Study-Unit Description

Study-Unit Description


TITLE Nervous System 2

LEVEL 02 - Years 2, 3 in Modular Undergraduate Course


DEPARTMENT Faculty of Medicine and Surgery

DESCRIPTION This study-unit is intended for preclinical students to grasp the basics in the neuroanatomical and neurophysiological concepts of the nervous system.

This will provide a solid foundation for understanding the pathophysiology of common clinical conditions.

Study-unit Aims:

- To provide an in depth knowledge of the central and peripheral nervous system anatomy and physiology;
- To provide the clinical consequences which ensue following a malfunction of the central and peripheral nervous system.

Learning Outcomes:

1. Knowledge & Understanding
By the end of the study-unit the student will be able to:

- describe neurophysiology;
- describe construction of neural circuits;
- explain the mechanisms through which exploratory growth cones lead to neuronal;
- migration and networking in the context of the chemoaffinity hypothesis;
- describe the underlying mechanisms of axonal pathfinding and guidance during early development;
- explain the molecular basics of neurotrophin signaling, synaptogenesis and
- maintenance of the blood-brain-barrier and drug delivery;
- explain the concept of spatial potassium buffering and the importance of a constant level in the brain- focus on seizure activity, stroke, TBI, Conduction block;
- brain Homeostasis II;
- explain how astrocytic glutamate exocytosis and calcium waves participate as detectors of neuronal activity in glial signalling;
- explain fundamental glial-regulating mechanisms that control brain water homeostasis, extracellular space volume, pH, modulation of synaptic activity and energetics - neuron-lactate shuttle hypothesis;
- describe the coupling of cerebral blood flow with neuronal activity/metabolism;
- factors that influence cerebral blood flow;
- describe altered states- glioma physiology and common tumours that metastasise in the brain;
- explain mechanisms of gray matter injury;
- explain the excitotoxic concept and its central role in common neurological disorders;
- describe the cellular mechanisms associated with vasogenic and cytotoxic edema formation and its implications in brain pathology;
- identify possible abnormalities of the glutamatergic synapse that may lead to neuronal necrosis/apoptosis;
- describe strategies to control excessive glutamatergic transmission;
- demonstrate understanding of the calcium hypothesis and altered states- the Ca hypothesis of neurodegeneration;
- discuss the mechanism of PSD95 as a mediator in death-promoting pathways.

Mechanisms of gray matter injury II

- Explain how neuronal death is caused by lead, NO and Zinc toxicity;
- Explain the role of the quinolinic acid pathway in neuroinflammation;
- Outline the calpain-cathepsin pathway in neuronal injury;
- Describe and explain the concept of neuronal selective vulnerability;
- Outline several factors that make the brain vulnerable to oxidative stress;
- Discuss various specific disease states that effect the gray matter.

Mechanisms of White matter injury I

- Describe the levels of white matter stratification in the brain and spinal cord;
- Describe the features of select diseases that preferentially target the white matter;
- Describe the involvement of oligodendrocyte injury, signaling cascades;
- Describe Axonal injury. Demyelination and conduction failure;
- Wallerian degeneration;
- Describe the vascular and maturational factors that lead to perinatal injury in PVL and cerebral palsy.

Mechanisms of White matter injury II

- Describe the biomechanics of traumatic brain injury (primary and secondary injury);
- Describe and understand the significance of diffuse axonal injury, whiplash, coup-countercoup forces, cavitation, shaken baby syndrome in the presentation of white matter subcortical injury;
- Identify the ionic and cellular events, pathways, associated with WM injury;
- Explain spinal cord injury- mechanisms of injury;
- Explain the differences between gray and white matter injury mechanisms and the possible targets for neuroprotection.

Repair and regeneration in the nervous system

- Elaborate on the cellular and molecular response to different forms of injury in the brain;
- Describe the concepts of Wallerian degeneration in the CNS and the PNS;
- Explain the underlying difficulties underlying CNS regeneration;
- Explain regeneration after damage to the CNS-neural stem cells;
- Describe strategies for the generation and replacement of neurons in the adult brain, including plasticity;
- Outline broad treatment strategies and clinical technologies for regeneration.

Basal ganglia and cortical control of movement

- Name the anatomical structures that constitute the basal ganglia and identify them in representative images;
- Describe the role of each component of the basal ganglia in motor activities;
- Describe the role of the caudate and putamen circuits in modulation of motor movement by the basal ganglia;
- Describe the functional organization of the D1 and D2 pathways;
- Explain in general terms how changes in the basal ganglia circuitry relates to motor abnormalities in Parkinson's Disease and Huntington's Disease;
- Describe the topographical representation of the motor cortex;
- Describe the main pathways from the motor cortex to the brainstem and spinal cord;
- Explain how the motor cortex is involved in skilled movement;
- Integration of the motor system during voluntary movement.

Neurophysiology of the basal ganglia

- Describe the electrophysiology activity of the different basal ganglia nuclei in normal and pathological conditions;
- Demonstrate familiarity with new experimental evidence in basal ganglia research;
- Describe the non-motor function of the basal ganglia.

Sleep and EEG

- Define and explain the physiological basis of the electroencephalogram (EEG);
- Describe the origin of spontaneous electrical activity of the cerebral cortex;
- Recognize normal and abnormal EEG records;
- Describe the behavioural, EEG, and other characteristics of the stages of slow-wave sleep and rapid-eye-movement (REM) sleep;
- Describe the neural systems important for the regulation of sleep-waking;
- Describe the neurochemical systems important for sleep and waking.


- Describe the transduction of nociceptive signals;
- Outline the central pain pathways;
- Describe the mechanisms that gives rise to peripheral and central sensitization;
- Describe the gate theory of pain;
- Describe the mechanisms for the descending control of pain perception;
- Describe the placebo effect.

Cognition and the Cortex

- Describe the structure of the cortex;
- Describe the functional attributes of the Parietal Association Cortex;
- Describe the functional attributes of the Temporal Association Cortex;
- Describe the functional attributes of the Frontal Association Cortex.

Memory and Plasticity

- Describe the mechanisms for short term synaptic plasticity;
- Describe the mechanisms for long term plasticity;
- Describe declarative and non-declarative memory;
- Describe the brain systems underlying declarative memory;
- Describe the brain systems underlying non-declarative memory;
- Describe the memory disorders that arise in relation to the brain systems that support the different types of memory.

Additional Anatomy

- Describe the anatomy of the spinal cprd, brainstem and cerebellum;
- Describe the embryological development of the diencephalon and telencephalon;
- Describe the structures at the base of the cerebrum including the hypophysis and the circle of Willis, including the circulatory system of the brain;
- Correlate the anatomy with the major functional divisions of the thalamus and hypothalamus;
- Describe the white matter pathways relating to the diencephalon and telencephalon and connecting them with lower brain and spinal cord;
- Correlate the Anatomy with the functional divisions of the basal ganglia;
- Describe the structure function correlations of the limbic system;
- Describe the structures at the base of the cerebrum including cerebral circulation and the production and circulation of CSF.

2. Skills
By the end of the study-unit the student will be able to:

- identify mechanisms involved in detoxification of ammonia and its replenishment into the glutamate pool;
- identify mechanisms involved in detoxification of ammonia and its replenishment into the glutamate pool;
- outline methods of neurological examination of the spinal cord and Cerebellum;
- describe the underlying mechanisms of injury to both gray and white matter elements and the control of brain homeostasis;
- explain the molecular basics of signaling, axonal pathfinding, synaptogenesis and repair and regeneration strategies in the CNS and PNS;
- outline the physiology of the basal ganglia and its cortical control in movement;
- describe the mechanisms involved in learning and memory and the functional attributes of the cortex in cognition;
- explain the physiological basis of sleep and EEG, Vision, hearing and pain;
- describe the embryological development of the diencephalon and Telencephalon;
- identify exogenous and endogenous sources of neurotoxicity;
- identify the neurotransmitters determining the flow of information in the system (dopamine, GABA, Glutamate, nitric oxide and adenosine);
- distinguish between slow wave sleep and paradoxical sleep.

Main Text/s and any supplementary readings:

Main Textbooks:

- Textbook of Medical Physiology (Guyton Physiology) Guyton & Hall, Saunders.
- Neuroscience, 3rd edition, Sinauer Associates, 2004. Editors; by Dale Purves, George J. Augustine, David Fitzpatrick , William C. Hall, Anthony-Samuel Lamantia, James O. McNamara, S. Mark Williams. ISBN 0-87893-725-0.
- Neuroanatomy, Crossman and Neary, Churchill Livingstone; 4 edition.
- Functional Neuroanatomy Adel Afifi , Ronald Bergman; McGraw-Hill, Medical; ISBN 71408126.

Supplementary Readings:

- Molecular Neuropharmacology: A Foundation for Clinical Neuroscience.
- Editors, Eric Nestler., Steven E. Hyman, and Robert C. Malenka. New York, McGraw-Hill, 2001. ISBN 083-856379-1.

STUDY-UNIT TYPE Lecture, Seminar & Independent Study

Assessment Component/s Assessment Due Resit Availability Weighting
Examination (3 Hours) SEM2 Yes 100%

LECTURER/S Jean Calleja Agius
Ruben Cauchi
Vincenzo Crunelli
Giuseppe Di Giovanni
Richard Muscat
Mario Valentino
Neville Vassallo
Christian Zammit (Co-ord.)

The University makes every effort to ensure that the published Courses Plans, Programmes of Study and Study-Unit information are complete and up-to-date at the time of publication. The University reserves the right to make changes in case errors are detected after publication.
The availability of optional units may be subject to timetabling constraints.
Units not attracting a sufficient number of registrations may be withdrawn without notice.
It should be noted that all the information in the study-unit description above applies to the academic year 2018/9, if study-unit is available during this academic year, and may be subject to change in subsequent years.