Summary of Nerve and Muscle Physiology

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  Contents
  
  Chapter 1. OVERVIEW OF THE NERVOUS SYSTEM (L. Pinar)
   Organization of the Central Nervous System....................................................... 4
   General Functions of the Main Parts of the Brain................................................ 4
   Cerebrum............................................................................................................... 4
   Brainstem............................................................................................................... 5
   Cerebellum............................................................................................................ 6
   Meninges (Meninx).............................................................................................. 6
   Cerebrospinal fluid (CSF) .................................................................................... 6
   Blood Brain Barrier (BBB)..................................................................................... 6
   Cranial Nerves....................................................................................................... 7
   REFERENCES............................................................................................................... 9
  Chapter 2. BIOELECTRIC POTENTIALS OF THE EXCITABLE CELL (L. Pinar)
   Resting Membrane Potential................................................................................. 13
   Generation of the resting membrane potential............................................ 14
   Individual Ions Involved in the Resting Membrane Potential..................... 15
   Nernst Potentials: Equilibrium Potentials of Ions.......................................... 15
   The Equilibrium (Nernst) Potential of Potassium.......................................... 16
   The Equilibrium (Nernst) Potential of Sodium............................................... 17
   Calculation of the Sum Effects of Several Permeable Ions on the
   Resting Membrane Potential: Goldman-Hodgkin-Katz Equation............... 18
   Gibbs Donnan Effect ......................................................................................... 18
   The Effects of Na-K ATPase on Membrane Potential................................... 20
   The Membrane of Excitable Cell...................................................................... 20
   Action Potential.................................................................................................. 22
   Investigation of Ion Channels: Voltage Clamp and Patch Clamp Techniques 26
   REFERENCES............................................................................................................ 27
  Chapter 3. NERVE PHYSIOLOGY (L. Pinar)
   Glial Cells ................................................................................................................. 31
   Astrocytes............................................................................................................ 31
   Functions of Astrocytes..................................................................................... 32
   Oligodendrocytes............................................................................................... 32
   Schwann cells..................................................................................................... 33
   Microglia.............................................................................................................. 33
   Ependymal Cells................................................................................................. 33
   Neurons..................................................................................................................... 33
   The Functional and Structural Parts of a Typical Neuron............................. 33
   Myelinated and Unmyelinated Neurons........................................................ 35
   Distribution of Ion Channels in Neurons........................................................ 36
   Conduction of the Action Potential Along the Axons.................................. 37
   Orthodromic and Antidromic Impulse Conduction...................................... 39
   Mixed Nerves...................................................................................................... 39
   Nerve Fiber Types.............................................................................................. 40
   Transport of Proteins in the Axons ................................................................ 41
   Neurotrophic Factors......................................................................................... 41
   Degeneration and Regeneration of Nerve Fibers........................................ 42
   Demyelinating Diseases................................................................................... 43
   Effects of Changing Concentrations of Plasma Ions on the
   Excitability of Nerves......................................................................................... 43
   Rhythmicity of Some Excitable Tissues........................................................... 45
   Electrotonic Potentials, Local Response ........................................................ 45
   Clinical Aspects........................................................................................................ 46
   Channelopathies (Ion Channel Myopathies)................................................. 46
   REFERENCES............................................................................................................ 47
  Chapter 4. MUSCLE PHYSIOLOGY (L. Pinar)
   Skeletal Muscle........................................................................................................ 51
   Morphology of Skeletal Muscle ....................................................................... 51
   Cross Striation..................................................................................................... 52
   Sarcolemma........................................................................................................ 54
   Sarcotubular System.......................................................................................... 54
   Contractile Proteins of Skeletal Muscle.......................................................... 55
   Thin filaments..................................................................................................... 55
   Thick Filaments .................................................................................................. 56
   Dystrophin-Glycoprotein Complex................................................................. 56
   Electrical Characteristics of Skeletal Muscles................................................. 57
   The Flux of Ions .................................................................................................. 57
   Contraction................................................................................................................ 58
   Muscle Twitch..................................................................................................... 58
   Molecular Basis of Contraction......................................................................... 58
   Excitation-Contraction Coupling...................................................................... 59
   Transmission of the Excitation to Contraction............................................... 60
   Sliding Mechanism............................................................................................. 60
   Relaxation............................................................................................................ 60
   Fatigue................................................................................................................. 61
   Rigor Complex ................................................................................................... 61
   Rigor Mortis......................................................................................................... 61
   The Length and Tension Relationship of Contraction.................................. 61
   Types of Excitation............................................................................................. 62
   Types of Contraction.......................................................................................... 62
   Energy Mechanism of Muscle Contraction........................................................ 63
   Muscle Fiber Types............................................................................................. 64
   Properties of Entire Muscles................................................................................. 65
   Motor Unit............................................................................................................ 65
   Grading of Muscular Activity............................................................................. 66
   Summation of the Contractions: Strengthening of the Muscle Twitches...... 67
   Temporal (Time-Related) Summation............................................................ 67
   Spatial Summation............................................................................................. 68
   Denervation Sensitivity of Skeletal Muscle, Denervation Potentials......... 68
   Diseases of Muscle ................................................................................................. 70
   Muscular Dystrophy........................................................................................... 70
   Channelopathies................................................................................................ 70
   Smooth Muscle......................................................................................................... 71
   REFERENCES............................................................................................................ 73
  Chapter 5. EXERCISE PHYSIOLOGY ( L. Pinar)
   Benefits of Regular (long-term) Aerobic Exercise............................................ 77
   Quantitative Values for Physical Capacities...................................................... 78
   Strength, Power and Endurance of the Muscles........................................... 78
   Energy Systems of Exercises............................................................................. 79
   Recovery of the Muscle Metabolic System after Exercise........................... 79
   Oxygen Debt....................................................................................................... 80
   Maximal Resistance Training............................................................................ 80
   Muscle Training for Hypertrophy and Strengthening .................................. 81
   Effects of the Exercise on the Respiratory System .......................................... 81
   Oxygen Consumption (VO2) ............................................................................ 82
   Effects of the Exercise on the Cardiovascular System .................................... 82
   Summary.............................................................................................................. 83
   Maximal Oxygen Consumption....................................................................... 84
   VO2 max Levels................................................................................................... 84
   Measurement of VO2 max....................................................................................... 84
   Submaximal Level of Exercises........................................................................ 85
   Uth-Sorenson-Overgaard-Pederson Estimation ........................................... 85
   Cooper Test......................................................................................................... 85
   6-Minute Walk Test ........................................................................................... 86
   Body Heat in Exercise............................................................................................. 86
   Heatstroke........................................................................................................... 86
   Doping Drugs...................................................................................................... 87
   REFERENCES............................................................................................................ 87
  Chapter 6. SYNAPTIC TRANSMISSION (L. Pinar)
   Types of Synapses................................................................................................... 91
   Morphology of Chemical Synapses................................................................. 92
   Presynaptic and Postsynaptic Structures........................................................ 93
   Fusion................................................................................................................... 94
   Divergence and Convergence......................................................................... 94
   Excitatory and Inhibitory Postsynaptic Potentials........................................... 94
   Excitatory Post Synaptic Potential ................................................................... 95
   Inhibitory Post Synaptic Potential.................................................................... 96
   Temporal and Spatial Summation.................................................................... 97
   Slow Post Synaptic Potentials........................................................................... 98
   Function of Dendrites........................................................................................ 98
   Inhibition and Facilitation at Synapses............................................................... 98
   Direct and Indirect Inhibitions.......................................................................... 98
   Presynaptic Inhibition and Facilitation.......................................................... 100
   Organization of Inhibitory Systems............................................................... 101
   Neuromuscular Transmission .......................................................................... 101
   Neuromuscular (or Myoneural) Junction..................................................... 101
   Drugs That Affect the Transition of Action Potential from Nerve to Muscle 104
   Blockers............................................................................................................. 104
   Drugs That Block Acetylcholinesterase........................................................ 104
   Clinical Aspects .................................................................................................... 105
   Myasthenia Gravis ........................................................................................... 105
   Lambert-Eaton Syndrome .............................................................................. 105
   Neurotransmitters................................................................................................. 106
   Neuromodulators............................................................................................. 106
   Receptors.......................................................................................................... 107
   Mechanism of Reuptake................................................................................. 108
   Monoamine Transmitters.................................................................................... 108
   Acetylcholine ................................................................................................... 108
   ACh Receptors.................................................................................................. 108
   Serotonin........................................................................................................... 109
   Serotonin Receptors........................................................................................ 109
   Histamine ......................................................................................................... 109
   Catecholamines .............................................................................................. 109
   Dopamine ........................................................................................................ 110
   Excitatory Amino Acids....................................................................................... 110
   Glutamate.......................................................................................................... 110
   Glutamate Receptors....................................................................................... 110
   Inhibitory Amino Acids....................................................................................... 111
   Glycine .............................................................................................................. 111
   GABA (Gamma Amino Butyric Acid)............................................................. 111
   GABA Receptors............................................................................................... 111
   Large Molecule Transmitters ............................................................................. 112
   Substance P....................................................................................................... 112
   Opioid Peptides................................................................................................ 112
   Clinical Aspects .................................................................................................... 112
   Excitotoxins....................................................................................................... 112
   Role of Serotonin in Mood and Behavior..................................................... 113
   Phenylketonuria............................................................................................... 113
   Schizophrenia .................................................................................................. 113
   REFERENCES.......................................................................................................... 113
  Chapter 7. CUTANEOUS SENSES and PAIN (T. Yörükan)
   Introduction to the Special Senses..................................................................... 117
   Types of Sensation................................................................................................ 117
   Touch and Pressure......................................................................................... 117
   Vibration............................................................................................................ 119
   Proprioception.................................................................................................. 119
   Tickle and Itch................................................................................................... 119
   Thermal Senses................................................................................................ 119
   Two-Point Discrimination............................................................................... 120
   Epicritic sensibility or localisation.................................................................. 120
   Topognosis (localisation of stimuli)............................................................... 121
   Pain or Nociception.............................................................................................. 121
   The Gating Theory............................................................................................ 124
   Somatic Pain............................................................................................................... 124
   Visceral Pain........................................................................................................... 124
   Referred Pain.................................................................................................... 124
   Transmission..................................................................................................... 126
   Lateral Inhibition.............................................................................................. 128
   Analgesia........................................................................................................... 128
   Analgesic Substances............................................................................................ 128
   Opiate Peptides ............................................................................................... 128
   Effect of Acetylcholine on Pain .................................................................... 129
   Cannabinoids in Pain Relief............................................................................ 129
   Pain Suppression in the Brain and Spinal Cord ........................................... 129
   Clinical Aspects ............................................................................................... 130
   Neuropathic Pain................................................................................................... 131
   Sensory Symptoms of Spinal Cord Diseases................................................ 132
   Cortical Representation.................................................................................. 132
   Clinical Aspects................................................................................................ 133
   REFERENCES.......................................................................................................... 134
  Chapter 8. PHYSIOLOGY OF VISION (T. Yörükan)
   Structure of the Eye............................................................................................... 137
   The Sclera.......................................................................................................... 138
   The Choroid...................................................................................................... 140
   The Retina......................................................................................................... 142
   The Optical System of the Eye- the first function of the eye........................ 146
   Lens strength and normal vision................................................................... 148
   Near Point Convergence Reflex.................................................................... 150
   Visual Fixation Reflex....................................................................................... 150
   Binocular Vision ............................................................................................... 150
   Visual Acuity...................................................................................................... 151
   Physiologic Mechanisms in Vision - the second step in vision.................. 151
   Scotopic Vision...................................................................................................... 152
   Photopic Vision..................................................................................................... 152
   Photochemical and Bioelectric Processes in Scotopic vision................... 152
   Mechanism of Excitation................................................................................. 153
   Physiologic Nystagmus................................................................................... 156
   Colour Vision......................................................................................................... 156
   Transmission of signals from the retina to the Visual centres ................. 158
   Lesions at different levels of the Optic tract .............................................. 161
   Eye movements .............................................................................................. 162
   Visual Field and Perimeter.............................................................................. 162
   Scotoma............................................................................................................. 162
   REFERENCES.......................................................................................................... 163
  Chapter 9. AUDITORY PHYSIOLOGY (T. Yörükan)
   Perilymph and Endolymph............................................................................. 171
   Sound - Physical characteristics........................................................................ 171
   The Decibel ...................................................................................................... 172
   Summary of the Auditory process..................................................................... 172
   Cochlear Sound Transmission........................................................................ 172
   Place Theory of Cochlear Function............................................................... 175
   Transmission to the Auditory Cortex................................................................ 176
   The Types of Hearing Loss.................................................................................. 177
   Equilibrium............................................................................................................ 177
   Disturbances of Balance................................................................................. 181
   REFERENCES.......................................................................................................... 181
  Chapter 10. CHEMICAL SENSES OF TASTE AND SMELL OR GUSTATION AND OLFACTION (T. Yörükan)
   Taste or Gustation................................................................................................. 185
   General mechanism of stimulation............................................................... 186
   Localisation....................................................................................................... 188
   Transmission......................................................................................................... 189
   Smell or Olfaction................................................................................................. 190
   Vomeronasal Organ......................................................................................... 191
   Mechanism of Excitation................................................................................. 192
   Sensation modalities....................................................................................... 192
   Transmission......................................................................................................... 193
   Disturbances of Olfaction............................................................................... 195
   REFERENCES.......................................................................................................... 195
  Chapter 11. AUTONOMIC NERVOUS SYSTEM (T. Yörükan)
   Sympathetic Division........................................................................................... 200
   Parasympathetic Division................................................................................... 201
   Synapses.................................................................................................................. 202
   Autonomic Transmitters................................................................................. 202
   Sympathetic postganglionic fibre Effector Organ Synapse....................... 204
   Regulation of Norepinephrine Release and Synthesis.............................. 204
   Adrenergic Receptors..................................................................................... 204
   Alpha Receptors............................................................................................... 205
   Beta Receptors................................................................................................. 205
   Acetylcholine Receptors................................................................................. 206
   Denervation Hypersensitivity............................................................................ 207
   Responses in Effector Organs............................................................................. 207
   The actions of sympathetic nerves on effector organs............................. 207
   Actions of Parasympathetic Nerves on Effector Organs............................ 209
   Cranial Division..................................................................................................... 209
   Responses of Effectors to Autonomic Nerve Impulses................................. 210
   Autonomic reflexes......................................................................................... 212
   Central Control of Autonomic functions........................................................... 213
   REFERENCES.......................................................................................................... 214
  Chapter 12. MOTOR FUNCTIONS OF THE CENTRAL NERVOUS SYSTEM (L. Pinar)
   Three Main Levels of the Central Nervous System Involved in Motor Functions 217
   Spinal cord (Medulla Spinalis) Level.............................................................. 217
   Lower Brain Level............................................................................................ 217
   Upper Brain Level, Cortical Level.................................................................. 218
   The Simplest Motor Activities Of the Spinal Cord.......................................... 219
   Stretch Reflex................................................................................................... 219
   The Effect of the Gamma Motor Neurons.................................................... 222
   Reciprocal Innervation and Inhibition........................................................... 223
   Golgi Tendon Reflex........................................................................................ 223
   Pathological Reflexes...................................................................................... 225
   Withdrawal Reflex (Flexion Reflex)............................................................... 225
   Spinal Shock...................................................................................................... 226
   Brown Sequard Syndrome ............................................................................. 227
   Mass Reflex....................................................................................................... 227
   Clinical Aspects..................................................................................................... 229
   Amyotrophic Lateral Sclerosis (Motor Neuron Disease)............................ 229
   Brainstem and Reticular Formation.................................................................. 230
   Reticular Facilitatory (Excitatory) Area.......................................................... 230
   Reticular Inhibitory Area................................................................................. 231
   Functions of the Neocortex................................................................................. 232
   Cerebral Dominance ...................................................................................... 232
   Control of Motor Functions................................................................................. 234
   Motor Areas in the Cerebral Cortex ............................................................. 235
   Primary Motor Cortex ..................................................................................... 235
   Premotor Cortex.............................................................................................. 236
   Supplementary Motor Cortex........................................................................ 236
   Somatic Sensory Area in Motor activity........................................................ 237
   Initiation of the Motor Commands by the Cerebral Cortex...................... 237
   Control of the Axial and Distal Muscles of the Body..................................... 238
   Corticospinal Tracts............................................................................................. 240
   Lateral Corticospinal Tract (Pyramidal tract)................................................ 240
   Anterior (Ventral) Corticospinal Tract .......................................................... 241
   Corticobulbar Tract.......................................................................................... 242
   Rubrospinal Tract.............................................................................................. 242
   Extrapyramidal System (Ventromedial System Tracts) .............................. 243
   Pontine Reticulospinal Tract (tr. Reticulospinalis medialis)....................... 243
   Medullary Reticulospinal Tract (tr. Reticulospinalis lateralis).................... 243
   Medial and Lateral Vestibulospinal Tracts.................................................... 243
   Tectospinal Tract.............................................................................................. 244
   The Inhibitory Areas of Central Nervous System ....................................... 244
   Decerebrate Rigidity....................................................................................... 245
   Decorticate Rigidity (Spasticity)..................................................................... 246
   Lower and Upper Motor Neurons and Their Lesions ................................ 246
   Lesions of Cortical Areas................................................................................. 247
   Cerebral Palsy (CP).......................................................................................... 249
   Impairment of the Sensorimotor Integration ............................................. 249
   Basal Ganglia.......................................................................................................... 250
   Direct Tract ....................................................................................................... 252
   Indirect Tract..................................................................................................... 252
   Neuronal Circuits of the Basal Ganglia............................................................. 253
   Putamen Circuit............................................................................................... 253
   Caudate Circuit................................................................................................. 254
   Metabolic Properties of the Basal Ganglia................................................... 255
   Clinical Aspects..................................................................................................... 255
   Huntington's disease....................................................................................... 255
   Parkinson's Disease (Paralysis Agitans)........................................................ 256
   Cerebellum.............................................................................................................. 257
   Function............................................................................................................. 257
   Afferent Tracts to the Cerebellum from the Brain .................................... 259
   Afferent Tracts to the Cerebellum from the Periphery............................. 259
   Efferent Tracts from the Cerebellum............................................................ 260
   Functional Unit of the Cerebellum............................................................... 260
   Function of the Lateral Hemispheres........................................................... 262
   Romberg Test................................................................................................... 262