered dorsal

column visceral pain pathway provides yet an additional possible explanation of

referred pain. consider the gracile nucleus, for

example. It's integrating inputs from the lower

part of the body from mechano-sensory afferents that are more peripheral in

their distribution. In the cutaneous surfaces, in the deeper

tissues of the limbs, for example. But in experimental studies using known

human primates, for example, we know that the very same gracile nucleus neurons may

also respond to distension of the bowel. So they seem to be receiving input from

visceral nociceptors, in addition to their mechan-osensory afferents

concerning the lower extremity. So this might be yet another means by

which some kind of crosstalk. might occur at the level of innervation

of a distinct gray matter structure. So, just keep in mind referred pain

doesn't necessarily have to happen via interactions in the dorsal horn to spinal

cord, it actually might happen at multiple levels of our somatic sensory

pathways. At least I think this gracile nucleus is

a good candidate where some visceral pain might be referred to a more peripheral

target. Well, let's get back to thinking more

broadly then, about the central integration of visceral sensory signals,

as the output of the visceral motor system is organized and ultimately

coordinated.

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