HSP is caused by degeneration of the upper motor neurons in the brain and spinal cord. Upper motor neurons control voluntary movement. The cell bodies of these neurons are located in the motor cortex area of the brain. They have long, hair-like processes called axons that travel to the brainstem and down the spinal cord. Axons relay the messages to move to lower motor neurons that are located all along the brainstem and spinal cord. Lower motor neurons then carry the messages out to the muscles. Click on the diagram at right to see how upper motor neurons connect to lower motor neurons that innervate leg muscles. When upper motor neurons degenerate, the correct messages cannot reach the lower motor neurons, and the lower motor neurons cannot transmit the correct messages to the muscles. As the degeneration continues, spasticity and weakness increase. The legs are affected because degeneration occurs primarily at the ends of the longest nerves in the spinal cord, which control the legs. In some cases, the upper body can be minimally affected as well, leading to problems with the arms or speech and swallowing muscles.
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