Lecture 1: Organisation of the Nervous System, Basic Functions of Synapses

LEARNING OUTCOMES: to describe the organization of the nervous system; to explain the main levels in the function of the central nervous system (CNS); to describe the cellular structure of neurons and glial cells; to describe the structure and function of synapses; to list types of synapses; to describe the physiological structure of synapses; to explain the role of calcium ions; to describe the function of receptor proteins on a postsynaptic neuron; to explain the signal transmission and processing in neuronal groups; to explain signal divergence and convergence and lateral inhibition; to explain the term reverberation, permanent signal output, and rhythmic signal output.

Lecture 2: Neurotransmitters, Neuropeptides, and Receptors

LEARNING OUTCOMES: to define the term neurotransmitter; to group the low-molecular fast-acting transmitters; to group slow-acting transmitters of neuropeptides; to describe the differences between these two groups of transmitters; to describe the procedures for identifying neurotransmitters and neuropeptides (according to Sheperd 1988); to describe the effects of neurotransmitters mediated by ionotropic or metabotropic postsynaptic receptors; to explain the concept and significance of receptor desensitisation; to explain glutamate metabolism in the brain; to describe the structure and function of NMDA and non-NMDA receptors; to explain the mechanism of action of inhibitory GABA and glycine neurotransmitters; to describe the formation and effect of acetylcholine via acetylcholine receptors; to describe the formation and effect of monoamine neurotransmitters (dopamine, noradrenaline and adrenaline) and serotonin; to describe the synthesis and processing of neuropeptides.

Lecture 3: Electrical Events During Neuronal Excitation and Inhibition

LEARNING OUTCOMES: to describe the membrane potential of neuronal soma: to review the ion concentrations on both sides of the neuron’s membrane; to define the term Nernst potential; to describe the role of diffusion and the Na/K pump in the generation of the nerve’s membrane potential; to describe the generation and all phases of the nerve’s action potential; to define the role of voltage-gated sodium and potassium channels; to describe the ‘all or nothing’ law; to explain the concept of saltatory impulse conduction in nerves; to explain the generation of excitatory and inhibitory postsynaptic potentials; to describe the generation of the action potential at the axon of the neuron and the concept of threshold stimulus; to define the term presynaptic inhibition; to explain the term spatial and temporal neuron summation; to explain the term neuronal facilitation; to describe the terms "electronic current" and decremental conduction along the dendrite to the soma; to explain synaptic transmission fatigue; to describe the effects of acidosis and alkalosis on synaptic transmission; to describe the concept of synaptic decay; to explain the consequences of the demyelination process on nerve conduction.

Lecture 4: Sensory Receptors, Somatic Sensation, Sensory Pathways for Transmitting Somatic Signals

LEARNING OUTCOMES: to group senses; to define sensory receptors; to group sensory receptors; to define the concept of sensory modality and the principle of the "labelled line"; to describe the origin of the receptor (generator) potential using the Pacinian corpuscle as an example; to define the relationship between receptor and action potential; to describe the mechanisms of receptor adaptation; to explain the term "tonic" and "phasic" receptor; to describe the physiological classification and function of nerve fibres; to describe the relationship between touch, pressure, and vibration; to describe the tactile receptors; to describe the structure and function of the sensory pathways for the transmission of somatic signals to the central nervous system: 1. a dorsal column–medial lemniscus and anterolateral system 2; to describe the location, parts and layers of the somatosensory cortex; to explain the functions of specific parts of the somatosensory cortex; to describe the somatosensory homunculus; to define the sense of position; to define the term dermatome.

Lecture 5: Special Senses  

LEARNING OUTCOMES: to describe the physical principles of optics of the eye; to describe the structure of the retina; to explain the photochemistry of vision; to explain the phenomena of adaptation and accommodation; to describe the visual pathway; to describe the eye movements and their control; to describe the creation of visual images from the signals of both eyes; to describe the anatomical structures of the ear; to explain the mechanism of impedance matching; to describe the function of the organ of Corti; to explain the mechanism of sound frequency discrimination; to describe the auditory pathway and auditory cortex; to describe the structure and function of the vestibular apparatus; to define different taste modalities; to describe the structure and function of the taste bud; to describe the gustatory pathways; to describe the sense of smell, types of odors and the transmission of olfactory signals.

Lecture 6: Pathophysiology of the Nervous System; Peripheral and Central Sensory Disorders; Pain

LEARNING OUTCOMES: to explain nerve conduction disorders; to elaborate on disorders of hypo- and hyperfunction of the neurotransmitters dopamine, acetylcholine, serotonin; to explain the development of myasthenia gravis; to review the mechanism of desensitisation; to describe the phenomenon of tardive dyskinesia, and the mechanism of the abstinence crisis; to explain the concepts of denervation hypersensitivity, hypoesthesia, paraesthesia and the concept of backward decay; to describe the anatomical isthmus syndrome; to define neuropathies and polyneuropathies; to describe Brown-Sequard syndrome, conus and epiconus syndromes; to describe a thalamic syndrome; to describe phantom sensations; to define types of pain; to describe pain receptors; to describe pathways pain signalling pathways: the neospinothalamic tract and paleospinothalamic tract; to describe the functions of reticular formation, thalamus, and cerebral cortex in pain perception; to describe the analgesic system in the brain and spinal cord; to explain the importance of the opiate system in the brain; to explain the terms of reflected and visceral pain; to describe and list types of headache.

Lecture 7: Cerebral Cortex, Intellectual Functions of the Brain, Learning, and Memory

LEARNING OUTCOMES: to describe the physiological structure of the cerebral cortex; to describe the thalamocortical system; to explain the functions of specific cortical areas: association areas (parietal-occipital-temporal, prefrontal and limbic association areas); to explain the location and importance of the Wernicke's area; to explain the concept of the dominant hemisphere; to explain the importance of the non-dominant hemisphere; to describe brain function in communication (speech); to name and describe types of speech disorders; to describe the importance of the corpus callosum; to define the thought, consciousness, and memory; to explain the concept of positive and negative memory; to describe the mechanism of short-term, intermediate and long-term memory formation; to describe the phenomenon of memory consolidation: the role of the hippocampus in the process of memory.

Lecture 8: States of Brain Activity – Sleep, Brain Waves, Epilepsy

LEARNING OUTCOMES: to describe two types of sleep; to explain basic theories of sleep; to describe the development and origin of brain waves; to distinguish epilepsies; to define schizophrenia, Alzheimer's disease, and dementia; to describe parts of the limbic system and the activation-stimulating brain system; to describe the functions of the hypothalamus; to explain the importance of reward and punishment in behaviour; to describe the functions of the hippocampus and the amygdala.

Lecture 9: Motor Neurophysiology: Motor Functions of the Spinal Cord

LEARNING OUTCOMES: to define three types of motor activities: voluntary, unconscious, and reflex; to describe the structure of the spinal cord; to describe the function of alpha and gamma motoneurons, interneurons, and Renshaw cells; to describe the structure of the muscle spindle and the sensory and motor innervation of the spindle; to explain the receptor function of the muscle spindle; to describe the reflex arc; to describe the stretch reflex (dynamic and static part of the reflex); to describe the importance of control of the gamma-motor system; to describe the term clonus; to describe Golgi tendon reflex; to describe the polysynaptic flexor reflex and the withdrawal pattern; to describe the cross-linked extensor reflex; to define the term reciprocal inhibition; to describe the postural and gait; to describe the spinal shock.

Lecture 10: Cortical and Brain Stem Control of Motor Function

LEARNING OUTCOMES: to define the location and functional parts of the motor cortex; to describe the motor homunculus; to highlight specialised motor control areas; to define the medial and lateral motor systems; to describe the corticospinal tract; to describe other neural pathways leaving the motor cortex; to describe the input pathways in the motor cortex; to describe the structure and function of  the cerebral cortex neuronal columns; to describe the stimulation of spinal cord motor neurons; to describe the role of the brainstem in the control of motor function – the role of reticular and vestibular nuclei (to describe reticulospinal and vestibulospinal tracts); to describe the location and the anatomical and functional parts of the cerebellum; to define the afferent tracts to the cerebellum; to describe the deep nuclei and efferent tracts of the cerebellum; to describe the parts and the functional unit of the cerebellar cortex; to describe the parts and function of the vestibulocerebellum; to describe the parts and function of the spinocerebellum; to describe the parts and function of the cerebrocerebellum; to describe the clinical disorders of the cerebellum.

Lecture 11: Contributions of the Cerebellum and Basal Ganglia to Overall Motor Control

LEARNING OUTCOMES: to name the basal ganglia; to describe the putamen circuit; to describe the caudate circuit; to explain the function of neurotransmitters in the basal ganglia system; to explain the development of Parkinson's disease; to explain the development and clinical presentation of Huntington's disease; to explain the development of athetosis and hemiballismus; to explain the functional connection of the basal ganglia with the brainstem and motor cortex; to describe the basics of motor nerve disorders; to describe the consequences of damage to the corticospinal tract; to describe disorders of cerebellar control; to describe disorders of neuromuscular junction (myasthenia gravis); to describe disorders of peripheral motor neurones; to describe disorders of motor unit.

Lecture 12: The Autonomic Nervous System; Disorders of Neurovegetative Regulation

LEARNING OUTCOMES: to describe the general organisation of the ANS; to describe the structure of the sympathetic nervous system:  preganglionic and  postganglionic  neurons; to  describe  the organisation  of  the parasympathetic nervous system: preganglionic and postganglionic neurons; to describe cholinergic and adrenergic fibres; to describe adrenergic and cholinergic receptors and their functions; to describe the effects of sympathetic and parasympathetic stimulation of certain organs: the eye, the glands, the digestive system, the heart, the blood vessels, the blood pressure; to describe the function of the adrenal medulla; to explain sympathetic and parasympathetic tone; to describe autonomic reflexes; to describe the sympathetic nervous system alarm response; to describe ANS control; to name the aetiological factors of neurovegetative disorders; to explain the concepts of primary and secondary ANS disorders; to describe circadian rhythm disorders; to describe sleep disorders; to explain the concept of psychosomatic illness; to describe chronic fatigue syndrome.

Lecture 13: Cerebral Blood Flow, Cerebrospinal Fluid and Brain Metabolism

LEARNING OUTCOMES: to describe the circle of Willis; to explain the role of the perivascular space; to describe the structure of the blood-brain barrier (BBB); to explain the function of the BBB; to describe the characteristics of microcirculation in the brain; to discuss transmission through the BBB; to describe the regulation of the cerebral blood flow: autonomic and nervous; to explain the origin and clinical presentation of stroke (ischaemic and haemorrhagic); to describe the cerebral metabolism; to describe the cerebrospinal fluid (CSF) system: formation, flow, and absorption of CSF; to explain the function of CSF; to describe the composition of CSF; to describe the blood-cerebrospinal fluid barrier; to describe the development of communicating and non-communicating hydrocephalus; to describe the functions of the ependyma; to name and define the functions of the circumventricular organs.

List of seminars (with titles and learning outcomes):

Seminar 1: Organisation of the Nervous System, Basic Functions of Synapses

LEARNING OUTCOMES: to group cells of the nervous system; to describe the structure and function of neurons; to describe the structure and function of glial cells; to describe the parts and function of central and peripheral synapses; to describe the process of neurotransmitter exocytosis; to describe the activation of ionotropic receptors; to describe the term EPSP and IPSP; to describe the synthesis, action, and degradation of acetylcholine; to describe the effects of certain medications and drugs on the neuromuscular junction.

Literature:

Chapter 46. Organization of the Nervous System, Basic Function of Synapses, Electrical Events during  Neuronal Excitation

Textbook: Medical Physiology, Guyton and Hall

Seminar 2: Sensory Receptors; Somatic Sensations

LEARNING OUTCOMES: To group senses; to define and group sensory receptors; to define the term sensory modality and the principle of the "labelled line"; to describe the origin of the receptor (generator) potential using the Pacinian corpuscle as an example; to define the relationship between receptor and action potential; to describe the mechanisms of receptor adaptation; to explain the term "tonic" and "phasic" receptor; to describe the physiological classification and function of nerve fibres; to describe the relationship between touch, pressure and vibration; to describe the tactile receptors; to describe the structure and function of the sensory pathways for the transmission of somatic signals to the central nervous system: 1. system of the dorsal column– medial lemniscus and anterolateral system 2; to describe the location, parts, and layers of the somatosensory cortex; to explain the functions of specific parts of the somatosensory cortex; to describe the somatosensory homunculus; to define the sense of position; to define the term dermatome.

Literature:

Chapter 47. Sensory receptors

Chapter 48. Somatic Sensation: General Organisation, The Tactile and Position Senses

Textbook: Medical Physiology, A.C. Guyton and Hall

Seminar 3: The Sense of Vision

LEARNING OUTCOMES: to review the physical principles of optics; to describe the optics of the eye; to explain the concept of visual acuity; to describe the structure of the retina; to explain the photochemistry of vision; to explain the adaptation and accommodation; to explain the principles of colour vision; to describe the neuronal function of the retina and all its cells; to explain the importance of lateral inhibition in the transmission of visual signal; to describe the visual pathway and its damage; to explain the method of determining of the visual field; to describe eye movements and their control; to describe the fusion of visual images from both eyes.

Literature:

Chapter 50. The Eye I: Optics of Vision

Chapter 51. The Eye II: Receptor and Neural Function of the Retina

Chapter 52. The Eye: III. Central Neurophysiology of Vision

Textbook: Medical Physiology, Guyton and Hall

Seminar 4: The Sense of Hearing, The Sense of Taste and Smell, Vestibular Sensations

LEARNING OUTCOMES: to describe the anatomical structure of the outer, middle, and inner ear; to explain the mechanism of impedance adaptation using the ossicular system; to describe the "travelling wave"; to describe the function of the organ of Corti; to explain the phenomenon of sound frequency determination (spatial principle); to describe the determination of sound volume; to describe the auditory nerve pathway; to understand the role of the auditory cortex; to name hearing disorders; to define types of taste; to describe the structure and function of the taste bud; to describe the taste pathways; to describe the sense of smell: types, signal transmission into the nervous system; to describe the structure and function of the vestibular apparatus in maintaining balance.

Literature:

Chapter 53. The Sense of Hearing

Chapter 54. The Chemical Senses – Taste and Smell

Chapter 56. Vestibular Sensations (p. 714-719)

Textbook: Medical Physiology, Guyton and Hall

 Seminar 5: Cerebral Cortex and Intellectual Functions

LEARNING OUTCOMES: to describe the parts and function of the association areas; to describe all intellectual brain functions (communication, thinking, consciousness, memory); to describe the mechanisms of short-term, intermediate and long-term memory; to describe the excitatory-activating

system of the brain; to describe the parts and function of the limbic system (hypothalamus, hippocampus, amygdala, limbic cortex); to describe the stages of sleep; to review the basic theories of sleep; to define the types of brain waves; to describe epilepsies; to define depression, schizophrenia, and Alzheimer's disease.

Literature:

Chapter 58. Cerebral Cortex, Intellectual Functions of the Brain, Learning, and Memory

Chapter 59. Behavioural and Motivational Mechanisms of the Brain – The Limbic System and the Hypothalamus

Chapter 60. State of Brain Activity – Sleep, Brain Waves

Textbook: Medical Physiology, Guyton and Hall

Seminar 6: Motor Neurophysiology

LEARNING OUTCOMES: to define the structure of the motor system; motor functions of the spinal cord and brainstem; cortical and cerebellar control of motor functions and the contribution of the basal ganglia to motor control.

 Literature: 

Chapter 55. Motor Functions of the Spinal Cord; The Spinal Cord Reflexes

Chapter 56. Cortical and Brain Stem Control of Motor Function

Chapter 57. Contributions of the Cerebellum and Basal Ganglia to Overall Motor Control 

Textbook: Medical Physiology, A.C. Guyton and Hall 

 List of practicals (with titles and learning outcomes):

Practical 1: The Neuromuscular Junction

LEARNING OUTCOMES: to describe the membrane and the action potential; to describe the structure and function of the neuromuscular junction; to describe the effect of strychnine on the spinal cord; to explain the concept and meaning of electromyography; to describe the concept of muscle fatigue.

Practical part:

• EMG I and II – illustration of the effects of muscle contraction on electrical voltage and frequency; recording of electrical changes in muscles during motor unit recruitment and muscle fatigue using the Biopac system.
• video on the effects of strychnine intoxication

For this practical, students should prepare the following material: 

•        from the textbook A. C. Guyton and Hall, Medical Physiology, Chapter 5. Membrane Potentials and  

      Action Potentials; Chapter 6. Contraction of Skeletal Muscle; Chapter 7. Excitation of Skeletal Muscle:  

      Neuromuscular Transmission and Excitation-Contraction Coupling 

• from the Handbook for Practicals in Neurophysiology, Rijeka, 2019, Practical 1.1. (EMG I), 1.2. (EMG II), and 1.3. (The effect of Strychnine on the Spinal Cord).

Practical 2: The Sense of Vision

LEARNING OUTCOMES: to examine eye movements; to perform a pupillary reflex; to perform a corneal reflex; to determine visual acuity; to check colour vision; to determine the width of the visual field; to perform the optokinetic test; to describe the concept of visual fixation.

Practical part:

1.) determination of visual acuity; 2.) colour recognition; 3.) reflex responses; 4.) ocular motility; 5.) perimetry (visual field examination); 6.) optokinetic nystagmus.

The student should prepare the following material: 

•         from the textbook A. C. Guyton and Hall, Medical Physiology, Chapter 50. The Eye I: Optics of Vision;  

       Chapter 51. The Eye II: Receptor and Neural Function of the Retina; Chapter 52: The Eye III: Central  

       Neurophysiology  of Vision 

-     from the Handbook for Practicals in Neurophysiology, Rijeka, 2019, Practicals 2.1. (Ocular Motility),  

        2.2. (Pupillary Light Reflex), 2.3. (Corneal Reflex), 2.4. (Visual Acuity), 2.5. (Perimetry), 2.6. (Color  

        Blindness), 2.7.  (Electrooculogram).

Practical 3: The Sense of Hearing, Taste and Smell; Vestibular Sensation

LEARNING OUTCOMES: to examine the sense of hearing with a tuning fork; to examine the sense of balance; to examine the excitability of the vestibular system; and the sense of taste and smell.

Practical part:

A. Ear: 1) The sense of hearing; 2) Functional tests of the vestibular organs

B. Taste: 1) Testing the sense of taste for sour, salty and bitter

C. Smell: 1) Measuring the sense of smell according to Bornstein

       The student should prepare the following material: 

• from the textbook A. C. Guyton and Hall, Medical Physiology, Chapter 53. The Sense of Hearing; Chapter 54.  The Chemical Senses – Taste and Smell; Chapter 56. Vestibular Sensations (p. 714-719) 
• from the Handbook for Practicals in Neurophysiology, Rijeka, 2019, Practicals 3.1. (Sense of Hearing), 3.2. (Sense of Balance), 3.3. (Sense of Taste), 3.4. (Sense of Smell).

Practical 4: Motor Neurophysiology

LEARNING OUTCOMES: to describe the concept of decerebration; to explain the method of electroencephalography (EEG) method; to describe the motor function of the spinal cord (spinal reflexes); to describe the role of the cerebral cortex and brainstem in motor functions; to describe the role of the cerebellum and basal ganglia in motor functions; to describe the states of brain activity: waves, sleep, epilepsies.

Practical part:

• examination of spinal reflexes, 
• measurement of motor reaction time to sensory stimuli with Biopac, 
• recording of EEG with Biopac, 
• decerebrate rigidity (video).

The student should prepare the following material: 

• from the textbook A. C. Guyton and Hall, Medical Physiology, Chapter 55: Motor Functions of the Spinal Cord, the Cord Reflexes; Chapter 56: Cortical and Brain Stem Control of Motor Function; Chapter 57: Contributions of the Cerebellum and Basal Ganglia to Overall Motor Control 
• from the Handbook for Practicals in Neurophysiology, Rijeka, 2019, Practicals 4.1. (Spinal Reflexes), 4.2. (Reaction Time), 4.3. (Decerebrate Rigidity), 4.4. (Electroencephalography).

1. Medical Physiology, Guyton and Hall, Medicinska naklada Zagreb,13th edition, 2016. 
2. Handbook for Practicals in Neurophysiology. Vesna Barac-Latas and Associates, Faculty of Medicine, University of Rijeka, 2019.
3. Pathophysiology, basic mechanisms of disease – textbook, book one – volume one; Stjepan Gamulin, Matko Marušić, Zdenko Kovač: Medicinska naklada -Zagreb, 2014. 
4. Pathophysiology, basic mechanisms of disease – textbook, book one – volume two; Stjepan Gamulin, Matko Marušić, Zdenko Kovač: Medicinska naklada -Zagreb, 2014. 

1. Neuroscience, Dale Purvis: Oxford University Press – New York, 6th edition, 2018.
2. Principles of Neural Science, Eric R. Kandel: McGraw-Hill, 5th edition, 2013.
3. Pathophysiology, Study guide algorithms – problem solver; Zdenko Kovač, Stjepan Gamulin; book two, Medicinska naklada, 2014.

Students are required to bring to the practicals a lab coat and the Handbook for Practicals in Neurophysiology.

Students are not allowed to switch groups unless they find a replacement.

A student is obligated to prepare the material that will be discussed in seminars and practicals.

 In accordance with the Law and Ordinance of the Faculty of Medicine in Rijeka, all forms of classes (lectures, seminars, and practicals) are mandatory. For justified reasons, a student may be absent from a maximum of 30% of each form of class (30% of lectures, 30% of seminars, 30% of exercises). 

I. Evaluation during the course (up to 50 grade points)

During the course, the aquired knowledge wil be evaluated by two midterm tests comprising 50 questions.

A student may obtain up to 25 grade points for each test, as indicated in the table:

Each test has one retake available for students who did not achieve the minimum grade points required to access the final exam, did not participate in the midterm exam, or are not satisfied with the grade points they obtained .  If a student retakes the midterm exam because he/she is not satisfied with the score achieved, only the grade points obtained in the retaken midterm will be considered. Retakes of the midterm exams will be held before the first date of the final exam.

II. Final exam (up to 50 grade points)

The final exam is oral and assesses specific learning outcomes defined for each course section.

Who can take the final exam: Students who have passed both midterm exams and have earned 25 to 50 grade points are eligible to take the final examination. The final examination is worth a maximum of 50 points. 

Who CANNOT take the final exam: Students who have not passed both midterm exams, have earned fewer than 25 points during the course, or have been absent for more than 30% of classes, are not eligible to take the final examination. They must re-enrol in the course in the following academic year and receive a failing grade (F).

 The final examination is an oral. To pass the final exam, the student must receive a passing grade in the oral examination.

 In the oral examination, the student can obtain 25 to 50 grade points, as shown in the table:

III. Final grade

The final grade is a sum of ECTS grade points obtained during classes and the final examination. 

MIDTERM EXAMS:

16.04.2027.  (L1 – L6; S1 – S3; P1 – P2)

31.05.2027.  (L7 -L13; S4 – S6; P3 - P4)

FINAL EXAMS: 

14.06.2027.

30.06.2027.

14.07.2027.

02.09.2027.

16.09.2027.

Other notes (related to the course) important for students: 

Teaching content and all information related to the course can be found on the Merlin. 

The final examination is an oral. To pass the final exam, the student must receive a passing grade on the oral examination.

In the oral examination, the student can obtain 25 to 50 grade points, as shown in the table:

The final grade is the sum of ECTS grade points obtained during classes and the final examination.

ECTS grading system

Students’ work will be assessed and graded during the course and on the final exam. During the course, students can earn a total of 100 grade points - up to 50 grade points during the course and up to 50 grade points on the final exam.

Student assessment is performed using ECTS (A-F) and a numerical system (1-5). Assessment in the ECTS system is by absolute distribution and follows the assessment criteria for graduates. 

Of the maximum 50 points that can be earned in class, a student must achieve at least 50% (25) of the points to be eligible to take the final exam. Students who achieve 0-49.9% (0-24.9%) of the grade points during the course will receive an F grade (insufficient), will not receive ECTS credits, and will have to re-enrol for the course.