Motor hemiplegia and the cerebral organization of movement in man: II. The myth of the human extrapyramidal system

Oliveira-Souza, R.

doi:10.1590/S0004-282X1989000100003

Abstracts

Following a brief review of the concept of extrapyramidal system, clinical and anatomic evidence is presented against its relative prominence in man. It is proposed that the greatest part of those structures traditionally labeled as extrapyramidal effects its respective functional activities by way of the pyramidal tracts themselves. Such structures, centered around the basal nuclei, the cerebellum and possibly, the limbic areas of the prosencephalon are, according to the present suggestion, indeed, pre pyramidal. This model is based upon the clinical analysis of patients and agrees with more than one century of anatomic verifications in human brains, favoring the notion of the singularity of the human brain.

Após revisão sumária do conceito de sistema extrapiramidal, são apresentadas evidências clínicas e anatômicas contra sua importância relativa no homem. Propõe-se que as estruturas tradicionalmente agrupadas sob o rótulo extrapiramidal efetuem a maior parte de suas atividades funcionais, respectivamente, por intermédio dos próprios feixes piramidais. Tais estruturas - centradas nos núcleos da base dos hemisférios cerebrais, no cerebelo e, possivelmente, também, nas áreas límbicas do prosencéfalo -, de acordo com nossa proposição são, na verdade pre-piramidais. Esse modelo se baseia na análise clínica de pacientes, está de acordo com mais de um século de verificações anatômicas em cérebros humanos e, depõe a favor da noção de singularidade do cérebro humano.

Motor hemiplegia and the cerebral organization of movement in man: II. The myth of the human extrapyramidal system

Hemiplegia motora e organização cerebral do movimento no homem: II. O mito do sistema extrapiramidal humano

R. Oliveira-Souza

Serviço de Neurologia (Prof. H. Alvarenga), Hospital Universitário Gaffrée e Guinle, Rio de Janeiro

SUMMARY

Following a brief review of the concept of extrapyramidal system, clinical and anatomic evidence is presented against its relative prominence in man. It is proposed that the greatest part of those structures traditionally labeled as extrapyramidal effects its respective functional activities by way of the pyramidal tracts themselves. Such structures, centered around the basal nuclei, the cerebellum and possibly, the limbic areas of the prosencephalon are, according to the present suggestion, indeed, pre pyramidal. This model is based upon the clinical analysis of patients and agrees with more than one century of anatomic verifications in human brains, favoring the notion of the singularity of the human brain.

RESUMO

Após revisão sumária do conceito de sistema extrapiramidal, são apresentadas evidências clínicas e anatômicas contra sua importância relativa no homem. Propõe-se que as estruturas tradicionalmente agrupadas sob o rótulo extrapiramidal efetuem a maior parte de suas atividades funcionais, respectivamente, por intermédio dos próprios feixes piramidais. Tais estruturas - centradas nos núcleos da base dos hemisférios cerebrais, no cerebelo e, possivelmente, também, nas áreas límbicas do prosencéfalo -, de acordo com nossa proposição são, na verdade pre-piramidais. Esse modelo se baseia na análise clínica de pacientes, está de acordo com mais de um século de verificações anatômicas em cérebros humanos e, depõe a favor da noção de singularidade do cérebro humano.

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Acknowledgements - The author is grateful to Profs. Helcio Alvarenga and Charles Esbérard (Dep Physiology, Rio de Janeiro University) for their opportune advices; to Dr. Rubens Pinheiro (Dep Radiology, Federal University of Rio de Janeiro) who aptly performed the CT scans; to Drs. Maurício Klajnberg and Sergio Szklarz for the evoked potential studies; to Axel Schlieter and Jutta Neupert (Freiburg University, Western Germany) for suggestions regarding the English manuscript; unvaluable help was given by Prof. Marc Fisher (Dep Neurology, University of Massachussetts Medical School, USA) concerning the review of the content and grammar of the text; the wise comments and criticisms by Prof. Peter W. Nathan (National Hospital, London, UK) guided the writing of every line of this article.

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Mar 1989

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[1] 1. Asanuma C, Thatch WT, Jones EG - Distribution of cerebellar terminations and their relation to afferent terminations in the ventral thalamic region of the monkey. Brain Res Rev 5:237, 1983.

[2] 2. Atwood CE - A case of double hemiplegia. J Nerv Ment Dis 35:513, 1908.

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