White matter synapses Form, function, and dysfunction

Synaptic transmission in the CNS represents the classic mechanism through which neural cells communicate. While vesicular neurotransmitter release has been known to be the preserve of gray matter, it is now known that synaptic-style release of glutamate, the brain's major excitatory neurotransmitter, occurs deep in white matter. Here it permits communication between axons and glial cells, enabling axon activity to couple with high fidelity to glial physiology. As white matter is increasingly well-recognized as a substrate for disease, dysregulation of white matter synaptic transmission will play an important role in the development of pathologies as diverse as stroke, multiple sclerosis, Alzheimer disease, and schizophrenia. This review highlights progress in this new and important field. Neurology (R) 2011;76:397-404