Motor neuron

Physiology

• Motor neuron (or motoneuron or efferent neuron) is a neuron whose cell body is located in the motor cortex, brainstem or the spinal cord, whose axon projects to the spinal cord or outside of the spinal cord to directly or indirectly control effector organs, mainly muscles and glands.
• There are two types of motor neuron
  1. Upper motor neurons
  2. Lower motor neurons
• Axons from UMN synapse onto interneurons in the spinal cord and occasionally directly onto LMNs.
• The axons from LMNs are efferent nerve fibers that carry signals from the spinal cord to the effectors.

A single motor neuron may innervate many muscle fibres and a muscle fibre can undergo many action potentials in the time taken for a single muscle twitch. Innervation takes place at a neuromuscular junction and twitches can become superimposed as a result of summation or a tetanic contraction. Individual twitches can become indistinguishable, and tension rises smoothly eventually reaching a plateau.

Upper motor neurons

• UMNs originate in the motor cortex located in the precentral gyrus.
• The axons descend from the cortex to form the corticospinal tract.
• Corticomotorneurons project from the primary cortex directly onto motor neurons in the ventral horn of the spinal cord. Their axons synapse on the spinal motor neurons of multiple muscles as well as on spinal interneurons. They are unique to primates and it has been suggested that their function is the adaptive control of the hands including the relatively independent control of individual fingers. Corticomotorneurons have so far only been found in the primary motor cortex and not in secondary motor areas.

Nerve tracts[edit]

Nerve tracts are bundles of axons as white matter, that carry action potentials to their effectors. In the spinal cord these descending tracts carry impulses from different regions. These tracts also serve as the place of origin for lower motor neurons. There are seven major descending motor tracts to be found in the spinal cord:

• Lateral corticospinal tract
• Rubrospinal tract
• Lateral reticulospinal tract
• Vestibulospinal tract
• Medial reticulospinal tract
• Tectospinal tract
• Anterior corticospinal tract

Clinic

• UMN are found in the cerebral cortex and brain-stem
• They carry information down to activate interneurons and LMN, which in turn directly signal muscles to contract or relax.
• UMN in the cerebral cortex are the main source of voluntary movement.
• UMN are the largest pyramidal neurons in the cortex that enter the spinal cord through the brain stem
• Their route is anterior (10%) and external (90%) corticospinal tract.

UMN pathways

Corticospinal tract

It is originated from motor cortex and goes to LMNs in the ventral horn of the spinal cord. Its major function is

• Fine voluntary motor control of limbs
• Voluntary body posture adjustments.

Corticobulbar tract

It is originated from motor cortex and goes to several nuclei in the pons and medulla oblongata. It is Involved in

• Control of facial and jaw musculature
• Swallowing
• Tongue movements

Colliculospinal tract

It also named tectospinal tract which is originated from superior colliculus and goes to LMNs. It is involved in

• Involuntary adjustment of head position in response to visual information.

Rubrospinal tract

It is originated from red nucleus and goes to LMNs. it is involved in

• Involuntary adjustment of arm position in response to balance information; support of the body

Vestibulospinal tract

It is originated from vestibular nuclei, which processes stimuli from semicircular canals.

• It is responsible for adjusting posture to maintain balance

Reticulospinal tract

It comes from reticular formation ir order to

• Regulates various involuntary motor activities and assists in balance.

Lower motor neurons

• LMNs are those that originate in the spinal cord and directly or indirectly innervate effector targets.
• The target of these neurons varies, but in the somatic nervous system the target will be some sort of muscle fiber. There are three primary categories
  1. Somatic motor neurons: Somatic motor neurons originate in CNS, project their axons to skeletal muscles which are involved in locomotion. They are called efferent to indicate the flow of information from CNS to the periphery.
  2. Special visceral motor neurons: These are also known as branchial motor neurons, which are involved in facial expression, mastication, phonation, and swallowing. Associated cranial nerves are the oculomotor, abducens, trochlear, and hypoglossal nerves.
  3. General visceral motor neurons: These motor neurons indirectly innervate cardiac muscle and smooth muscles of the viscera ( the muscles of the arteries).They synapse onto neurons located in Sympathetic and Parasympathetic ganglia, located in the peripheral nervous system (PNS), which themselves directly innervate visceral muscles

Neuromuscular junctions[edit]

A single motor neuron may innervate many muscle fibres and a muscle fibre can undergo many action potentials in the time taken for a single muscle twitch. As a result, if an action potential arrives before a twitch has completed, the twitches can superimpose on one another, either through summation or a tetanic contraction. In summation, the muscle is stimulated repetitively such that additional action potentials coming from the somatic nervous system arrive before the end of the twitch. The twitches thus superimpose on one another, leading to a force greater than that of a single twitch. A tetanic contraction is caused by constant, very high frequency stimulation - the action potentials come at such a rapid rate that individual twitches are indistinguishable, and tension rises smoothly eventually reaching a plateau.

The interface between a motor neuron and muscle fiber is a specialized synapse called the neuromuscular junction. Upon adequate stimulation, the motor neuron releases a flood of acetylcholine (Ach) neurotransmitters from the axon terminals from synaptic vesicles bind with the plasma membrane. The acetylcholine molecules bind to postsynaptic receptors found within the motor end plate. Once two acetylcholine receptors have been bound, an ion channel is opened and sodium ions are allowed to flow into the cell. The influx of sodium into the cell causes depolarization and triggers a muscle action potential. T tubules of the sarcolemma are then stimulated to elicit calcium ion release from the sarcoplasmic reticulum. It is this chemical release that causes the target muscle fiber to contract.

In invertebrates, depending on the neurotransmitter released and the type of receptor it binds, the response in the muscle fiber could be either excitatory or inhibitory. For vertebrates, however, the response of a muscle fiber to a neurotransmitter can only be excitatory, in other words, contractile. Muscle relaxation and inhibition of muscle contraction in vertebrates is obtained only by inhibition of the motor neuron itself. This is how muscle relaxants work by acting on the motor neurons that innervate muscles (by decreasing their electrophysiological activity) or on cholinergic neuromuscular junctions, rather than on the muscles themselves.

Synaptic input to motor neurons[edit]

Motor neurons receive synaptic input from premotor neurons. Premotor neurons can be 1) spinal interneurons that have cell bodies in the spinal cord, 2) sensory neurons that convey information from the periphery and synapse directly onto motoneurons, 3) descending neurons that convey information from the brain and brainstem. The synapses can be excitatory, inhibitory, electrical, or neuromodulatory. For any given motor neuron, determining the relative contribution of different input sources is difficult, but advances in connectomics have made it possible for fruit fly motor neurons. In the fly, motor neurons controlling the legs and wings are found in the ventral nerve cord, homologous to the spinal cord. Fly motor neurons vary by over 100X in the total number of input synapses. However, each motor neuron gets similar fractions of its synapses from each premotor source: ~70% from neurons within the VNC, ~10% from descending neurons, ~3% from sensory neurons, and ~6% from VNC neurons that also send a process up to the brain. The remaining 10% of synapses come from neuronal fragments that are unidentified by current image segmentation algorithms and require additional manual segmentation to measure .

• Neuromuscular junction or myoneural junction is a chemical synapse between a motor neuron and a muscle fiber.
• It allows the motor neuron to transmit a signal to the muscle fiber, causing muscle contraction.
• Muscles require innervation to function and even just to maintain muscle tone, avoiding atrophy.
• In the neuromuscular system nerves from CNS and the peripheral nervous system are linked and work together with muscles.

Synaptic transmission at the neuromuscular junction begins when an action potential reaches the presynaptic terminal of a motor neuron, which activates voltage-gated calcium channels to allow calcium ions to enter the neuron. Calcium ions bind to sensor proteins (synaptotagmins) on synaptic vesicles, triggering vesicle fusion with the cell membrane and subsequent neurotransmitter release from the motor neuron into the synaptic cleft. In vertebrates, motor neurons release acetylcholine (ACh), a small molecule neurotransmitter, which diffuses across the synaptic cleft and binds to nicotinic acetylcholine receptors (nAChRs) on the cell membrane of the muscle fiber, also known as the sarcolemma. nAChRs are ionotropic receptors, meaning they serve as ligand-gated ion channels. The binding of ACh to the receptor can depolarize the muscle fiber, causing a cascade that eventually results in muscle contraction.

Neuromuscular junction diseases

• Genetic disorders, such as Congenital myasthenic syndrome, can arise from mutated structural proteins that comprise the neuromuscular junction
• Autoimmune diseases, such as myasthenia gravis, occur when antibodies are produced against nicotinic acetylcholine receptors on the sarcolemma.

Diseases Autoimmune[edit]

Myasthenia gravis[edit]

Myasthenia gravis is an autoimmune disorder where the body makes antibodies against either the acetylcholine receptor (AchR) (in 80% of cases), or against postsynaptic muscle-specific kinase (MuSK) (0–10% of cases). In seronegative myasthenia gravis low density lipoprotein receptor-related protein 4 is targeted by IgG1, which acts as a competitive inhibitor of its ligand, preventing the ligand from binding its receptor. It is not known if seronegative myasthenia gravis will respond to standard therapies.

Neonatal MG[edit]

Neonatal MG is an autoimmune disorder that affects 1 in 8 children born to mothers who have been diagnosed with myasthenia gravis (MG). MG can be transferred from the mother to the fetus by the movement of AChR antibodies through the placenta. Signs of this disease at birth include weakness, which responds to anticholinesterase medications, as well as fetal akinesia, or the lack of fetal movement. This form of the disease is transient, lasting for about three months. However, in some cases, neonatal MG can lead to other health effects, such as arthrogryposis and even fetal death. These conditions are thought to be initiated when maternal AChR antibodies are directed to the fetal AChR and can last until the 33rd week of gestation, when the γ subunit of AChR is replaced by the ε subunit.

Lambert-Eaton myasthenic syndrome[edit]

Lambert–Eaton myasthenic syndrome (LEMS) is an autoimmune disorder that affects the presynaptic portion of the neuromuscular junction. This rare disease can be marked by a unique triad of symptoms: proximal muscle weakness, autonomic dysfunction, and areflexia. Proximal muscle weakness is a product of pathogenic autoantibodies directed against P/Q-type voltage-gated calcium channels, which in turn leads to a reduction of acetylcholine release from motor nerve terminals on the presynaptic cell. Examples of autonomic dysfunction caused by LEMS include erectile dysfunction in men, constipation, and, most commonly, dry mouth. Less common dysfunctions include dry eyes and altered perspiration. Areflexia is a condition in which tendon reflexes are reduced and it may subside temporarily after a period of exercise.

50–60% of the patients that are diagnosed with LEMS also have present an associated tumor, which is typically small-cell lung carcinoma (SCLC). This type of tumor also expresses voltage-gated calcium channels. Oftentimes, LEMS also occurs alongside myasthenia gravis.

Treatment for LEMS consists of using 3,4-diaminopyridine as a first measure, which serves to increase the compound muscle action potential as well as muscle strength by lengthening the time that voltage-gated calcium channels remain open after blocking voltage-gated potassium channels. In the US, treatment with 3,4-diaminopyridine for eligible LEMS patients is available at no cost under an expanded access program. Further treatment includes the use of prednisone and azathioprine in the event that 3,4-diaminopyridine does not aid in treatment.

Neuromyotonia[edit]

Neuromyotonia (NMT), otherwise known as Isaac's syndrome, is unlike many other diseases present at the neuromuscular junction. Rather than causing muscle weakness, NMT leads to the hyperexcitation of motor nerves. NMT causes this hyperexcitation by producing longer depolarizations by down-regulating voltage-gated potassium channels, which causes greater neurotransmitter release and repetitive firing. This increase in rate of firing leads to more active transmission and as a result, greater muscular activity in the affected individual. NMT is also believed to be of autoimmune origin due to its associations with autoimmune symptoms in the individual affected.