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Correlation between facial involuntary movements and abnormalities of blink and corneal reflexes in Huntington's chorea.

Blink and corneal reflexes were studied in 11 patients with Huntington's chorea and the results compared with the severity of the disease. The latency of the R2 component of the blink reflex was delayed and the duration of R2 and of the corneal reflex (CR) prolonged. A greater habituation of the R2 component was found in the patients with involuntary movements in the face, and in some patients a long-lasting depression of R2 was present. A correlation was found between: (a) severity of involuntary face movements and R2 and CR latency and (b) severity of involuntary movements in the neck and latency of R2.

Adolescent↗

Blink reflex and the masseter inhibitory reflex in patients with dystonia.

The excitatory and inhibitory interneuronal pathways in the brainstem are tested by examining the blink reflex and the masseter inhibitory reflex, respectively. We studied the R2 component of the blink reflex and the SP2 component of the masseter inhibitory reflex and their recovery cycle in 56 patients with various forms of dystonia. In patients with cranial, cervical, and generalized dystonia, but not in patients with extracranial segmental dystonia, the recovery cycle of both reflexes was enhanced. The recovery cycle of R2 and SP2 can demonstrate subclinical changes in excitability of brainstem interneurons. The degree of enhancement of the recovery cycles did not correlate, however, with the severity of clinical facial muscle impairment. In addition, the recovery cycles correlated positively with each other, showing that excitatory as well as inhibitory interneuronal pathways in the brainstem are perturbed in dystonia. Study of the trigemino-facial and trigemino-trigeminal reflexes provides an objective tool for assessing functional abnormalities in dystonia.

Adult↗

Exteroceptive reflexes in dystonia: a study of the recovery cycle of the R2 component of the blink reflex and of the exteroceptive suppression of the contracting sternocleidomastoid muscle in blepharospasm and torticollis.

The recovery cycle of the R2 component of the blink reflex and the exteroceptive suppression of EMG activity in the contracting sternocleidomastoid muscle produced by electrical stimulation of the supraorbital nerve were studied in normal subjects and in patients with either blepharospasm or torticollis. The latencies of the reflexes were normal, suggesting that the neural structures that mediated them were intact. However, the recovery of the R2 component of the blink reflex was enhanced in patients with either blepharospasm or torticollis. Also, the size of the exteroceptive suppression of the sternocleidomastoid muscle was reduced in both groups of patients. Our results are indicative of abnormalities of interneurons mediating exteroceptive reflexes in patients with craniocervical dystonia that are not restricted to the systems controlling the muscle involved in the dystonia.

Adult↗

Blink reflex excitability is abnormal in patients with periodic leg movements in sleep.

The excitability of the late component of the blink reflex was measured in 19 patients with periodic leg movements in sleep (PLMS) and in 18 control patients with other sleep complaints. PLMS patients were not different from controls regarding age, body mass index, and apneas and hypopneas per hour of sleep. The latencies of the R1 and R2 components of the blink reflex were not different between the groups. However, in PLMS, the excitability of the R2 response was markedly enhanced: The second R2 response to a pair of stimuli given at an interval of 500 ms was in PLMS 59.5% (range 21-87%) of the first R2 response and in controls 18.8% (range 2-79%) (p < 0.0001, Mann-Whitney U test). These results provide further evidence of an altered motor control in PLMS, which is likely to be located subcortically and possibly related to the dopaminergic striatopallidal system.

Adult↗

Multi-channel orbicularis oculi stimulation to restore eye-blink function in facial paralysis.

Facial paralysis due to facial nerve injury results in the loss of function of the muscles of the hemiface. The most serious complication in extreme cases is the loss of vision. In this study, we compared the effectiveness of single- and multiple-channel electrical stimulation to restore a complete and cosmetically acceptable eye blink. We established bilateral orbicularis oculi muscle (OOM) paralysis in eight dogs; the OOM of one side was directly stimulated using single-channel electrical stimulation and the opposite side was stimulated using multi-channel electrical stimulation. The changes in the palpebral fissure and complete palpebral closure were measured. The difference in current intensities between the multi-channel and single-channel simulation groups was significant, while only multi-channel stimulation produced complete eyelid closure. The latest electronic stimulation circuitry with high-quality implantable electrodes will make it possible to regulate precisely OOM contractions and thus generate complete and cosmetically acceptable eye-blink motion in patients with facial paralysis.

Animals↗

In vitro eye-blink reflex model: role of excitatory amino acids and labeling of network activity with sulforhodamine.

Evidence is presented suggesting that the neural correlate of the eye-blink reflex can be evoked in an in vitro brainstem-cerebellum preparation from the turtle by using electrical rather than natural stimulation of cranial nerve inputs. Abducens nerve discharge is triggered by brief electrical stimulation of the ipsilateral trigeminal nerve. This discharge corresponds behaviorally to EMG recordings of extraocular muscles and eye retraction recorded in situ, in a reduced preparation. The abducens nerve discharge has two components: a short-duration response having a latency of 3-6 ms and a duration of 50-100 ms, followed by a long-duration component having a latency of 12-20 ms and a duration of several seconds. The long-duration component of the reflex is blocked by the NMDA receptor antagonist APV, while both reflex responses are blocked by the non-NMDA glutamate receptor antagonist CNQX. To visualize the spatial distribution of activity during the abducens nerve reflex, bath application of the activity-dependent dye sulforhodamine was used. During reflex activity, neurons in the ipsilateral trigeminal nucleus, principal abducens nucleus, and presumed interneurons ventrolateral to the principal abducens nucleus, labeled with the dye, in addition to areas in the raphe nucleus and reticular formation. In conditions where the long-duration component of the reflex was suppressed, sulforhodamine label was absent in the principal abducens nucleus and in the caudal brainstem. From these data it is hypothesized that the region of interneurons and the accessory abducens nucleus participate in the short-duration component of the reflex. This response is mediated by non-NMDA receptors. The principal abducens nucleus is postulated to contribute also to the short-duration portion of the reflex, but is primarily involved in the generation of the long-duration component. This component of the reflex is mediated principally by NMDA receptors. Sustained reflex activity is further postulated to originate from recurrent excitation in pathways within the caudal brainstem, particularly the reticular formation. This interpretation is consistent with the observed patterns of sulforhodamine label, the effects of local microinjections of APV, and the elimination of sustained activity when the caudal brainstem is transected. These data have implications for pathways that may underlie conditioning of the eye-blink response.

2-Amino-5-phosphonovalerate↗

The acoustic blink reflex: stimulus dependence, excitability and localizing value.

The acoustic blink reflex was examined in 26 subjects with open eyes and 20 subjects with closed eyes by means of an electrooculogram. Amplitude and excitability are highly dependent on the loudness of the stimulus used and on the opening or closure of the eyelids. Particularly if the eyes are closed, it may be necessary to use a stimulus of high (105-110 dB SPL) intensity (hand-clapping is often not loud enough). If an acoustic blink reflex can be elicited, it can be assumed that certain pontine and mesencephalic structures are intact.

Acoustic Stimulation↗

Unusual blink reflex with four components in a patient with periodic ataxia.

Characteristic findings in blink reflex are reported in a 55-year-old female with periodic ataxia. The blink reflexes on the side ipsilateral to the stimulation consisted of four components with latencies of 11, 21, 35 and 47 ms, instead of the usual two components seen in normal subjects. On the contralateral side, the last three components were also present. The second component was different from the normal R2 response in that its latency was shorter than normal and it did not habituate by stimulation at a rate of 10 Hz. In addition, it was more affected by diazepam than the third or fourth components. It is considered that R2 may have consisted of three components and that a shorter latency of the second component could be explained by facilitation.

Ataxia↗

The intercentral relationships of rabbit brain biopotentials during the creation of a blink dominant.

The intercentral relationships of the biopotentials of the sensorimotor area of the cerebral cortex, the ventroposteromedial nucleus of the thalamus, and the motor nucleus of the oculomotor nerve during the formation of a blink dominant, created by means of serial stimulation of one eye by an airstream, were investigated in chronic experiments on rabbits by the spectral correlation analysis method. An increase in the power of the spectrum and an increase in the COH of the potentials of the delta range were identified in structures associated with the function of the blinking of the stimulated eye. Analogous reorganizations of biopotentials were identified in a dominant focus arising by induction of the symmetrical center of the other eye.

Animals↗

Pupillary responses and blink reflex in myotonic dystrophy.

We have studied pupillary responses to parasympathetic and sympathomimetic agents, pupillary cycle time and the electrophysiology of the blink reflex in 18 patients with myotonic dystrophy. The response of the iris to dilute pilocarpine and phenylephrine did not indicate pharmacologic supersensitivity. Pupillary cycle time was prolonged in nine of the 18 patients. Ipsilateral R1 blink reflex latencies were normal in all cases, and bilateral R2 were normal in 16 of the 18 patients. These results do not support either autonomic or brainstem dysfunction in the majority of patients with myotonic dystrophy. In 50% of the patients the results are compatible with smooth muscle involvement of the iris.

Adult↗

Image processing used to harness blinking as a channel of communication and control for physically disabled people.

Sophisticated mathematical algorithms (such as differencing, thresholding, aggregation and statistical analysis of skin colours) are used to compare successive frames of computer-captured images of the face. From these, changes in state of the eyes are determined and are used to detect blinks. A recognition performance of 83.74 +/- 0.03% is achieved over five subjects with a low rate of false positives 2.71 +/- 0.01%. A logical decision rule identifies purposeful blinks and applies them to control either a custom-designed communication package or an external device.

Adult↗

Prepulse modulation of the startle reaction and the blink reflex in normal human subjects.

Blink reflexes are usually considered the most representative and consistent response of the auditory startle reaction (ASR), and they are often the only response evaluated in human psychophysiological studies. However, auditory stimuli also induce an auditory blink reflex (ABR), the physiological characteristics and brainstem circuitry of which may be different from those of the ASR. This study aimed to investigate whether there were differences between the orbicularis oculi (OOc) responses elicited with the ABR (OOcABR) and those elicited with the ASR (OOcASR) regarding their behavior to prepulse modulation. For comparison, we also examined the OOc responses to supraorbital nerve stimulation (OOcEBR). Electromyographic responses were simultaneously recorded from the OOc, masseter (MAS) and sternocleidomastoid (SCM) muscles. ABRs were considered when auditory stimuli induced responses limited to the OOc, and ASRs were considered when responses were induced in all muscles recorded from. Prepulse stimuli were either a weak electrical stimulation at the third finger (somatosensory prepulse) or a weak acoustic tone (auditory prepulse) that preceded the response-eliciting stimuli by intervals ranging from 0 to 200 ms. Prepulse effects differed according to prepulse modality, but the OOcABR and the OOcASR were always modulated in the same way. In both responses, somatosensory prepulses induced facilitation from 20 to 50 ms, followed by inhibition beyond 75 ms, and auditory prepulses induced no facilitation but a significant inhibition beyond 30 ms. In the OOcEBR, both somatosensory and acoustic prepulses induced facilitation of R1 and inhibition of R2 beyond 30 ms. Our results suggest that the OOcABR and the OOcASR exhibit the same physiological behavior regarding prepulse modulation. It is hypothesized that prepulse facilitation is due to direct impingement of subthreshold excitatory inputs onto the facial motoneurons while prepulse inhibition results from the engagement of a presynaptic inhibitory circuit in the brainstem.

Acoustic Stimulation↗

Abolished laser-evoked potentials and normal blink reflex in midlateral medullary infarction.

We investigated two patients presenting with the rare finding of almost isolated hemianalgesia with a sensory level on the contralateral side sparing the face. Clinical findings, electrophysiological studies (absent laser-evoked pain-related somatosensory potentials, normal electrically evoked somatosensory potentials, magnetically evoked potentials, and blink reflexes), and magnetic resonance imaging showed the ventrolateral medullar tegmentum containing the spinothalamic tract to be affected by lacunar infarction. The blink reflex R2 component was unimpaired in both patients.

Adult↗

Changes in the blink responses to combined trigeminal, acoustic and visual repetitive stimulation, studied in the human subject.

Habituation of blink reflexes as measured by amplitude decrement in the orbicularis oculi EMG was examined in 9 human subjects using combinations of repetitive electric stimuli to the bridge of the nose (trigeminal stim.), short clicks (acoustic stim.), and flashes (visual stim.). With trains of paired stimuli, both homogeneous and mixed, habituation was increased when the two stimuli were separated by 250 msec but was decreased when the interval was 30 (50) msec, as compared to single stimulus trains of identical repetition rate. Following acoustic or visual prehabituation the habituation to trigeminal stimuli was enhanced. This "transfer of habituation' was also obtained with acoustic before visual stimuli and vice versa. Regarding dishabituation, interposition of single extrastimuli, for example visual or acoustic within repeated trigeminal stimulation, was more effective than a simple pause by omitting one electric pulse. The results suggest the existence of a pool of interneurones that is that the common final relay for the blink relfex afferents from the trigeminal, acoustic and visual input.

Acoustic Stimulation↗

Quantitative analysis of blink reflexes in patients with hemiplegic disorders.

Electrically evoked blink reflexes were investigated in 18 patients with hemiplegia and in 15 control subjects, using common electromyographic techniques. The EMG activities of the early and late components were quantitatively and integration. In addition, the latencies of the single components were determined. Regarding the EMG activity of the late components two major types of BR alteration could be distinguished. In type I stimulation of the clinically affected side evoked significantly decreased late components on both the affected and the unaffected sides. This pattern points to a lowered excitability of the brain stem trigeminal systems and may be associated with predominantly sensory disorders. In type II the decrease of the late components was confined to the affected side independent of the side of stimulation. This pattern may indicate a lowered excitability of the brain stem facial systems and/or of the lateral bulbar reticular formation and may be correlated with predominantly motor deficits. Both types are presumably due to a loss of facilitatory influences associated with the hemispheral lesion. Although the early component was frequently decreased on the affected side there was no consistent pattern and no relation to the alterations of the late components. The latencies of both responses, predominantly of the late ones were frequently prolonged, in particular following stimulation of the affected side. Comparison of the seemingly normal components in the patients with the corresponding control values pointed to a generally lowered blink reflex excitability in hemiplegic patients.

Adult↗

The R3 component of the blink reflex in man: a reflex response induced by activation of high threshold cutaneous afferents.

Ten successive experiments were carried out in 10 volunteers to compare the physiological properties of R2 and R3 components of the blink reflex. The electrical activation threshold of the R3 component was found to be significantly higher than that of the R2 response and was more susceptible to anaesthetic blocking of the peripheral afferents. This result suggests that the R3 component is induced by the activation of a different population of peripheral afferents from the R2 component. A recovery cycle study performed using a double stimulus showed that R3 is inhibited to a greater extent and for a longer time than R2. The temporal relationship of R3 to the voluntarily produced blink demonstrates that R3 is not a voluntary response to electrical stimulation. In conclusion, these experiments support the existence of an independent R3 component and its relationship with the activation of small diameter and higher threshold afferent fibres, perhaps nociceptive ones.

Adult↗

Blink reflex in patients with hemifacial spasm. Observations during microvascular decompression operations.

The blink reflex cannot normally be elicited during surgical anesthesia using inhalation anesthetics. However, in patients with hemifacial spasm (HFS) the early component of the reflex response (R1) can be elicited on the affected side but not on the unaffected side during such anesthesia. The electromyographic (EMG) response from the mentalis muscle to stimulation of the supraorbital nerve was recorded during microvascular decompression (MVD) of the facial nerve to relieve HFS and compared to the response from the same muscle to stimulation of the zygomatic branch of the facial nerve in four patients. During the operation before the facial nerve was decompressed, contractions in both the orbicularis oculi and the mentalis muscles could be elicited by stimulation of the supraorbital nerve (mean latencies 12.2 +/- 1.9 and 12.9 +/- 2.0 ms, respectively). When the facial nerve had been decompressed the blink reflex could no longer be elicited, and there was no response from the mentalis muscle to stimulation of the zygomatic branch of the facial nerve. Compound action potentials (CAP) recorded from the 7th cranial nerve in response to stimulation of the supraorbital nerve had latencies of 7.5 ms +/- 1.4 ms to the negative peak.

Anesthesia, General↗

Contralateral early blink reflex in patients with facial nerve palsy: indication for synaptic reorganization in the facial nucleus during regeneration.

Fifty patients with Bell's palsy and 30 patients with etiologically different symptomatic peripheral facial nerve palsy were studied by means of electrically evoked blink reflexes 1-23 days after onset of paresis. Their results were compared with a normal control group of 30 healthy subjects. In a significant number of patients (64% in Bell's palsy and 53% in symptomatic facial nerve palsy) a contralateral early blink reflex response (R1) could be elicited upon stimulation of the normal side as compared to 13% in the control group. It is suggested that this result may be explained by synaptic reorganization of the facial nucleus leading to functional unmasking of pre-existing crossed trigemino-facial reflex pathways during regeneration. This view is in line with previous experimental data in animals on the time course of structural changes in the facial nucleus after lesioning of the ipsilateral facial nerve.

Adolescent↗