Satellitensysteme der Basalganglien – Anatomische Einordnung, klinische Relevanz

Zusammenfassung

Die Interaktion der Basalganglien mit anderen Hirnbereichen sowohl auf anatomischer als auch auf funktioneller Ebene ist weitaus komplexer als bisher vermutet. Das bisher angenommene klassische Modell der Basalganglienschleifen muss entsprechend vorliegenden Studien auf mindestens vier Nebensysteme erweitert werden, die modulierenden Einfluss auf motorisch-exekutive, assoziative und limbisch-motivationale Anteile haben: (i) ein „indirektes“ Projektionssystem, (ii) eine striato-nigro-striatale Schleife, (iii) ein hyperdirektes Projektionssystem sowie zusätzliche direkte Verbindungen zum Ncl. subthalamicus und (iv) multisynaptische Verbindungen des Cerebellums mit dem indirekten Projektionssystem. Die Betrachtung dieser Nebensysteme kann zu einem besseren Grundlagenverständnis basalganglionärer Verschaltungsprinzipien führen und potenzielle Erklärungsansätze zu bisher nicht hinreichend erklärbaren Symptomen wie z. B. Ruhetremor beim Morbus Parkinson liefern. Durch die Analyse der Satellitensysteme im Menschen entstehen zudem neue Erklärungsansätze für unter dopaminerger Therapie und Tiefer Hirnstimulation auftretende nicht-motorische Nebenwirkungen mit Möglichkeiten für neue Therapieansätze.

Abstract

The interaction of basal ganglia and other brain regions is more complex regarding anatomic and functional perspectives than previously assumed. Hence, the classical basal ganglia model has to be extended to at least four satellite systems modulating motor-executive, associative and limbic-motivational brain regions: (i) an indirect projection system, (ii) a striato-nigro-striatal loop, (iii) a “hyperdirect” projection system as well as additional projections to the subthalamic nucleus and (iv) multisynaptic connections from the cerebellum exerting influence on the indirect projection system. The investigation of these satellite systems would be invaluable to foster our understanding of basal ganglia circuitries and may yield a better appreciation of largely opaque symptoms like resting tremor in Parkinson’s disease; analysis of these anatomic pathways and functional implications may facilitate explanatory model approaches to side effects due to dopaminergic therapy and deep brain stimulation in humans and thereby offer the possibility for new therapeutic approaches in movement disorders.

Schlüsselwörter

Basalganglien - klassisches Modell - Satellitensysteme - Bewegungsstörungen - therapeutische Implikationen - tiefe Hirnstimulation

Key words

basal ganglia - classical model - satellite systems - movement disorders - therapeutic implications - deep brain stimulation

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