The rostromedial medulla, including the nucleus gigantocellularis (NGC) and magnocellularis (NMC), plays a role as a relay nucleus for both the sensory and motor systems. The NGC/NMC is important in the modulation of somatic and visceral activities. Electrophysiological and pharmacological studies have shown that the NGC/NMC is involved in nociception, locomotion, regulation of basal muscle tone, sleep, as well as cardiovascular and pulmonary activities. Pharmacological and electrical stimulation of the NGC/NMC can produce opposite effects on physiological functions: analgesia or hyperalgesia, and suppression or facilitation of motor activity, depending on the subgroups of neurons activated and the states of the sleep-wake cycle at the time of stimulation. Sensory inputs including noxious and innocuous stimuli converge on the NGC/NMC. The NGC/NMC also plays a role as a relay nucleus, which sends sensory information to the higher centers. The NGC/NMC receives projections from the supra-bulbar motor facilitatory and inhibitory areas, and plays an important role in the regulation of motor activity. Pharmacologically, neurons in the NGC/NMC contribute to opioid, glutamate, GABA, acetylcholine, dopamine, substance P, neurotensin, hypocretin (orexin), and cannabinoid mediated sensory and motor activities, as well as cardiovascular and pulmonary functions. In this review, we will discuss the neuronal morphology, physiological functions and pharmacological characterization of the rostromedial medulla. We will consider the evidence that dysfunction of the NGC/NMC is a factor in a number of neurological diseases, including Parkinson's disease, restless legs syndrome, periodic leg movement, REM sleep behavior disorder, amyotrophic lateral sclerosis and narcolepsy.
INTRODUNTIONThe medullary reticular formation is traditionally segregated into the medial somatic-and lateral visceralrelated areas. However, somatic and autonomic activities are well coordinated. For example, cardiovascular-respiratory changes are correlated with somatic sensory-motor activity during exercise. Coordination of somatic and autonomic activity can result from interconnections between somatic and autonomic control structures, as well as interactions within nuclei, which are involved in both somatic and autonomic activities. The rostromedial medulla (RMM) is one of the areas of the central nervous system (CNS) that is involved in both somatic and autonomic regulation. However, the RMM has traditionally been considered as a somatic nociceptive and a motor control area. The autonomic role of the RMM has received little attention, although Bach [22] demonstrated that the activation of RMM causes changes in cardiovascular and respiratory activity, as well as the facilitation and inhibition of somatic motor activity in 1952. Therefore, we will discuss the functional aspects of RMM in the modulation of both somatic and autonomic systems in this review. Section 1 will focus on the morphology of the RMM, and the anatomical link between RMM and the other areas...