Striatal plasticity and extrapyramidal motor dysfunction

Knowledge of molecular events contributing to motor dysfunction in Parkinson's disease has advanced rapidly during the past decade. Studies in animal models as well as in patients afflicted by this disorder suggest that the nonphysiologic stimulation of striatal dopamine receptors, first as a result of dopaminergic denervation and later as a consequence of the intermittent high-intensity stimulation produced by standard therapeutic regimens, leads to plastic changes in striatal medium spiny neurons. The clinical appearance of parkinsonism and subsequently of motor response complications is associated with the aberrant activation of signaling cascades within medium spiny neurons that modify the phosphorylation state of their ionotropic glutamatergic receptors. Resultant NMDA and AMPA receptor sensitization augments cortical excitatory input to these spiny efferent neurons, thus altering striatal output in ways that compromise motor function. These findings have already yielded new insight into mechanisms subserving motor memory and synaptic integration as well as accelerated development of novel approaches to the improved treatment of motor disability.