UMN LMN

dr. Rohmania Setiarini

What is Motor Neurone?

Upper motor neurones (UMN) originate in the base of the cortex of the brain Lower motor neurones (LMN) originate in the spinal cord Act as transmitters that provide a chain of command for voluntary movement to muscles throughout the body

Lower motor neurons

LMN or second order neurons are Cranial and spinal nerves. The cell bodies of these neurons are located in the brain stem, but their axons can leave the central nervous system and synapse with the muscles of the body. All lower motor neurons are either spinal or cranial nerves. All spinal nerves have a lower motor neuron component as they are mixed nerves. However, not all cranial nerves have lower motor neuron components. Some of the cranial nerves contain only sensory fibers and therefore cannot be classified as lower motor neurons. For example, CN I, the olfactory nerve, CN II the optic nerve, and CN VIII, the auditory nerve, do not have motor components.

Upper motor neuron (UMN) disusun oleh: Pyramidal Ekstrapyramidal

Traktus piramidal

Terdiri dari : Serabut kortikospinalis Serabut kortikobulbar

Corticospinal Tract
First order neuron (upper motor neuron) originates in precentral gyrus Passes through internal capsule 90% decussates in caudal medulla
Lateral corticospinal tract

10% undecussated
Anterior corticospinal tract

Synapses on second order neuron (lower motor neuron) in ventral gray of the cord Second order neuron innervates muscle

organization of motor subsystems

Upper & Lower Motor Neurons

Motor Ctx
UMN

Upper Motor Neuron

Motor Cortex to Ventral Grey Horn Modulatory influence on stretch reflex arc

Lower Motor Neuron

Ventral Grey Horn to Neuromuscular Junction Efferent of stretch reflex arc Helps maintain tone

Ventral Grey Horn

LMN

Upper & Lower Motor Neurons

Maintenance of Tone Input from stretch receptors causes lower motor neuron to supply tonic stimulation to the muscle The upper motor neuron modulates this

UMN

LMN

Upper & Lower Motor Neurons

Reflex Arc Afferent is sensory neuron detecting a sudden stretch Signal is strong and results in a strong response by the lower motor neuron Strong signal usually overcomes mild cortical input from the UMN

UMN

LMN

Upper & Lower Motor Neurons

Motor Ctx
UMN

Upper Motor Neuron Signs

Spastic paresis Hypertonia Hyperreflexia No muscle atrophy (until perhaps late in the course) Positive Babinski

Ventral Grey Horn

Why?
Loss of voluntary UMN signal Loss of modulation of tone and reflexes by UMN -the circuit runs unchecked

LMN

Upper & Lower Motor Neurons

Motor Ctx
UMN

Lower Motor Neuron Signs

Flaccid paresis/paralysis Muscle fasciculations Hypotonia Hyporeflexia Muscle atrophy Negative Babinski

Ventral Grey Horn

Why?
Loss of LMN for voluntary movement Loss of efferent component of reflex arc and tone pathway

LMN

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White Matter: The Big Four Pathways

Corticospinal tract
Dorsal Columns Spinothalamic tract Spinocerebellar tracts

 Corticospinal tract
Voluntary motor

Dorsal columns/ medial lemniscus

Discriminative touch Conscious proprioception

Spinocerebellar tract (dorsal and ventral)

Unconscious proprioception

Spinothalamic tract Pain/temperature

Alpha motoneuronsextrafusal fibers bigger and more numerous than intrafusal myofibrils all along length this causes muscle contraction Gamma motoneurons intrafusal fibers tightens spindles enhances sensitivity of spindles

Motor end plates

David B. Fankhauser, Ph.D., Professor of Biology and Chemistry, University of Cincinnati Clermont College

Principal Features of UMNL & LMNL

UMNL: (1) No muscle wasting, except from disuse ( disuse atrophy) (3) Spasticity ( hypertonia ) , called clasp-knife spasticity (4) Clonus present (5) Brisk ( exaggerated ) tendon jerks (6) Extensor plantar reflex , Babinski sign ( dorsiflexion of the big toe and fanning out of the other toes ) (7) Absent abdominal reflexes (8) No fasciculations (9) No fibrillation potential in EMG
LMNL: (1) Marked muscle wasting (atrophy ) (3) Flacidity (Hypotonia ) , hence given the name flaccid paralysis (4) No clonus (5) Diminished or absent tendon reflexes (6) Absent plantar reflex (normally it is flexor ) . (7) Absent abdominal reflexes (8) Fasciculations may occur . (9) Fibrillation potentials present .

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Examples of Conditions in Which there is UMNL or LMNL

Upper Motor Neuron Lesion
Can result from (1) Haemorrhage , thrombosis or embolism in the internal capsule (2) Spinal cord transection or hemisection (BrownSequard syndrome ) Lower Motor Neuron Lesion Can result from (1) Spinal root lesions or peripheral nerve lesion ( e.g. nerve injury by trauma or compressive lesion (2) Anterior horn cell lesions ( e.g. , poliomyelitis, motor neuron disease )