Education PNS and CNS axons

E
Peripheral nervous
system and central nervous system nerve axons



Mark Baker tells you more about nerves

A nerve that we see in the peripheral nervous system (PNS) or
a white-matter ‘tract’ in the central nervous system (CNS) is composed of many
axons. The axons are elongated extensions of individual nerve cells, and they
are structures specialized for signalling over distance. Let me try to explain.


When you see a peripheral nerve in a limb, from the outside,
it is protected by a robust sheath, made of connective tissue. This sheath
gives the peripheral nerve a degree of robustness and stretchiness. 



Peripheral
nerves are unharmed by being stretched a bit, and to a surprising degree they
move or glide past adjacent tissues for example at the carpal tunnel, when we
move and bend our limbs, quite normally. Held within that stretchy coating are
the nerve axons, either sending signals towards the spinal cord or the brain,
in the form of sensory input, or away from the spinal cord or brain to provide
some motor function be it muscle contraction, or secretion. 



The same is not
true of nerves protected inside the skull and spinal column. 



The nerve fibres
within the central nervous system are not covered in a stretchy coat in the
same way as in the periphery, and these axons are usually to be found in
tracts, notable for their white appearance in dissection, the ‘white matter’
that most people have heard about. These nerve fibres are known to signal over
distance by sending nerve impulses from one part of the CNS to another, or also
down the spinal cord to control our body movements. 



They are embedded in the
three dimensional anatomical structure of the brain and spinal cord. Like the
axons in peripheral nerves they are accompanied by nearby blood vessels and
capillaries that provide the necessary oxygen and glucose that allow them to
function.


The median nerve (in red) is an example of a long peripheral nerve
innervating the arm and hand. It is a mixed nerve, with sensory and motor
function. It innervates the hand via the carpal tunnel at the wrist. The main stem of the nerve is
flexible and moves around quite a lot as we move and bend our arm. Central axons in the brain or spinal cord are not able to move independently of the tissue around them, and are held fast

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Mark Baker

5 comments

  • Prof G, I have PPMS. Had it since the mid-naughties. I am still in my thirties. I am about EDSS 6 or 6.5.

    Should I ask my neurologist for cladribine? Do I stand a chance in the UK NHS? Is it worth getting condescending looks from my MS team yet again?

    • Re: "Should I ask my neurologist for cladribine?"

      Cladribine is only licensed for highly-active relapsing MS. So it is unlikely to be prescribed. The only drug licensed for PPMS is ocrelizumab and it is not available yet on the NHS. It has to be NICEd first and there is no guarantee that ocrelizumab will be given the greenlight by NICE.

      Another option in ~6-9 months time will be the new phase 3b ocrelizumab in PPMS trial. However, this will be a placebo-controlled trial with a 50% chance of being on placebo.

      I hope this helps.

    • Make a private appointment with a neurologist. Costs about £200. Get a private prescription for Rituximab. Get administered free on NHS. It will halt progression for short term. However as it's mouse DNA your body will eventually produce antibodies and will cause disease breakthrough. However before that happens Ocrelizumab will of been licenced by Nice.

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