The substantia nigra is critical in the development of many diseases and syndromes, including
parkinsonism and
Parkinson's disease. There exists a study showing that high-frequency stimulation delivery to the left substantia nigra can induce transient acute depression symptoms.
Parkinson's disease Parkinson's disease is a
neurodegenerative disease characterized, in part, by the death of dopaminergic neurons in the SNpc. The major symptoms of Parkinson's disease include
tremor,
akinesia,
bradykinesia, and stiffness. Other symptoms include disturbances to posture,
fatigue,
sleep abnormalities, and
depressed mood. The cause of death of dopaminergic neurons in the SNpc is unknown. However, some contributions to the unique susceptibility of dopaminergic neurons in the pars compacta have been identified. For one, dopaminergic neurons show abnormalities in
mitochondrial complex 1, causing aggregation of
alpha-synuclein; this can result in abnormal protein handling and neuron death. Secondly, dopaminergic neurons in the pars compacta contain less
calbindin than other dopaminergic neurons.
Calbindin is a protein involved in
calcium ion transport within cells, and excess calcium in cells is toxic. The
calbindin theory would explain the high cytotoxicity of Parkinson's in the substantia nigra compared to the ventral tegmental area. Regardless of the cause of neuronal death, the plasticity of the pars compacta is very robust; Parkinsonian symptoms do not generally appear until at least 30% of pars compacta dopaminergic neurons have died. Most of this plasticity occurs at the neurochemical level; dopamine transport systems are slowed, allowing dopamine to linger for longer periods of time in the chemical synapses in the striatum. Menke, Jbabdi, Miller, Matthews and Zari (2010) used diffusion tensor imaging, as well as T1 mapping to assess volumetric differences in the SNpc and SNpr, in participants with Parkinson's compared to healthy individuals. These researchers found that participants with Parkinson's consistently had a smaller substantia nigra, specifically in the SNpr. Because the SNpr is connected to the posterior thalamus, ventral thalamus and specifically, the motor cortex, and because participants with Parkinson's disease report having a smaller SNprs (Menke, Jbabdi, Miller, Matthews and Zari, 2010), the small volume of this region may be responsible for motor impairments found in Parkinson's disease patients. This small volume may be responsible for weaker and/or less controlled motor movements, which may result in the tremors often experienced by those with Parkinson's.
Oxidative stress and oxidative damage in the SNpc are likely key drivers in the etiology of
Parkinson's disease as individuals age.
DNA damages caused by oxidative stress can be
repaired by processes modulated by
alpha-synuclein. Alpha synuclein is expressed in the substantia nigra, but its
DNA repair function appears to be compromised in
Lewy body inclusion bearing
neurons.
Schizophrenia Increased levels of dopamine have long been implicated in the development of
schizophrenia. However, much debate continues to this day surrounding this
dopamine hypothesis of schizophrenia. Despite the controversy, dopamine antagonists remain a standard and successful treatment for schizophrenia. These antagonists include
first generation (typical) antipsychotics such as
butyrophenones,
phenothiazines, and
thioxanthenes. These drugs have largely been replaced by
second-generation (atypical) antipsychotics such as
clozapine and
paliperidone. In general, these drugs do not act on dopamine-producing neurons themselves, but on the receptors on the post-synaptic neuron. Other, non-pharmacological evidence in support of the dopamine hypothesis relating to the substantia nigra include structural changes in the pars compacta, such as reduction in synaptic terminal size. Other changes in the substantia nigra include increased expression of
NMDA receptors in the substantia nigra, and reduced
dysbindin expression. Increased NMDA receptors may point to the involvement of
glutamate-
dopamine interactions in schizophrenia. Dysbindin, which has been (controversially) linked to schizophrenia, may regulate dopamine release, and low expression of dysbindin in the substantia nigra may be important in schizophrenia etiology. Due to the changes to the substantia nigra in the schizophrenic brain, it may eventually be possible to use specific imaging techniques (such as neuromelanin-specific imaging) to detect physiological signs of schizophrenia in the substantia nigra.
Wooden Chest Syndrome Wooden chest, also called fentanyl chest wall rigidity syndrome, is a rare side effect of synthetic
opioids such as
Fentanyl, Sulfentanil,
Alfentanil,
Remifentanil. It results in a generalised increase in skeletal
muscle tone. The mechanism is thought to be via increased dopamine release and decreased GABA release in the nerves of the substantia nigra/striatum. The effect is most pronounced on the chest wall muscles and can lead to impaired ventilation. The condition is most commonly observed in anaesthesia where rapid and high doses of these drugs are given intravenously.
Multiple system atrophy Multiple system atrophy characterized by neuronal degeneration in the striatum and substantia nigra was previously called
striatonigral degeneration. ==Chemical modification of the substantia nigra==