The bulbar pyramids were the first part of the motor system to be studied morphologically (Vieussens, 1685). The pyramidal decussation was first reported by Mistichelli in 1709 and by Pourfoir du Petit in 1710, while its first diagram was included in Duverney’s (1761) treatise. The discovery that the pyramids are formed by fibre bundles conveying motor impulses ended some long-standing controversies. According to Magendie (1839), in fact, “very few questions have generated so much research as those concerned with the anatomy and physiology of anterior pyramids”. In the present account of successive views on this subject it is argued that the concept of extrapyramidal diseases must be treated with caution.