Anatomia Talamo y Gangliobasal (1)

8/11/2019 Anatomia Talamo y Gangliobasal (1)

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Received: 3 January 2002Published online: 26 July 2002 Springer-Verlag 2002

ticofugal projection provides posi-tive feedback to the correct input,while at the same time suppressing

irrelevant information. Topographi-cal organisation of the thalamic af-ferents and efferents is contralateral,and the lateralisation of the thalamicfunctions affects both sensory andmotoric aspects. Symptoms of le-sions located in the thalamus areclosely related to the function of theareas involved. An infarction orhaemorrhage thalamic lesion can de-velop somatosensory disturbancesand/or central pain in the oppositehemibody, analgesic or purely algesic

thalamic syndrome characterised bycontralateral anaesthesia (or hypaes-thesia), contralateral weakness, atax-ia and, often, persistent spontaneouspain. Basal ganglia: Basal gangliaform a major centre in the complexextrapyramidal motor system, as op-posed to the pyramidal motor system(corticobulbar and corticospinalpathways). Basal ganglia are in-volved in many neuronal pathwayshaving emotional, motivational, as-sociative and cognitive functions as

well. The striatum (caudate nucleus,putamen and nucleus accumbens) re-ceive inputs from all cortical areasand, throughout the thalamus, pro-

ject principally to frontal lobe areas(prefrontal, premotor and supple-mentary motor areas) which are con-cerned with motor planning. Thesecircuits: (i) have an important regu-latory influence on cortex, providing

information for both automatic andvoluntary motor responses to the py-ramidal system; (ii) play a role in

predicting future events, reinforcingwanted behaviour and suppressingunwanted behaviour, and (iii) are in-volved in shifting attentional setsand in both high-order processes of movement initiation and spatialworking memory. Basal ganglia-thal-amo-cortical circuits maintain so-matotopic organisation of move-ment-related neurons throughout thecircuit. These circuits reveal func-tional subdivisions of the oculomo-tor, prefrontal and cingulate circuits,

which play an important role in at-tention, learning and potentiating be-haviour-guiding rules. Involvementof the basal ganglia is related to in-voluntary and stereotyped move-ments or paucity of movementswithout involvement of voluntarymotor functions, as in Parkinsonsdisease, Wilsons disease, progres-sive supranuclear palsy or Hunting-tons disease. The symptoms differwith the location of the lesion. Thecommonest disturbances in basal

ganglia lesions are abulia (apathywith loss of initiative and of sponta-neous thought and emotional re-sponses) and dystonia, which be-come manifest as behavioural andmotor disturbances, respectively.

Keywords Thalamus Basal ganglia Anatomy Behavioural disorders Motor disorders

Childs Nerv Syst (2002) 18:386404DOI 10.1007/s00381-002-0604-1 F O C U S S E S S I O N

Mara-Trinidad HerreroCarlos BarciaJuana Mari Navarro

Functional anatomy of thalamusand basal ganglia

M.-T. Herrero ( ) C. BarciaJ.M. NavarroExperimental Neurologyand Neurosurgery Group,Department of Morphological Sciencesand Psychobiology,School of Medicine, University of Murcia,Campus Espinardo, 30071 Murcia, Spaine-mail: [email protected].: +34-968-364683/3953Fax: +34-968-363955/4150

Abstract Thalamus: The humanthalamus is a nuclear complex locat-

ed in the diencephalon and compris-ing of four parts (the hypothalamus,the epythalamus, the ventral thala-mus, and the dorsal thalamus). Thethalamus is a relay centre subservingboth sensory and motor mechanisms.Thalamic nuclei (5060 nuclei) pro-

ject to one or a few well-defined cor-tical areas. Multiple cortical areas re-ceive afferents from a single thalam-ic nucleus and send back informationto different thalamic nuclei. The cor-

The pathologies that damage the humanbrain are rarely restricted to single ana-tomical structures. Stroke, trauma and par-ticularly degenerative diseases do not re-

spect functional anatomical boundaries. But there is much to be learned from obser-vation of what occurs in humans whosebrains are damaged by such insults. [12].


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The thalamus

The thalamus is a nuclear complex situated in the dien-cephalon. The diencephalon forms the central core of thebrain and is surrounded by the hemisphere, so that onlythe basal surface is exposed to external view in a dia-mond-shaped area containing hypothalamic structures.The diencephalon is located at the dorsal end of the brain

stem surrounded by the internal capsule laterally and thelateral ventricles and corpus callosum superiorly. It is di-vided into symmetrical halves separated by the narrowthird ventricle but connected by the massa intermedia(Fig. 1). The rostrocaudal dimension of the human thala-mus is about 30 mm, its height about 20 mm and itswidth about 20 mm. It has been estimated that there areabout 10 million thalamic neurons in each hemisphere.The human thalamus is divided into 5060 nuclei (Fig. 1,Table 1). The names of most of these nuclei are derivedfrom their geographical locations within the thalamus.The thalamus is made up of four parts: the hypothalamus,the epithalamus, the ventral thalamus, and the dorsal thal-

amus. The traditional partition of the diencephalon intolarge ontogenic-embryologic subdivisions corresponds toHerrickss columnar model. The new neuromeric modelplaces the hypothalamus in a different neuromere [159].The epithalamus belongs to the same prosomere as thedorsal thalamus, but we can consider it separately; itcomprises the paraventricular complex, the habenularcomplex and the pretectal group. Moreover, the perithala-mus (ventral thalamus) originates from a different proso-mere and corresponds to the reticular nucleus, the zona

incerta and the pregeniculate nucleus. The dorsal thala-mus is in fact the main part of the thalamus.

The dorsal thalamus has two regions: 1 the allothalam-ic region and the isothalamic region.

The allothalamic region can be divided into:

1. The paraventricular region or midline nuclei (includ-ing the massa intermedia) (receiving afferents fromthe amygdala)

2. The centre-median-parafascicular complex (isolatedby a continuous capsule), which appears to be a majorelement in the basal ganglia system [51, 153]

3. The intralaminar region, which includes the nucleiwithin the lamina medialis

The isothalamic region constitutes the bulk of the thala-mus. It has bushy neurons and microneurons, andmost of its connections are directed to the cortical areasreceiving an important mass of corticothalamic axons (inprimates, much more important than the thalamocortical

Fig. 1 Diagrammatic view of the internal structure of the dor-sal thalamus. The figure repre-sents a posterior view of rightand left sectioned thalamus.Note the regio centralis of theallothalamus and their organi-zation. The internal medullarylamina separates the regio su-perior, regio lateralis and regiomedialis. Nucleus perithalam-icus covers the thalamus ( A re-gio superior, Cme nucleus cen-tralis medius, CPf nucleus cen-tralis parafascicularis, GL nu-cleus geniculatus lateralis,GM nucleus geniculatus media-lis, dotted areas internal med-ullary lamina, LCL nucleusventralis caudalis lateralis,

LCM nucleus ventralis caudalismedialis, L regio lateralis,

M regio medialis, mi massa in-termedia, P regio posterior,PTh nucleus perithalamicus)

1Traditionally, (i) a thalamic region is defined as a gross topo-graphical division corresponding to the former nuclei; (ii) a terri-

tory such as the cerebral space filled by afferent endings from onesource; (iii) the thalamic space where neurons project to a givencortical target constitutes a source space; and (iv) a thalamic nu-cleus is defined as the intersection of a thalamocortical space withone territory. The principal terms in the nomenclature are the an-teroposterior, mediolateral and dorsoventral subdivisions, butthere are three classes of thalamic nuclei in relation to its function:specific, nonspecific and association nuclei (even if the classicconcept of nonspecific thalamus has important intranuclear varia-tions [154])


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Table 1 Diencephalic elements in hierarchical order (from [154] with permission of the authors). Situs are topographic locations. Theymay or may not correspond to cytoarchitectonic subdivisions

I. Diencephalic nonthalamic elementsI.A. Perithalamus PTh (ventral thalamus, thalamus ventralis)Nucleus perithalamicus PTh

Situs perithalamicus PTh (= N. reticularis R)Situs incertus PTh ZI (= Zona incerta Zi)

Situs pregeniculatus PTh Pr (= N. pregeniculatus orprepeduncularis)

I.B. Epithalamus Hb = habenulaNucleus habenulae lateralis HbL (Hlmc)Nucleus habenulae medialis HbM (Hlpc)

II. Thalamus T (dorsal thalamus)

II.A. Allothalamus (neuronal types different from those of the isothalamus)i. Regio paraventricularis E or paramediana = Midline nuclei

+ adhesio interthalamica(massa intermedia)

ii. Regio centralis C = Centre medianparafascicularcomplex (basal ganglia)

Nucleus centralis parafascicularis CPf Nucleus centralis medius Cme pallidal thalamusNucleus centralis paralateralis CpL

iii. Regio intralaminaris Il = Intralaminar nuclei(in true sense of term)

Nucleus intralaminaris oralis IlO = paracentralis PCnNucleus intralaminaris caudalis IlC = centralis lateralis CLNucleus intralaminaris posterior IlP = I.La Postiv. Nucleus limitans Li

II.B. Isothalamus (made up of bushy thalamocortical projection neurons + microneurons)II.B.1. Regio superior SNucleus anterior A Nucleus anterior principalis

AV + AMNucleus anterodorsalis AD Nucleus anterior accessorius

Nucleus superficialis S Nucleus lateralis dorsalisII.B.2. Superregio medioposteriori. Regio medialis M Main part of the dorsomedial

nucleusNucleus medialis (man) MNucleus medialis medialis MM (amygdalar afferences)Nucleus medialis lateralis MLii. Regio posterior P Main part of the pulvinar

Nucleus posterior P4Situs medialis PuMSitus lateralis PuLSitus oralis PuOSitus oralis dorsalis PuOD (nucleus lateralis posterior)

II.B.3. Superregio basalis

i. Regio basalis BNucleus suprageniculatus Spinothalamic thalamusii. Regio intergeniculata Ig

Nucleus intergeniculatus Tectal thalamus

II.B.4. Superregio inferolateralis (sensory and motor thalamus)i. Regio geniculata G

Nucleus geniculatus GM auditory thalamusmedialisNucleus geniculatus GL visual thalamuslateralis


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projection [154]). The internal and superior laminae di-vide the isothalamus into several subregions. The inter-nal medullary lamina divides the principal thalamic nu-clei into two major parts: a medial group on one side anda ventrolateral group on the other side of the internalmedullary lamina (Fig. 1). The anterior part of the inter-nal medullary lamina splits into two lamellae, which sur-round the anterior group o-nuclei. The cell groups withinthe internal medullary lamina in the caudal part are thenamed intralaminar nuclei (allothalamic region) [87].

Since the beginning of the twentieth century, the hu-

man thalamus has been divided into subnuclei and insome functional aspects on the basis of anatomical crite-ria and clinicopathological observations [38, 39, 76, 81,86]. However, the functional parcellation of the thala-mus has suffered from historical and technical draw-backs because of an archaic, rigid conception of thethalamic nucleus; overexploitation of cytoarchitecturetechnique, comparative anatomy and cortical connec-tions; underexploitation of subcortical afferent territo-ries, and opposition between ventral (relay) and dorsal

(associative) nuclei [154]. The thalamus is a relay cen-tre in subserving both sensory and motor mechanismsand then, awareness [179], attention [20] and other neu-rocognitive processes such as memory and language[47, 85]. Thalamic relay neurons receive excitatory glu-tamatergic input from peripheral sensory pathways [15].After neuroanatomical tracing studies in primates usingstereotactic atlases [140, 198] we know that most of thethalamic nuclei project to one or few well-defined corti-cal areas, with the exceptions of the reticular nucleusand the intralaminar nuclei, which project diffusely to

many areas of the cortex and have been defined as non-specific thalamic nuclei (Fig. 2) [81, 86, 87, 154]. Thecentromedian and parafascicular nuclei (nucleus centra-lis medius and nucleus centralis parafascicularis, respec-tively) also project back to the striatum [153]. More-over, thalamocortical interconnections may not be sim-ple one-to-one connections between single thalamic nu-clei and single cortical areas [81, 154]: multiple corticalareas receive afferents from a single thalamic nuclei andsend information back to different thalamic nuclei [63].

ii. Regio lateralis L (lateral mass plusparalaminar partsof the dorsomedialnucleus with ventralafferences)

a. Subregio arcuata LArc gustatory thalamusNucleus lateralis arcuatus LAcSensorimotor thalamus

b1. Subregio caudalis LC lemniscal thalamusNucleus ventralis caudalis LCL

lateralisNucleus ventralis caudalis LCM

medialisb2. Motor thalamus

I. Subregio intermedia LI cerebellar thalamusNucleus lateralis LIL

intermedius lateralisNucleus lateralis LIM (VIM + DI)intermedius mediodorsalisSitus ventralis medialis LIMmSitus dorsalis LlMdSitus postremus LlMps

Situs paralaminaris plIintermediusII. Subregio oralis LO pallidal thalamus

Nucleus lateralis oralis LO (VOL + DO)Situs principalis LO1 (VOL = Voe = Vlo)Situs dorsalis LOd (DO = Doe = dorsolateral VA)Situs ventralis Lov (VOV = VLm, lat)

III. Subregio dorsalis LR nigral thalamusNucleus lateralis rostralis LR ( VOM + LPo)Situs polaris LrpoSitus perifascicularis LRmcSitus ventralis medialis LRvmSitus paralaminaris rostralis PlONucleus lateralis rostralis LRM nigral + amygdalar

pars medialis

Table 1 (continued)

I


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In addition to this, the corticofugal projection providespositive feedback to the correct input, while at thesame time suppressing irrelevant information: a giventhalamic neuron receives excitation from a small corti-cal area that shares the same stimulus selectivity (ego-centric selection) [203]. The corticothalamocorticalloops amplify the cortical oscillations (fast synchronousrhythms) [115], but thalamocortical neurons control theslow oscillations [116]. Within the thalamus exist pow-erful mechanisms that lead the promotion of synchro-nous and phasic 3 Hz neuronal activity that appears toarise from a perturbation of a physiological higher fre-quency spindle oscillation [80]. In normal circumstanc-es inhibitory synaptic responses, including those fromthe reticular nucleus, are required for network syn-chronisation. Cortical oscillations (fast synchronousrhythms) [115] are differentially affected by lesions of the corticothalamocortical loops and/or by lesions of thedifferent areas involved. Both fast [180] and slow oscil-lations [116] are synchronised not only in intracortical

but also in intrathalamic and thalamocortical networks.Moreover, the role of thalamus in cortico-cortical com-munication addresses the implications on higher corticalfunctions when thalamic or corticothalamocortical path-ways are involved [63].

The topographical organisation of the afferents at thelevel of the thalamic nuclei is contralateral. The laterali-sation of the thalamic functions affects motoric aspectsof different patterns such as speech production and non-verbal memory [85]; however, some nuclei have bothcontralateral and ipsilateral connections [144]. Instead of this, deafferentation results in reorganisation of the so-matosensory map but with different patterns and degrees

of somatotopic organisation, all of which may be associ-ated with pain syndromes [88, 92]. The plasticity and re-organisation are mediated by corticofugal loops [49], andit has been suggested that thalamic maps are constantlyadjusted by sensory experience [200]. However, the in-trathalamic connections [32] are still essential to under-stand, for instance, how thalamic syndrome produces al-terations to visual orientation when somatosensory fieldsare involved [7].

Each anatomically defined thalamic nucleus has itsown characteristic afferent and efferent connections [154]:this defines its function. Two distinct types of thalamicnucleus are proposed on the basis of their afferent fibres

from ascending pathways and/or from the cerebral cortex:1. First-order nuclei, with a modulatory function, receive

primary afferent fibres from ascending pathways andreceive corticothalamic afferents from cortical layer 6,which sends branches to the reticular nucleus

2. Higher order nuclei receive primary afferents from py-ramidal neurons of the cortical layer 5 lacking a branchto the reticular nucleus; its function is concerned withtransmitting information about the output of one corti-

Fig. 2 Distribution of the reciprocal right thalamocortical path-way. Above : lateral ( left ) and medial ( right ) surfaces of the hemi-sphere show the main thalamocortical projections. Correspondenc-es with thalamic nuclei are shown with the same pattern ( below ).[ I Regio superior (nucleus anterior), II regio medialis (nucleus me-dialis), III regio posterior (nucleus posterior), IV regio lateralis:

A subregio oralis + subregio dorsalis (pallidal + nigral thalamus), B subregio intermedia (cerebellar thalamus), C subregio arcuata +subregio caudalis (gustatory + lemniscal thalamus), GL nucleusgeniculatus lateralis, GM nucleus geniculatus medialis]


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2. Elevation of the intracranial pressure and intracranialherniations produced by the oedema and the tumourmass

Tumours located deep in the brain, (involving the centralregion of thalamus and/or basal ganglia and spreadingbilaterally) can produce internal hydrocephalus, cortico-spinal signs, extrapyramidal symptoms, dementia, andeven neuroendocrine dysfunction. The symptoms of le-sions located in different parts of the thalamus are close-ly related to the function of the areas involved (nucleiare named as in Table 1).

Nucleus perithalamicus

The reticular nucleus, which surrounds much of the thal-amus like an eggshell, especially on its lateral side, wasdescribed by Klliker [94] as the Gitterkern or latticenucleus, as the fibrous latticework is a characteristic fea-

ture of this area. It contains inhibitory GABAergic neu-rons, which exert weak or strong inhibitory connectionswith significantly different responses on thalamic neu-rons [31]. A thalamic nucleus that does not project to thecortex, however, receives collaterals from thalamocorti-cal and corticothalamic axons. It is in an excellent posi-tion to monitor the activity in the corticothalamic andthalamocortical channels and to transmit informationback to the thalamus and the midbrain. Then the reticularnucleus controls the activity of thalamocortical channels,which is of fundamental importance for the two-waythalamocortical and corticothalamic connections [1, 14].The reticular nucleus can be divided into sectors that are

connected to more than one thalamic nucleus and tomore than one cortical area: and each sector has topo-graphically mapped connections with the thalamus andthe cortex, and each has a different function (sight, hear-ing, touch, movement or limbic functions) [64].

Allothalamus

The intralaminar nuclei have been included in the non-specific ascending reticular activating system projectingto extensive areas of the cerebral cortex the inputs re-ceived from the brain stem reticular formation [151].

These nuclei have been functionally associated with at-tention, arousal and consciousness. The nuclei are divid-ed into a rostral group and a central-caudal group. Aunique combination of calcium-binding protein stainingclearly delineates the intralaminar nuclei. The regio in-tralaminaris (nucleus intralaminaris oralis or paracentra-lis, nucleus intralaminaris caudalis or centralis lateralis)showed intense staining for both calretinin and calbin-din-D28 k [129]. The central-caudal group (regio centra-lis: nucleus centralis parafascicularis and nucleus centra-

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cal area to another cortical area (playing a part in cor-tico-cortical connections on higher cortical functions)[63]; but again, intrathalamic interactions among dorsalthalamic nuclei can also be important [32]

Few neurological diseases have been correlated withchanges in a particular thalamic nucleus. The most fre-quent pathologies are vascular lesions and tumours.Haemorrhagic stroke frequently involves multiple struc-tures in basal ganglia-thalamocortical circuits and, sur-prisingly, those permit enhanced recovery comparedwith stroke restricted to the putamen or thalamus [124].Lesions confined to the thalamus have been associatedwith asterixis [103], and lesions of the thalamus plusbasal ganglia seem to be related to dystonia [104]. Focallesions of the thalamus and/or of the subthalamic regionlead to the development of dyskinesia and bilateralblepharospasm (associated with right posterior thalamiclesions). A classic thalamic syndrome is characterised bycontralateral anaesthesia (or hypaesthesia), contralateral

weakness, ataxia and, often, persistent spontaneous painthat can be treated by stereotactic thalamotomy [139].The vascularisation of the thalamus is of a great impor-tance when tumor pathology or infarction is affectingthese structures [150]; there is even a correspondence be-tween specific arteries and thalamic areas, which deter-mines the semeiology of thalamic syndromes [18, 47,133, 188]. A thalamic lesion caused by infarction orhaemorrhage can quickly lead to the development of so-matosensory disturbances and/or central pain in the op-posite hemibody, analgesic thalamic syndrome or a purealgesic syndrome [44]. CT scanning has shown that aparamedian or an anterolateral thalamic lesion (infarc-

tion) causes central pain, but a posterolateral ischaemicthalamic lesion will not be accompanied by central pain[194]. The posterior cerebral artery stroke syndrome in-volving the lateral thalamus (superregio inferolateralis)includes visual field deficits and, frequently, sensory,slight motor, neuropsychological and unilateral head-aches or migraine [18]. When the haemorrhages are re-stricted to the ventral posterior lateral territories of thethalamus (regio lateralis) this leads to a cheiro-oral syn-drome [175] or choreiform and dystonic movements as-sociated with rhythmic, alternating movements of low-frequency (myorhythmia) [108]. When tumours involvethe inferolateral nucleus of the thalamus one symptom

can be mutism, which is defined as a state in which thepatient is conscious but unwilling or unable to speak,even if this is usually a transient condition [34]. On theother hand, if a tumor grows slowly and infiltrates tissuerather than destroying it, symptoms will evolve slowlyand may be overlooked for a long time. The two basicmechanisms by which tumours produce symptoms are:

1. Focal disturbances resulting from compression, irrita-tion or destruction of adjacent tissue


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Superregio medioposterior

Regio medialis . The nucleus medialis receives a largeprojection from the rhinal and dorsolateral prefrontalcortices [149], amygdala, ventral globus pallidus and ni-gral projections [27, 164, 169]. It projects to the orbital,medial and dorsal prefrontal cortex [141, 163] and showsstrong degeneration after frontal leucotomy [142]. Thenucleus shows an intensive pattern of cannabinoid recep-tors, as many of the regions are associated with higherfunctions [60]. It has been implicated in cognition [9],recognition memory [136] and habituation, in olfaction[157], in the wakesleep cycle, in respiration [3] and inother vegetative and endocrine circadian activities [10].In the case of infarcts involving the anterior or medialregion of the thalamus (both regio superiorregio media-lis), a loss of memory processes and cognition disordershave been described in the acute phase of insult [89].Moreover, it may be important to look at the conse-quences of thalamic infarctions, the damage to the nucle-

us medialis and nuclei of the allothalamus, or a com-bined lesion of these structures for deficits of executivefunctioning [188]. After a bithalamic infarction involv-ing the nucleus medialis a syndrome of lost physicalself-activation is common; this includes apathy, indiffer-ence and poor motivation [48].

Regio posterior . The pulvinar-lateral posterior complex,which has reciprocal connections with the associated pa-rieto-occipito-temporal cortical areas, is involved in vi-sual and language functions. The pulvinar has a role inselective visual attention. It has four areas (medial, cen-tral, lateral and lateral shell) demarcated by acetylcholin-

esterase and cytochrome oxidase [28]. Even if its lesionsare apparently silent they can affect superior functionsinvolving visual and language modalities and are relatedto hallucination experiences in patients.

Superregio basalis

Regio basalis . The nucleus suprageniculatus is locatedposteromedial to the nucleus ventralis caudalis lateralis(lemniscal thalamus), ventral to the regio posterior (pul-vinar) and the regio ventralis (allothalamus), lateral tothe nucleus centralis parafascicularis and dorsal to the

nucleus geniculatus medialis. The nucleus is the relay forpain and temperature sensation [33], including visceralinformation [24, 54]. Pain is a message that is protectivein nature. There are two pain systems, one signalling thediscriminative aspects of pain (location and intensity)and the other, the affective aspects of pain. Our responseto a noxious stimulus reflects the actions of both systems[196]. The spinothalamic tract arises from cells in laminaI and lamina V of the dorsal horn and projects to the nu-cleus suprageniculatus of the thalamus [161] establishing

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lis medius) showed a complementary pattern of staining:the nucleus parafascicularis shows immunoreactivity forboth calbindin-D28 k and calretinin, while the nucleuscentralis medius shows immunoreactivity only for parv-albumin. As the nuclei from the regio centralis have im-portant connections with the basal ganglia [153], it hasbeen suggested that calcium-binding protein may play animportant role in the interactions between cerebral cortexand the basal ganglia [129]. By way of nonselective in-puts, mainly from the cholinergic brain stem nuclei aspedunculopontine nucleus and laterodorsal nucleus, thecentral-caudal group could modify the activity of thebasal ganglia-thalamocortical loops [62]. In fact, there isa loss of neurons in the caudal intralaminar nuclei in Par-kinsons disease and in progressive supranuclear palsy[69]. This central group is prominent in primates: themotor functional importance in the basal ganglia circuit-ry is related to the nucleus centralis medius, whereas thenucleus centralis parafascicularis is related mainly tocognitive, oculomotor and limbic functions [168]. The

functional role of these nuclei remains uncertain. Theyhave been proposed as an appropriate target for the treat-ment of intractable deep pain of central origin or follow-ing stroke or due to cancer, as they receive nondiscrimi-native or affective sensory information [11]. However,even if the nuclei are projecting diffusely to much widercortical areas (to one or few well-defined cortical fields)as a part of the diffuse or nonspecific ascending acti-vating system its nonspecificity has been questioned [62,117].

Isothalamus

Regio superior

The nucleus anterior receives projections from the mam-millary body (mammillothalamic tract) and projects tothe cingulate cortex belonging to the Papez circuit, theneural circuit for emotion [75, 143]. Lesions involvingthe nucleus anterior resulted in neuropsychological dys-function (aphasia and memory impairments) [133, 136]and in anomia for proper names [125]. Then, cognition,memory and emotion affect each other reciprocally, andatrophy or dysfunction of the midline groups has beenassociated with anterograde amnesia [148, 192]. Tu-

mours involving part of the Papez circuit, such as the an-terior nucleus of the thalamus, the hypothalamus andeven the anterior part of basal ganglia, disclosed memorydisturbances (but not emotional impairment), and aftersurgery of the tumour an improvement in memory func-tion has been reported even though radiation therapy candecrease the intellectual ability [136].


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simple axodendritic synapses [162]. The calbindin-im-mnunoreactive fibres belong to the lamina I spinotha-lamic tract fibres and to the vagal-solitary-parabrachialafferents, representing different aspects of enteroceptiveinformation and regarding the physiological status of thetissues and organs of the body [16]. In humans, vascularinfarcts in this region cause analgesia and thermoanaes-thesia and can lead to the paradoxical development of central pain. It has even been suggested that activation of thermal pathways may contribute to modulation of noci-ceptive information [46]. The thalamic pain syndromehas been studied and located by anatomical (magneticresonance imaging) and metabolic correlation in thesame area [44]. The nucleus evokes painful and nonpain-ful paraesthetic cutaneous sensations when stimulated.The pain is described as like having a baby, and thestimulation of a ventrocaudal region to the ventrocaudalnucleus evokes visceral pain and even triggers painmemories [36, 37]. Moreover, the dorsal aspect of thisnucleus has a significant tonic, graded response to cool

stimuli and to innocuous mechanical stimuli [106].

Superregio inferolateralis

Regio geniculata . The GM (nucleus geniculatus media-lis) is situated lateral to the midbrain tegmentum in thecaudal region of the diencephalon rostral to the pulvinar.It has three parts:

1. A medial part with magnocellular neurons which re-ceive somatosensory, vestibular and auditory affer-ents.

2. A dorsal part, a small nucleus, receiving visual andauditory inputs.3. A ventral part with parvocellular neurons which re-

ceive only auditory signals.

The brachium from the inferior colliculus enters the nu-cleus in its posteromedial aspect. The acoustic radiationbegins in the anterolateral border of the nucleus andcurve in an anterior direction through the white matterwithin the transverse temporal gyrus to reach the primaryauditory cortex. Clinically, it has been reported that asmall haemorrhagic infarction located in the nucleus hascaused auditory illusions, such as hyperacousia and pa-

linacousia [57], dichotic listening and complete extinc-tion of the contralateral ear input [53]. Lesions, such asbilateral putaminal haemorrhage, involving the acousticradiation cause auditory agnosia for all sounds or for en-vironmental sounds only [185].

The GL (nucleus geniculatus lateralis) resembles ahat in shape and is positioned inferior to the pulvinar andlateral to the nucleus geniculatus medialis . In sagittalMR images the nucleus lies anterior and superior to thehippocampal formation and in coronal MR images the

nucleus is situated between the pulvinar and the cerebralcrus (the corticospinal fibres in the anterior part of themidbrain). Microscopically, it is made up of six layersseparated by thin white layers. The retinotopy is easilystudied by functional magnetic resonance imaging [26].The optic radiation begins in the posterior half of the lat-eral side of the nucleus and curves over the temporalhorn of the lateral ventricle to reach the primary visualcortex [25]. Both the nucleus and the optic radiation canbe analysed by MRI for the interpretation of the brain le-sions [21]. Lesions involving the nucleus or the optic ra-diation may result in homonymous quadrantanopia andhomonymous hemianopia. The syndrome of posteriorchoroidal artery territory infarction includes homony-mous quadrantanopsia, neuropsychological dysfunction(aphasia and memory disturbances) with or withouthemisensory loss, and the damage involves the nucleusgeniculatus lateralis, the posterior thalamus, the nucleusanterior and other regions, such as the hippocampus orthe parahippocampal gyrus [133].

Regio lateralis. Subregio arcuata . The gustatory thala-mus , just rostral to the lemniscal thalamus, is the relayfor gustatory sensation receiving the inputs from the ros-tral part of the lemniscus medialis (trigeminal pathway).The posterior border of the ventral posterolateral nucleus(nucleus ventralis caudalis lateralis) leading to the pulvi-nar is indicated by a triangular area (Wernickes triangu-lar area), and patients with lesions of this region demar-cated by the posterior limb of the internal capsule, havean absence of sensitivity.

The nucleus of the subregio caudalis lemniscal thala-mus is found lateral to the internal medullary lamina,

caudal to the ventral intermediate nucleus (subregio in-termedia) and rostral to the pulvinar. Laterally it is sur-rounded by the nucleus reticularis (nucleus perithalam-icus) and the external medullary lamina, and dorsally bythe nucleus posterior. The lemniscus medialis enters thisthalamic nucleus on its inferomedial aspect at its borderwith the pulvinar. The nucleus has a role as a somatosen-sory information modulator [127]. A three-link neuronalchain forms the lemniscus medialis system, connectingthe mechanosensory and propioceptive receptors neuronsof the extremities, trunk, neck and back of the head withthe primary somatosensory cortex throughout the thala-mus using glutamate as a transmitter [40]. However, a

visceral nociceptive input to this nucleus has also beendescribed [4]. It has been reported that single ischaemiclesions in the nucleus lead to development of the sensorythalamic syndrome [175] whose basic symptom is chron-ic pain [199]. Moreover, as sensory inputs have a signifi-cant role in dystonia, a reorganisation in the cutaneousreceptive fields at the level of the lemniscal thalamus hasbeen described in dystonia [105].

The motor thalamus can be identified as the nucleithat transfer information from the substantia nigra (sub-

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regio dorsalis), the globus pallidus (subregio oralis) andthe cerebellum (subregio intermedia) to the prefrontal,supplementary, premotor, motor and somatosensory ar-eas of the cerebral cortex [78, 118, 154]. Notwithstand-ing these segregated pathways, there are overlappingprojections to the pre-supplementary motor area, wherethere are interdigitating foci of pallidal and cerebellarterritories [170]. All the thalamic motor neurons becomeactive before the onset of movement [193]. In the nucle-us a voluntary unit has been described, a cluster of neurons that are linked to rhythmic activity [160]. Theseneurons are activated only by voluntary movements of the contralateral limb and not by passive movements[160]. The motor thalamus receives projections from thenucleus perithalamicus in a specific diffuse manner,which can also contribute to the transfer of motor infor-mation [82]. One report described how a lesion in thebasal territory of the thalamus (ventral anterior and ven-tral lateral nuclei: subregio dorsalis and subregio oralis)either severely disrupted or completely prevented the re-

learning of a motor task [23]. Focal lesions involving theposterolateral quadrant of the thalamus are associatedwith abnormal movements [175]. The cerebellar thala-mus connections with motor cortex are an essential com-ponent in the pathophysiology of tremor [120]. The nu-cleus lateralis oralis (LO/VOL) has received much atten-tion in stereotactic treatment of Parkinsons disease andother involuntary motor disorders [135, 184], and thala-motomy of the motor thalamus is effective for dystoniatreatment even if the concrete target is not well defined[113]. Thalamotomy of the nucleus lateralis oralis ame-liorates rigidity but not tremor [137], but the thalamoto-my of the subregio intermedia (LIM/Vim), the cerebellar

thalamus, results in a permanent abolition of the tremorwithout affecting the general somatic sensation [68,138]. Multiple sclerosis patients with disabling tremorhave also benefited from thalamotomy [111]. Moreover,thalamotomy is also recommended for the treatment of dystonia [113], as thalamic activity of this nucleus con-tributes to dystonic movements [107].

Conclusion

The thalamus has been of great interest as a target organin stereotactic surgery for pain relief and in treatment of

movement disorders [83, 181, 202]. In fact, even as earlyas the second part of the nineteenth century, the livinghuman thalamus was studied directly by a stereotacticapproach and some atlases constructed using the inter-commissural line (connecting the anterior and posteriorcommissures in relation to the third ventricle) [67]. Re-cently, some changes have been brought about by stan-dardisation procedures correcting the antero-posteriorco-ordinates in relation to different intercommissural dis-tances, to interindividual nuclear variations [126] or

based on intraoperative neurophysiological data and in-traoperative X-ray films [201], or in detailed studies pre-serving post-mortem anatomical structures [98]. Howev-er, it is still far from easy to achieve the desired localisa-tion in functional surgery of the thalamus, because manyof the nuclei remain unstudied enigmas [186].

The basal ganglia

The term basal ganglia has not been precisely delimitedand there is no generally accepted definition. Classicanatomists described the deep large grey masses col-lectively as the basal ganglia of the telencephalon, whichare embedded in the white matter of each cerebral hemi-sphere. Initially basal ganglia was a descriptive termfor use in onto-phylogenetic or topographic classifica-tions (even the thalamus was regarded as a part of thebasal ganglia until the work of Vicq dAzyr in 1786).The basal ganglia include the caudate nucleus, the lenti-

form nucleus (the distinction between the putamen andthe pallidum was not made until the beginning of thetwentieth century), the subthalamic nucleus and the sub-stantia nigra (Fig. 3). The largest of these structures isthe corpus striatum. The corpus striatum (neostriatum),which is especially well developed in man, comprisesthe caudate nucleus and the putamen. The caudate nucle-us assumes the shape of a comet curving along the lateralwall of the lateral ventricle. It consists in a large head atthe front, a narrow dorsal body and a thin tail which fol-lows a course passing ventrally along the temporal hornof the ventricle and ending at the amygdaloid body. Theinferior part of the head is connected with the putamen at

the ventral part, at the level of the nucleus accumbens.The demarcation of the caudate nucleus at the level of the body and tail is easy, as is surrounded medially bythe lateral ventricle and laterally by the internal capsule.The head of the caudate nucleus and the putamen areconnected by thin bridges of grey matter (pontes griseicaudatolenticularis). The putamen is a shell-shapedstructure situated medial to the cortex of the insula andsurrounded laterally by the external capsule, medially bythe lateral medullary lamina of the globus pallidus, andsuperiorly by the white matter of the corona radiata. inT1-weighted MR images putamen is demarcated by thewhite matter and the globus pallidus, which are less sig-

nal intense. The globus pallidus (paleostriatum) has twoparts, medial and lateral. Both lie medial to the putamen,and together with it, constitute the lentiform nucleus.The lateral medullary lamina separates the lateral globuspallidus from the putamen, and the medial medullarylamina separates the medial from the lateral globus pall-idus. Medially it is limited by the posterior limb of theinternal capsule, while inferiorly it lies close to the sub-stantia innominata and the anterior commissure in therostral part. The subthalamic nucleus is a small lentiform

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nucleus located at the border between the midbrain andthe diencephalon. It is bordered medially by the posteriorlimb of the internal capsule, dorsally by the lenticularfasciculus and ventrally by the zona incerta. As the sub-thalamic nucleus is surrounded by white fibres, it is easi-ly demarcated in T1- and T2-weighted MR images. Thesubstantia nigra lies in the ventral tegmentum of the mid-brain. The pars compacta is the largest part; it is dorsal

and caudal to the pars reticulata. In post-mortem tissuethe pars compacta is defined by the black staining by ne-uromelanin (included in dopaminergic neurons).

The anatomical and functional organisation of the bas-al ganglia help us to understand how motor and cognitivefunctions operate in normal and in diseased brain. Thebasal ganglia make up a major centre in the complex ex-trapyramidal motor system, as opposed to the pyramidalmotor system (corticobulbar and corticospinal pathways).The basal ganglia have been considered a motor centre

since the end of the nineteenth century: the corpus stria-tum contained the centres of automatic or sub-voluntary

integration of the various motor centres where habitual orautomatic movements become organised 52]. Its motoractions are mediated through the pyramidal system [187],as the basal ganglia do not make direct output connec-tions to the spinal cord [152] even if parallel projectionsfrom the substantia nigra pars reticulata to the tectum andthe reticular formation can descend to the spinal cord(through the tectospinal and reticulospinal pathways).The basal ganglia participate in many neuronal pathways,and their functions are not restricted to the motor behav-iour: they also have emotional, motivational, associativeand cognitive functions [6, 19, 93, 130, 167, 171, 172].Moreover, the basal ganglia have a role in error correc-

tion mechanisms [102], in which striatum is a central se-lection device [165]. New concepts have been establishedby basic research in human and in nonhuman primates[29, 166] and by a practical ex vivo method of learningfunctional thalamic and basal ganglia anatomy [195].

It was not until the 1960s that the importance of thestriato-pallido-nigral network (the Nauta-Mehler loop)was recognised [132]. The main transmission circuit of the basal ganglia originates in the whole of the neocortex[66, 174] (Fig. 4, left). The caudate and putamen receive

Fig. 3 Anatomical localisation of thalamus and basal ganglia,viewed from the left. Thalamus and basal ganglia are located closetogether. Lesions do not usually involve one nucleus only, but af-fect multiple structures in basal ganglia-thalamocortical circuits.Note the massa intermedia connecting right and left thalamus ( dis-continuous trace )


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inputs from associative areas of the neocortex and thesensorimotor cortex (dorsal basal ganglia circuit), andthe nucleus accumbens receives input from the orbito-frontal cortex and other limbic cortical areas as well asfrom the hippocampus and the amygdala (ventral basalganglia circuit) [58, 131]. Dorsal and ventral basal gan-glia circuits are anatomochemically segregated in rela-

tion to the relative abundance of parvalbumin striatal in-terneurons [58, 173] and to the nitric oxide synthasemRNA expression [134]. Both circuits start in the cere-bral cortex (and/or subcortical telencephalic structures)throughout the neostriatum, paleostriatum and the ven-tral thalamic nuclei and reach not only the motor andpremotor areas of the frontal lobe concerned with themotor planning but also the associative and limbic corti-cal areas of the frontal lobe [182]. The funnel system of information flow has been discarded in favour of the five

parallel and largely segregated loops pertaining to motor,oculomotor, cognitive, associative and limbic functionsrelated to the major cortical areas of origin, which main-tain apparently segregated parallel pathways through thestriatum, both segments of the globus pallidus, the sub-thalamic nucleus and the substantia nigra pars reticulatawith a strict somatotopic organisation [5, 6, 19]. Howev-

er, these five parallel loops are not completely indepen-dent; there is a convergence of information:

1. At the level of the globus pallidus and substantia ni-gra pars reticulata [55, 95, 153]

2. At the level of the thalamus [176]3. By axonal collateralisation within the different nuclei

[147]

It is likely that the parallel but convergent and integra-tive mechanisms is the reason for the varied symptoma-tology seen in basal ganglia disease [131].

The efferent neurons of the striatum are the medium

spiny neurons which have a common morphology interms of dendritic organisation, local axon collateralsand size. All of them are GABAergic neurons. However,there is some segregation of projections. The efferencesfrom the striatum are divided into a dual projection of striatal outputs, some neurons projecting to the internalglobus pallidus and the substantia nigra pars reticulata(the striatal direct output pathway) and others to the ex-ternal globus pallidus (the striatal indirect output path-way) (Fig. 4, left) [146]. The direct pathway is provided

Fig. 4 Cortico-basal ganglia-cortical circuitry (through thalamicnuclei) in control brain ( left ) and in one affected by parkinsoniansyndrome ( right ). In the latter, imbalance in both direct and indi-rect pathways is seen by the size of the arrows . Note hyperactivityof output nucleus of basal ganglia circuit (substantia nigra pars re-ticulata and internal globus pallidus) and subthalamic nucleus inparkinsonian syndrome. Only a subset of basal ganglia pathwaysis shown ( D1 dopamine receptor type 1, D2 dopamine receptortype 2, SP substance P, Met-Enk met-enkephalin, DA dopamine,Gpe external globus pallidus, Gpi internal globus pallidus, SNpcsubstantia nigra pars compacta, SNpr substantia nigra pars reticul-ata, STN subthalamic nucleus; SO subregio oralis, SI subregio in-termedia


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by D1-dopamine receptors, substance-P and dynorphin-containing neurons. The indirect pathway is provided byD2-dopamine receptors and enkephalin-containing neu-rons. Output neurons of the external globus pallidus areGABAergic and exert an inhibitory effect on the subtha-lamic glutamatergic neurons, which in turn send excita-tory projections to both output nuclei of the basal ganglia(namely the internal globus pallidus and the substantianigra pars reticulata, whose neurons are GABAergic asare those of the external globus pallidus). Both pathwaysthen provide antagonistic effects to the output of the bas-al ganglia: the direct pathway sends an inhibitory inputto both nuclei, whereas the indirect pathway results inexcitatory input (Fig. 4, left). The dual projection fromthe output nuclei of the basal ganglia to the different nu-clei of the thalamus (regio lateralis, regio centralis andregio dorsalis; see above) is organised in parallel and so-matotopically [5, 55] while, again, thalamic neuronssend convergent inputs to the same cortical areas but dif-ferent laminae [77]. The function of basal ganglia is

modulated by both striatal and extrastriatal dopaminergicinnervation [30, 177]. However, dopamine in striatalspiny neurons gives rise to synapses at dendritic spinesthat are also modulated by excitatory inputs from thecortex [178]. In these circumstances, striatal spiny neu-rons are trained by a dopamine-mediated reinforcementsignal to recognise and register salient contexts and/orstates that are likely to be useful in guiding behaviour[79].

The pathophysiological changes that occur in disor-ders of the basal ganglia have been clarified in recentyears by experimental approaches using the MPTP(1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) model

of parkinsonism in non-human primates. MPTP is aneurotoxin that induces extensive dopaminergic degen-eration resulting in a parkinsonian syndrome [70, 90].The basal ganglia are organised in such a fashion thatnigrostriatal denervation (the hallmark of Parkinsonsdisease) leads to overactivity of the internal globus pall-idus and the substantia nigra pars reticulata (Fig. 4,right) [74, 190]. The pathological hyperactivity of boththese nuclei and the subthalamic nucleus [191] has beenseen as the result of a reduced inhibitory input from thestriatum to the direct pathway [109] and increased activ-ity of the indirect pathway [71]. However, the activityand function of other nuclei, such as the external globus

pallidus, needs to be better understood [73], and clinicalsymptoms of Parkinsons disease or other pathologies,even the symptoms observed by focal pathology, are notfully explained by the current models of basal gangliacircuitry [110, 114].

The study of 240 cases with lesions in the basal gan-glia [12] has indicated that the commonest disturbancesin basal ganglia lesions are the syndrome of abulia (apa-thy with loss of initiative and of spontaneous thoughtand emotional responses) and dystonia, which manifest

397

as behavioural and motor disturbances, respectively.The symptoms differ depending on the location of thelesion: when lesions affect the caudate nucleus evenunilateral lesion can cause abulia, or more rarely disin-hibited behaviour; and occasionally they cause motordisorders (never cause parkinsonism but sometimes cho-rea or dystonia); lesions of the lentiform nucleus com-monly cause dystonia and rarely cause chorea; lesionsinvolving the putamen are more prone to cause dystoniathan those involving the globus pallidus; infrequentlythey cause abulia or disinhibition, and in this case, theglobus pallidus is usually involved; however, bilaterallesions involving the globus pallidus do not often causeparkinsonism but it is common for them to cause behav-ioural disturbances.

Motor symptomatology

Where necrosis of the caudate nucleus and putamen has

been present for a long period there is retrograde degen-eration of the cortico-striate fibres both in the subcallo-sal fasciculus and in the external capsule [42]. As thepyramidal motor system, the basal ganglia-thalamocorti-cal circuits maintain somatotopic organisation of move-ment-related neurons throughout the circuit [5, 99],mainly through the putamen, where neurons related toactive and/or passive movements of the lower extremityare found in a long rostrocaudal extension of the dorso-lateral putamen, neurons related to orofacial movementsare located ventromedially, and neurons related tomovements of the upper extremity are located in an in-termediate position. This somatotopical distribution has

the same pattern in both segments of the globus pallidus[145]. Interruption of the extrapyramidal system appearsto be responsible for muscle spasticity and hyperactivedeep reflexes. Involvement of the basal ganglia (includ-ing ventrobasal nuclei of the thalamus) is linked with in-voluntary and stereotyped movements without involvingvoluntary motor functions. Diseases of the basal ganglia(extrapyramidal pathology) result in profound move-ment disorders, which cause changes in motor func-tions:

1. Spontaneous hyperkinetic disorders such as are seenin Huntingtons disease [61, 84] or Tourettes syn-

drome2. Diminished movement (akinesia or hypokinesia) suchas is seen in Parkinsons disease [189] and progres-sive supranuclear palsy [112]

3. Motor stereotypies [22]

Moreover, lesions of the basal ganglia result in changesin muscle tone (muscular rigidity), fine resting tremor,postural disorders and athetosis (vermicular movementsof the distal extremities). Other involuntary movement


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disorders include such symptoms as hyperactivity, dys-kinesia or hemiballismus, depending of the position of the lesion in the basal ganglia. A progressive generali-sed chorea and dementia with neostriatal neuronal lossand gliosis (vascular chorea) has been described [13].The variable tremor and rigidity of Wilsons disease isassociated with degeneration of the lenticular nucleus(putamen and globus pallidus) resulting from a disorderof copper metabolism [59]. Other degenerative changesin the basal ganglia (caudate nucleus and putamen) areassociated with complex stereotypies [119], dystonia af-ter head trauma [41, 43, 105], involuntary movementsof choreiform type (jerky, rapid and purposeless move-ments involving axial and proximal musculature of theextremities), athetoid-type movements (slow, sinuousand aimless movements involving distal limb muscula-ture) [43] or ballism [45]. Indeed, the best pathologicalcorrelation is that of hemiballismus: uncontrollable sud-den, flailing gross movements of the proximal limbmusculature of one or both limbs on the contralateral

side of the lesion [91]. It is associated with lesion of thecontralateral subthalamic nucleus of Luys [121] or itsconnections, but there are even reports of hemiballis-mus without subthalamic lesion but with a lenticular la-cunar infarct, probably with internal globus pallidus in-volvement [122, 123]. Subthalamic nucleus (and inter-nal globus pallidus) are important pacemakers of thebasal ganglia [156]. The cardinal motor signs found inParkinsons disease (akinesia, rigidity and resting trem-or) are generally attributed to the loss of dopaminergicinput to the striatum that results from the degenerationof the substantia nigra pars compacta [50]. Chronictreatment with levodopa and/or dopaminergic agonists

results in unacceptable side effects, such as dyskinesiaor hyperkinesia [189]. This reversal of symptoms iscaused by the imbalance of the direct and indirect basalganglia pathways required for coordinated movements[72, 96]. In recent years, new therapeutic approacheshave included:

1. Pharmacological strategies with different dopamine-receptor agonists [114] and new surgical approachessuch as

2. Transplantation of dopaminergic neurons [56]3. Lesions or deep brain stimulation of the subthalamic

nucleus or of the internal globus pallidus [65, 97]

Behavioural disturbances

Basal ganglia and the adjacent structures play a part inpredicting future events, reinforcing wanted behaviourand suppressing unwanted behaviour [172] and are in-volved in shifting attentional sets and in high-order pro-cesses of movement initiation [17] as well as in spatialworking memory [158]. As functions of the basal gan-

glia include cognitive and emotional aspects, clinicalsymptomatology is not restricted to the motor system;some psychological, disorders of mood and thought dis-turbances are known, including depression, schizophre-nia and obsessive compulsive disorder [2, 61, 155, 173].Basal gangliathalamocortical circuits reveal functionalsubdivisions of the oculomotor, prefrontal and cingulatecircuits [5, 19, 58, 66], which have an important role inattention, learning and potentiation of behaviour-guidingrules [171, 197, 198], making them comparable to thesomatotopic channels within the motor circuit, which areinvolved in the programming and control of movement.In the Bhatia and Marsden study [12] of a total of 240patients with basal ganglia lesions, 111 had some type of behavioural disorder with aphasic and dysarthric dys-function, abulia, depression, disinhibited behaviour andacute confusional state after haemorrhage into the cau-date (even if this last is probably the consequence of awidespread brain dysfunction due to intraventricularbleeding). Aphasia has been described without haemor-

rhagic lesions when lesions are located in the caudatenucleus [8, 35, 100, 101]. Frontal lobe syndrome [183],psychic akinesia [100] and obsessive compulsive distur-bances [101] have been described when bilateral lesionsare established. The caudate nucleus contributes to mem-ory [197], learning [93, 130], cognitive [165, 171] andbehaviour [172] functions; its bilateral damage leads toapathy, decreased recent memory and reduced initiativeand spontaneity [128].

Despite the voluminous literature available on it, therole of basal ganglia in health and disease remains con-troversial. Moreover, as basal ganglia are closely locatedto the thalamus and they have intimate and highly specif-

ic afferent and efferent connections with cerebral cortexand thalamus, basal ganglia should not be viewed as nu-clei with a role independent of both structures [130,153].

Acknowledgements The authors would like to express their ac-knowledgement to their colleagues of the Experimental Neurologyand Neurosurgery Group. M.T.H. also wishes to thank ProfessorAgid, Dr. Hirsch, Dr. Obeso and Dr. Percheron for their scientificsupport and helpful advice on these topics. Drawings in the figureshave been performed by C. Barcia. This work was supported bygrants nos. FIS 99/1392 and FEDER 1FD971931.


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