Alissa Higinbotham, MD Profile picture
Jun 22, 2022 5 tweets 4 min read Read on X
Hey #Medtwitter & #Neurotwitter With 2 simple rules you can learn the #basalganglia direct and indirect pathways for the LAST TIME and actually remember them! 🤯Here’s how! 🧵 :
#MedEd #medicalstudent #Neurology #Neurologyresident #Movementdisorders #Neuroscience #Neuroanatomy
Rule 1: The “OG” basal ganglia (striatum and globus pallidi) use GABA ➖as their neurotransmitter. Everything else uses glutamate ➕.

Rule 2: Once you know Rule 1, all you have to do is memorize the order of the structures:

Direct pathway: CS___GiT
Indirect pathway: CS GeS GiT
Both pathways start with
cortex (C)>striatum (S)
and end with globus pallidus internus (Gi)>Thalamus (T).

For the indirect, just add GeS (Globus pallidus externus>STN) in the middle!
On exams I draw out these letters and fill in the neurotransmitter (GABA for the OG BG, Glutamate for the rest), and I can answer any question about the direct & indirect pathways! Hope this helps you to study these pathways for the last time! 🧠
Glad I got the BG basics down with my 2 step mnemonic above, because I just learned in #Aspen from a lecture by @DrSusanHFox there could be a second hyperdirect pathway! 😅 @movedisorder Image

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More from @AlissaHigMD

Oct 12, 2022
Myoclonus-Dystonia syndrome (MDS) is a very interesting diagnosis to be aware of as it can become quite disabling for patients from a movement disorder and a psychiatric standpoint! 🧵#movementdisorders #MedTwitter #NeuroTwitter #MedStudentTwitter #MedEd
-Onset is typically in childhood with myoclonus alone or in combination with dystonia.

-Most cases are due to inherited SGCE gene mutations

-Symptoms are very alcohol-responsive *which can lead to abuse and addiction*

-Co-morbid anxiety, depression, OCD, etc. are common
- The myoclonus preferentially affects the upper body but spreads to the lower body with action

- Zonisamide has Class I evidence for the treatment of myoclonus in MDS
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