Nervous system anatomy and organisation
- the central nervous system (CNS) composed of the brain and spinal cord;
- the peripheral nervous system (PNS) which is mainly composed of the nerves that contain the nerve fibres of lower motorneurons, sensory neurons and autonomic neurons; the PNS also includes the dorsal root ganglia containing the cell bodies of sensory neurons and autonomic ganglia harbouring the cell bodies of the postganglionic autonomic neurons.

Fig.1 Nervous system organisation. A) Frontal view of a body, colour coded to indicate head, cervical, thoracic, lumbar and sacral regions; the positions of upper/lower motorneurons and sensory neurons with their extremely long nerve fibres are indicated. B) side and back view of the CNS; different brain and body regions are colour-coded (see Box 1) and the locations of peripheral and autonomic nerves including their ganglia are shown. C) Wiring diagram of a reflex circuit and how it connects to the brain (see below).
The Central Nervous System
The CNS is composed of the brain and the spinal cord (Fig.1B). The Brain is the control centre, subdivided into functionally distinct regions dedicated to the orchestration of often well-defined aspects of our behaviour (Box 2). Accordingly, lesions in different areas of the brain will cause characteristic behavioural deficits that explain the symptoms of those degenerative neural diseases (DNDs) affecting these areas (Box 1).
Box 1. Key functions and associated degenerative neural disorders of different brain regions, spinal cord and sensory system (compare Fig.1 for illustrations).
- The cerebral cortex is the outermost layer of the brain with its characteristic folds found only in humans and apes. It is subdivided into different regions: for example, the primary somatosensory cortex receives and processes sensory information from the skin and musculoskeletal organs, the visual cortex from the eyes. Two regions have strong links with DNDs:
- The primary motor cortex contains the upper motor or pyramidal neurons with nerve fibres that reach up to a meter into the spinal cord to instruct voluntary muscle movements; DNDs affecting upper motor neurons include MND, HSP or MS and are associated with body paralysis.
- The prefrontal cortex coordinates highly complex behaviours such as decision-making and personality expression; it explains personality loss in FTD patients.
- The hippocampus mediates consciously aware (explicit) learning and memory formation; it is usually the first area affected in AD.
- The substantia nigra is a mid-brain area rich in dopaminergic neurons and involved in the regulation of voluntary movement; it is primarily affected in PD patients, explaining the movement disorder.
- The cerebellum is an accessory area to the hindbrain coordinating and fine-tuning motor functions; it is primarily affected in ataxias explaining lost motor control including balance and speech.
- The spinal cord is the central nervous system of the body; it forms a long tubular structure extending from the brainstem down the vertebral column. It transmits information between the brain and the rest of the body and controls information flow in each body segment including the reflexes.
- Lower motorneurons have their cell bodies in the spinal cord and form the long nerve fibres in our segmental nerves that innervate the somatic musculature.
- Sensory neurons of the trunk have their cell bodies in dorsal root ganglia lateral to the spinal cord; they form long nerve fibres in our segmental nerves that convey information about stretch, heat, injury or body posture from the periphery to the spinal cord where these fibres often continue up to the mid brain (achieving lengths of up to 2 m in total).
The Spinal Cord is embedded within the vertebral column, organised into body segment-specific units, and composed of white matter and grey matter regions (Fig.1B, C).
- The white matter forms the rind of the spinal cord. It contains myelinating oligodendrocyte glia (explained below) and the long nerve fibres transmitting information between the brain/head region and the trunk. It can be subdivided into ascending and descending tracts: for example, upper motor neuron fibres project through the descending pyramidal/corticospinal tract and many ascending sensory fibres through the dorsal column (Fig.1C). These long nerve fibres are interrupted in spinal cord injury explaining paralysis and loss of sensation below the point of injury. These nerve fibres are also affected in motor neuron diseases, multiple sclerosis or spastic paraplegia, explaining paralysis occurring in these diseases which can be accompanied by sensation loss.
- The grey matter forms the butterfly-shaped central core in transverse sections of the spinal cord (Fig.1C). It contains the cell bodies and dendrites of neurons required for the local coordination of each body segment. For example, the ventral horn of the grey matter contains the cell bodies and dendrites of lower motor neurons (Fig.1C) which send nerve fibres through the peripheral nerves to innervate muscles of their respective body segments. These lower motor neurons are instructed by the upper motor neurons during voluntary movement. They are also innervated by muscle-specific sensory neurons to establish the local reflex circuits that trigger compensatory sub-conscious muscle contractions in response to posture change, important to keep our body in balance (Fig.1C). Deterioration of lower motor neurons causes paralysis, as observed in Charcot Marie Tooth disease, but also motor neuron diseases where both upper and lower motor neurons are usually affected.
- EXPLAINER: The terms grey versus white matter are derived from anatomical sections treated with Nissl stain. This method primarily highlights subcellular components which are restricted to cell bodies and dendrites but are absent from axons. It therefore stains the central region of the spinal cord packed with cell bodies and their dendrites (hence grey matter) but very little the rind which contains mainly axons and far less abundant cell bodies of stained oligodendrocytes (hence white matter). Nissl stain is violet in nature but was first published by Franz Nissl in 1903 documented in grey scale drawings which might explain the term “grey” that is commonly used.
The Peripheral Nervous System
The Peripheral Nervous System (PNS) comprises the nerves and their associated ganglia in the head and trunk, which establish bidirectional connections between the CNS and the body (Fig.1B). Most nerves contain elements of both the voluntary somatic and involuntary autonomic nervous systems (SNS/ANS).
- The ANS controls functions outside our conscious control. It is subdivided into the sympathetic and parasympathetic systems (light/dark grey in Fig.1B). The ANS is composed of preganglionic efferent neurons positioned in the grey matter of the CNS which project fibres to the peripheral para/sympathetic ganglia; in these ganglia, the fibre endings of preganglionic neurons form synapses onto postganglionic neurons which, in turn, send fibres to innervate the respective target organs. The most prominent ANS element is the vagus nerve which is mostly parasympathetic and controls functions such as heart and gastrointestinal movements or sweating (Fig.1B). The vagus nerve is also referred to as the 10th cranial nerve which also contains some voluntary elements, such as motor fibres controlling somatic muscles in the mouth region relevant for speech.
- The SNS comprises outgoing motor fibres and ingoing sensory fibres. Examples of outgoing motor fibres are those of lower motor neurons in segmental nerves of the trunk or of oculomotor neurons innervating eye muscles via the 3rd cranial nerve. Ingoing sensory fibres carry information derived from sense organs in the head, joints, tendons and muscles, or from sensory nerve endings in the skin. Sensory neurons of the trunk have their cell bodies in the dorsal root ganglia (lined up on each side of the spinal cord; Fig.1B, C). From here they project a single nerve fibre reaching from the body’s periphery into the spinal cord, often sending a branch through the white matter up to the brain (Fig.1A,C). The cellular processes of a single sensory neuron can therefore extend almost 2 m from the tip of the toe to the brain (Fig.1A).
Sensory neurons are primarily affected in sensory neuropathies, as observed in hereditary sensory and autonomic neuropathies (HSAN) or as a complicating side effect in diabetes or upon cancer treatment (referred to as chemotherapy-induced peripheral neuropathy; CIPN).
What are synapses? Where are they located?
The nervous system coordinates the behaviour of animals and humans: it mediates perception of information (through the different senses), integration and processing of this information and, as a result, coordinates stimulation of muscles and glands. The nervous system is composed of different types of nerve cells which carry out these functions: sensory neurons (perception), interneurons (integration, processing) and motorneurons (stimulation of muscles and glands).These different nerve cell types are organised into complex networks. For this, the neurons carry cellular processes, the cable-like nerve fibres (axons), which propagate ‘electrical messages’ in the form of nerve impulses, passed on at synaptic contacts to other nerve cells, muscles or glands.
Nerve impulses (also called action potentials) are focal depolarisations travelling along axons (yellow cloud in the animation): usually, neurons are polarised, i.e. they display a voltage difference of up to ~70mV across their membranes (the outside of the neuron being zero, the inside negative); when a nerve impulse passes through (as a matter of milliseconds), dedicated pores open in the membrane that permit the flow of charged ions in a way that the voltage reduces to 0mV or even turns positive (depolarisation), and then immediately reverses back to negative potential (repolarisation) – thus curtailing the depolarisation and making it a very brief and local event (for more detailed explanations see here). The paths in which nerve impulses can propagate are defined by the way in which nerve fibres are laid out and connected within the nervous system and body, like the hard-wiring of an electrical circuit.

How does synaptic transmission work?
Action potentials constitute information that can be passed on to other cells at synapses through a process referred to as ‘synaptic transmission’. At electrical synapses, the state of depolarisation (yellow arrow in left figure) can directly pass through open pores (gap junctions) that connect the pre- and postsynaptic cells; this transmission is fast but provides little means of regulation.
In contrast, transmission at chemical synapses occurs via translation of the action potential into chemical information and back into a nerve impulse (see right figure). The incoming action potential triggers the opening of calcium pores (voltage-gated calcium channels; green). The inflowing calcium (Ca2+) binds to certain proteins specialised to mediate the fusion of vesicles with the presynaptic membrane. These vesicles contain chemical neurotransmitter molecules (red dots) which are released into the synaptic cleft upon fusion and diffuse to bind to postsynaptic receptors (red). Upon neurotransmitter binding, these receptors open a pore for the flow of charged ions, thus triggering a new action potential in the postsynaptic cell (true only for excitatory synapses; see next section). Transmission at chemical synapses is complicated and far slower than at electrical synapses. But chemical synapses have many means to manipulate their function by strengthening, toning down or even blocking the transmission process. By changing transmission properties of synapses in this way, the information flow in neuronal circuits can be modified, which constitutes a key mechanism that can explaining the phenomena of learning and memory formation. For this reason it makes sense that most synapses in our bodies are of chemical nature.
How does an inhibitory synapse work?
The image shows a postsynaptic terminal (post) innervated by two presynaptic terminals (pre), the top one being of excitatory (Ex), the lower one of inhibitory nature (In). The two terminal types use different transmitters and receptors (light grey, excitatory; dark grey, inhibitory). The colour code of the terminals represents their polarisation state relative to the extracellular environment (white; defined as zero), as indicated in the scale above. Three different scenarios are shown:
- Transmitter release from the excitatory (Ex) presynaptic terminal induces influx of positively charged ions (plus symbol) into the postsynaptic terminal causing a voltage shift from the resting state (here about -50mV) to less negative values (depolarisation). If a certain threshold voltage close to 0mV is reached, a postsynaptic nerve impulse is triggered (yellow arrow).
- Transmitter release from the inhibitory terminal (In) induces influx of negatively charged ions (minus symbol) driving the voltage from the resting state to more negative values (hyperpolarisation; dark blue), thus further away from the threshold voltage. Consequently, no nerve impulse is triggered.
- If both terminals release transmitter at the same time, the hyperpolarisation counterbalances the depolarisation. Therefore, the threshold close to 0mV is not reached and no postsynaptic nerve impulse is triggered.
How excitatory and inhibitory synapses are used in neuronal circuits
The neuronal circuits that mediate voluntary movements and local reflexes require both excitatory and inhibitory synapses, making them suitable examples to explain how these synapse types are used. The animation shows two antagonising muscles of the arm, the flexor (bending the arm) and the extensor (stretching the arm). Two scenarios are shown:
- REFLEX: If an external force stretches the arm involuntarily, spindle organs sense the unexpected muscle stretch. This information is transmitted to the spinal cord via a sensory neuron (red). The sensory neuron forms an excitatory synapse onto a lower motor neuron (light blue; l-motor). This motor neuron innervates and triggers contraction of the same flexor muscle which harbours the stretched spindle organ. In this way, the sensory and motor neurons form a local reflex circuit where any involuntary stretch of the arm subconsciously triggers compensatory muscle contraction that keeps the arm in position.
- VOLUNTARY MOVEMENT: Voluntary movements are induced by excitatory upper motorneurons in the primary motor cortex of the brain (dark blue; u-motor). These neurons send long nerve fibres into the spinal cord where they form excitatory synapses onto lower motorneurons. In this example, the upper motor neuron innervates the lower motor neuron which can instruct the extensor muscle to contract, thus inducing voluntary stretch of the arm. In this case, the reflex circuit of the flexor muscle MUST NOT BE ACTIVATED. To achieve this, the upper motor neuron co-innervates interneurons which form inhibitory synapses on the flexor motor neuron (beige; inter). In this constellation, the sensory neuron which responds to flexor muscle stretch, tries to activate the flexor motor neuron, but this is blocked through the simultaneous inhibitory innervation through the interneuron (red circle), thus preventing reflex circuit activation.

































According to the US’ National Research Council, over half of initial pregnancies are affected by developmental defects, ~3% of live births suffer from major developmental aberrations, ~70% of neonatal deaths and 22% of infant deaths have developmental causes, and ~30% of admissions to paediatric hospitals are due to developmental defects. The causes can be random errors, inherited or acquired gene mutations or toxins – as illustrated by severe limb malformations of thousands of new-borns during the thalidomide/Contergan drug scandal in the 1950s, or the stark increase in birth defects after the Bhopal gas catastrophe in 1984.
Matthew Cobb is an inspiring advocate and communicator of science, in particular of biology. This is clearly reflected in his