NEUROSCIENCES MODULE. Semester: Three Year: Second Year MBBS Region/s: Neurosciences

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1 NEUROSCIENCES MODULE Semester: Three Year: Second Year MBBS Region/s: Neurosciences Course Duration: Six weeks l. Credit Hours: 6.0 Theory, 3.00 Practical and Demonstration

2 Introduction: T h e N e u r o s c i e n c e s m o d u l e i s d e v e l o p e d t o p r o v i d e t h e l e a r n e r s w i t h i n - d e p t h k n o w l e d g e a b o u t h o w t h e b r a i n i s s t r u c t u r e d a n d h o w i t w o r k s u n d e r n o r m a l a n d a b n o r m a l c i r c u m s t a n c e s. S t u d e n t s l e a r n t h e d e v e l o p m e n t a l p r o c e s s e s o f t h e b r a i n i n o r d e r t o u n d e r s t a n d w h e r e t h e s t r u c t u r e s c o m e f r o m a n d h o w e a c h i s l i n k e d w i t h t h e o t h e r s. T h i s m o d u l e d e a l s n o t o n l y w i t h t h e b r a i n b u t a l s o w i t h t h e p e r i p h e r a l n e r v o u s s y s t e m. S t u d e n t s g e t t o k n o w h o w t h e h u m a n b o d y c a r r i e s o u t i t s m y r i a d f u n c t i o n s, s o m e o f w h i c h a r e u n d e r o u r c o n t r o l ( e. g. w a l k i n g ) w h i l e o t h e r s a r e n o t ( e. g. b e a t i n g o f t h e h e a r t ). T h e A u t o n o m i c N e r v o u s s y s t e m, o n e o f t h e e s s e n t i a l s y s t e m s m a i n t a i n i n g o u r h o m e o s t a s i s, i s d e a l t w i t h i n d e t a i l. O n e o f t h e m a i n r e a s o n s f o r t h i s i s b e c a u s e m a n y m e d i c a t i o n s a l t e r A u t o n o m i c f u n c t i o n s. ; a d o c t o r h a s t o h a v e d e t a i l e d k n o w l e d g e a b o u t s u c h m e d i c a t i o n s a n d t h e i r i n t e r a c t i o n s. T h e N e u r o s c i e n c e s m o d u l e i s g e a r e d t o h e l p l e a r n e r s g r a d u a t e f r o m n o r m a l s t r u c t u r e s a n d f u n c t i o n s t o p a t h o l o g i c a l o n e s. P h a r m a c o l o g y i s i n t e g r a t e d t o g u i d e t h e l e a r n e r s a b o u t e s s e n t i a l a s p e c t s o f m e d i c a t i o n s w h i c h d i r e c t l y a f f e c t t h e n e r v o u s s y s t e m. I t i s h o p e d t h a t t h i s m o d u l e w i l l h e l p t h e l e a r n e r s o b t a i n a c l e a r v i s i o n o f h o w t h e b r a i n w o r k s a n d c o n t r o l s t h e b o d y f u n c t i o n s. T h e a i m s o f t h i s m o d u l e s a r e t o h e l p s t u d e n t s d i a g n o s e c o m m o n n e u r o l o g i c a l c o n d i t i o n s b a s e d o n t h e i r k n o w l e d g e o f b a s i c s c i e n c e s. T h e y s h o u l d b e a b l e t o c o n d u c t n e u r o l o g i c a l e x a m i n a t i o n s o n n o r m a l s u b j e c t s o r m a n n e q u i n s s o t h a t w h e n t h e y m e e t r e a l p a t i e n t s, t h e y a r e a d e q u a t e l y t r a i n e d t o d e a l w i t h t h e s i t u a t i o n s Page 2

3 Departments: Anatomy Physiology Biochemistry Pharmacology Community Medicine Pathology Clinical Sciences Medical Education Objectives: By the end of this sub module, students should be able to: ANATOMY Describe the development of brain (i.e. forebrain, mid brain & hind brain), the spinal cord, ventricles, meninges, peripheral & autonomic nerves Explain the general organization of nervous system and different types of nerve tissue Describe the bony features of adult and fetal skull & cranial cavity Describe microscopic features of nervous tissue, nerve & ganglion when shown under microscope Explain the meninges of brain & spinal cord with its neurovascular supply and in-foldings Discuss the Dural venous sinuses with their clinical importance Discuss the gross anatomy & cross sections of spinal cords at different levels with its neurovascular supply Describe the ascending and descending tracts with their clinical importance Describe the formation of spinal nerves Explain the gross structure, vascular supply, internal structure and clinical importance of the following: i. brain stem (i.e. medulla, pons and midbrain) ii. cerebellum and fibres associated iii. diencephalon (i.e. thalamus, sub thalamus, pineal gland and hypothalamus) iv. basal nuclei v. the limbic system vi. cerebral hemisphere with surfaces, lobes, sulci and gyri Explain the different cortical areas of brain with their functions and lesions Describe the white matter of cerebral hemisphere (I.e. commissural, association & projection fibers) Discuss the clinical correlation associated with the lesions of internal capsule Discuss the organization of Autonomic Nervous system (ANS) Describe the microscopic features of different parts of cerebral and cerebellar cortex Explain the ventricular system of brain, its abnormalities and formation Explain the circulation of cerebrospinal fluid (CSF) Describe the blood supply of the brain and spinal cord with clinical manifestations in relation to the blockage and rupture of blood vessels Name the cranial nerves Describe the location of cranial nerve nuclei and their functional components Enumerate the congenital anomalies of brain & spinal cord BIOCHEMISTRY Define CSF and neurotransmitters 2017 Page 3

4 Classify neurotransmitters based on their structure and modes of action Describe mechanisms of action of the neurotransmitters Match names of disorders with abnormal levels of various neurotransmitters (Acetylcholine, Catecholamines, Dopamine, GABA and Serotonin) Explain the chemistry of brain lipids (glycolipids) Explain the biochemical composition of the Blood Brain Barrier List the chemical composition of normal CSF Differentiate between normal and abnormal CSF based on its composition Diagnose different types of Meningitis and Sub Arachnoid Hemorrhage based on CSF analysis reports Discuss the role of free radicals in degenerative diseases of CNS Discuss the biochemical importance of vitamin B1 & B6 in neurological disorders. COMMUNITY MEDICINE Discuss fatality and disability of CNS related communicable diseases Discuss the epidemiology, transmission, prevention, risk factors of CNS diseases e.g. Poliomyelitis, Tetanus, Leprosy, Diphtheria, stroke and Rabies. Explain the management of Stroke PATHOLOGY Describe the pattern of nerve injury and their regeneration Explain etio-pathogenesis of cerebral edema, hydrocephalus, raised intracranial pressure and types of brain herniation Describe traumatic brain injuries and differentiate between different types of intracranial hemorrhage Discuss cerebrovascular diseases and the consequences of ischemic, hemorrhagic and hypertensive cerebrovascular accidents 2017 Page 4

5 PHARMACOLOGY Introduction To Autonomic Nervous System (ANS) Describe the organization of ANS and systemic effects of stimulation of sympathetic and parasympathetic nervous system List the major neurotransmitters in ANS and the steps in synthesis, storage and release of neurotransmitters Explain how drugs can affect different steps of neurotransmission Describe the major autonomic receptors in ANS, their location and their signal transduction mechanisms Discuss the effect of activation of the various autonomic receptors Introduction to Power Lab Identify the parts of power lab and its functions Perform different experiments using powerlab Parasympathomimetic Drugs Describe the cholinergic nerves, types and location of cholinergic receptors, their signal transduction mechanisms and effect of activation of these receptors Classify the cholinergic agonist drugs Describe the pharmacodynamics and pharmacokinetics of directly acting cholinomimetic drugs Explain the mechanism of action of indirectly acting cholinomimetic drugs Discuss the signs & symptoms, and treatment of organophosphate poisoning Parasympatholytic Drugs Identify the muscarinic blocking drugs Discuss the indications of muscarinic antagonists Explain the adverse effects and contraindications for the use of muscarinic antagonists Describe the systemic effects of atropine Describe the signs & symptoms and treatment of atropine overdose Describe the nicotinic receptors, their location and signal transduction mechanism Classify the ganglion blockers and neuromuscular blocking drugs ; describe their mechanism of action Compare the depolarizing and competitive neuromuscular blockers Discuss the pharmaco-dynamic and pharmacokinetic properties of neuromuscular blocking drugs Sympathomimetic Drugs Describe the adrenergic receptors, their location, signal transduction mechanism and effect of activation of and receptor subtypes Classify the sympathomimetic drugs on basis of their receptor affinity and chemical structure Compare catecholamines and noncatecholamines Discuss basic pharmacology of epinephrine, norepinephrine and isoproterenol and compare the cardiovascular effects of these drugs Discuss basic and clinical pharmacology of other adrenergic agonists including, dopamine, phenylephrine, methoxamine, clonidine, amphetamine, ephedrine, MAO inhibitors etc Sympatholytic Drugs Classify the alpha and beta blocking drugs and describe their mechanism of action Describe the pharmacokinetics, systemic effects, uses and adverse effects of alpha and beta blockers Explain the contraindications of alpha and beta blockers Explain the rationale for clinical use of alpha and beta blockers 2017 Page 5

6 Anti- Parkinson s Drugs Describe the pathophysiology of Parkinson s disease Discuss the causes of Parkinson s disease including drug-induced Parkinsonism Explain the pharmacologic basis for use of levodopa, dopamine agonists, MAO and COMT inhibitors, Anti-Cholinergic and Amantadine in Parkinson s disease Describe the therapeutic and toxic effects of Anti-Parkinsonism drugs PHYSIOLOGY Define neuronal membrane potential and explain generation and propagation of nerve impulse Define synapse and List properties of synapses Classify sensory receptors and explain their functions including pacinian corpuscle Describe muscle spindle proprioceptors along with their functions Describe somatosensory pathways which include dorsal lemniscal and antero-lateral Describe somatosensory cortex Explain touch, pressure and temperature sensation Explain the physiology of pain I Explain the physiology of pain II Describe functions of spinal cord and reflexes Explain motor, vital and non-vital functions of brain stem in respiratory system, CVS, vasomotor centers, coughing, sneezing and vomiting reflexes Enumerate physiologic correlation of various parts of cerebellum and its functions Describe the basic neuronal circuit of cerebellum along with cerebellar disorders Explain pyramidal tracts along with Upper Motor Neuron (UMN) /Lower Motor Neuron (LMN Describe the functions of Diencephalon which includes Thalamus, Sub-Thalamus and Epi-Thalamus Explain Extra pyramidal tracts of the motor cortex) Describe functions and integration of Autonomic Nervous System I Explain functions of Autonomic Nervous System II Describe structures included in the basal ganglia and their disorders Describe CSF formation and explain circulation and function Describe Reticular Activation system, sleep and its disorders including electroencephalography Explain functional description of limbic System Describe mechanism of learning and memory Explain speech and its related disorders MICROBIOLOGY Explain the etiology and pathogenesis of meningitis, encephalitis and brain abscess 2017 Page 6

7 PRACTICALS ANATOMY There will be demonstration of the following: i. Structure of neuron and neuroglia ii. General organization of nervous system. iii. Bones of skull iv. Skull and cranial fossae v. Different types of nerve tissue vi. Spinal cord (Ascending and Descending tracts) vii. Spinal cord lesion, transection and spinal shock viii. Medulla Oblongata, mid brain and 3 rd ventricle ix. Fourth ventricle & cerebral aqueduct x. Histology of cerebellar cortex xi. Meninges of brain and Spinal cord xii. Spinal cord arterial supply and venous drainage xiii. (Histology) xiv. Microscopic anatomy of Spinal cord, spinal nerve and ganglia, cerebral cortex & cerebellum xv. Functional areas of cerebral cortex and their associated lesion xvi. Gray matter of cerebral hemisphere: Basal nuclei xvii. White matter of cerebral hemisphere projection fibres. xviii. Internal capsule and related anomalies xix. Development of brain neurulation and development of forebrain, mid brain and hindbrain (Embryology) xx. Developmental anomalies of ANS xxi. Arterial supply of brain and spinal cord BIOCHEMISTRY 1. Explain the process of Lumber Puncture for taking sample of CSF 2. Estimate glucose in CSF 3. Estimate proteins in CSF 4. Estimate chloride in CSF PHARMACOLOGY Power Lab: Introduction To Power Lab And Its Operation For Practicals 1. Identify the components of a power lab and describe their functions 2. Perform any experiment using power lab Power lab: effect of cholinergic drug on frog Rectus Abdominus muscle. 1. demonstrate the effect of cholinergic agonist on frog rectus muscle and interpret the results. PHYSIOLOGY i. Functions of spinal cord and cord reflexes ii. Motor, vital and non-vital functions of brain stem iii. Physiology of pain 2017 Page 7

8 iv. Physiologic correlates of various parts of cerebellum and its function; e f f e c t s of cerebellar dysfunction v. Motor cortex (pyramidal tracts, extra pyramidal tracts, UMN/LMN) v i. Neuron membrane potential: generation and propagation of vii. nerve impulse. viii. Synapses, properties of the synapses ix. Sensory receptors (including muscle spindle) and neuronal circuits x. Somatic sensation, sensory pathways for transmission of somatic signals into spinal cord, somatosensory cortex. xi. Somatic sensation, sensory pathways for transmission o f somatic signals into spinal cord, somatosensory cortex. xii. Basal ganglia and disorders xiii. Cerebral cortex surfaces, lobes, sulci and gyri of cerebral hemisphere. xiv. Examination of Deep & Superficial reflexes xv. Functions of diencephalon xvi. Body temperature xvii. Functions and integration of autonomic nervous system xviii. EEG xix. SKILL L A B : Measurement and recording of Vital signs Examination of nervous system Mode of Internal Evaluation (Continuous Assessment): There will be continuous monitoring of attendance Internal assessment will be held in the form of MCQs, assignments, stages/sub-stages, projects, quiz and/ or OSPE. Internal evaluation carries 20% weightage in summative semester examination. Mode of End of Semester Examination/s: One Correct MCQs, One Best MCQs, Extended Matching MCQs and OSPE (Observed Non Observed stations) 2017 Page 8

9 SUGGESTED READINGS SUBJECT ANATOMY BIOCHEMISTRY COMMUNITY MEDICINE PATHOLOGY/MICROBIOLOGY PHARMACOLOGY PHYSIOLOGY RESOURCES A. GROSS ANATOMY 1. K.L. Moore, Clinically Oriented Anatomy 2. Neuro Anatomy by Richard Snell B. HISTOLOGY 1. B. Young J. W. Health Wheather s Functional Histology C. EMBRYOLOGY 1. Keith L. Moore. The Developing Human 2. Langman s Medical Embryology 1. Harper s Illustrated Biochemistry 2. Lippincott s Illustrated reviews of Biochemistry 3. Lehninger s Principles of Biochemistry 4. Biochemistry by Devlin. TEXT BOOKS 1. Community Medicine by Parikh 2. Community Medicine by M Illyas 3. Basic Statistics for the Health Sciences by Jan W Kuzma. TEXT BOOKS 1. Robbins & Cotran, Pathologic Basis of Disease, 9 th edition. 2. Rapid Review Pathology, 4th edition by Edward F. Goljan MD TEXT BOOKS 1. Lippincot Illustrated Pharmacology 2. Basic and Clinical Pharmacology by Katzung. TEXTBOOKS 1. Textbook Of Medical Physiology by Guyton And Hall 2. Ganong S Review of Medical Physiology 3. Human Physiology by Lauralee Sherwood 4. Berne & Levy Physiology 5. Best & Taylor Physiological Basis of Medical Practice. REFERENCE BOOKS 1. Guyton & Hall Physiological Review 2. Essentials Of Medical Physiology by Jaypee 3. Textbook Of Medical Physiology by InduKhurana 4. Short Textbook Of Physiology by Mrthur 5. NMS Physiology 2017 Page 9

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