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The basal nuclei are a collection of paired structures that modulate motor pathways from the cerebral cortex and play a role in the fine control of movement. Part of this is a pathway from the substantia nigra in the midbrain to an area called the striatum in the basal nuclei. The neurotransmitter of this pathway is dopamine and loss of dopamine-containing neurons here causes Parkinsons disease.
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If the enzyme is inhibited these substances cause rapid elevation in blood pressure leading to a hypertensive crisis, which can be fatal. Newer selective drugs inhibit MAO-A reversibly, allowing displacement by exogenous amines and so are less likely to interact with drugs and food substances and are safer. An example is moclobemide. Nevertheless, MAOIs should be regarded as second line drugs and are indicated when the patient is resistant to other therapy, or is phobic, hysterical or has other atypical symptoms.
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