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Klinische Neurophysiologie 2003; 34(1): 8-14
DOI: 10.1055/s-2003-37748
Originalia
© Georg Thieme Verlag Stuttgart · New York

Die elektrophysiologische Untersuchung des Blinkreflexes

Physiologie, Ableitebedingungen und Bedeutung in der klinischen DiagnostikElectrophysiological Investigation of the Blink ReflexPhysiology, Electrophysiological Reflex Testing and Significance of Clinical DiagnosticsJ.  J.  Marx1
  • 1Klinik und Poliklinik für Neurologie, Universität Mainz (Direktorin: Fr. Prof. Dr. med. M. Dieterich)
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Publication History

Publication Date:
10 March 2003 (online)

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Zusammenfassung

Der Blinkreflex mit seiner nach elektrischer Stimulation des Nervus trigeminus über dem Musculus orbicularis oculi ipsilateral ableitbaren frühen Antwortkomponente R1 und ipsi- und kontralateral zur Stimulation ableitbaren späten Antwortkomponente R2 ermöglicht Aussagen über die verschiedenen Abschnitte des polysynaptisch verschalteten Lidschlussreflexes. Insbesondere eignet er sich zum Nachweis funktioneller Läsionen im zentralen Verlauf des Reflexbogens durch den Pons und die Medulla oblongata. Die vorliegende Übersicht beschreibt die anatomischen Grundlagen des Reflexbogens und die Technik der elektrophysiologischen Ableitung. Daneben wird auf die klinische Bedeutung der Untersuchung bei verschiedenen Krankheitsbildern eingegangen, insbesondere bezüglich der topodiagnostischen Aussagen, die sich aus bestimmten Befundkonstellationen für die Lokalisation funktioneller Hirnstammläsionen ergeben.

Abstract

The electrophysiological investigation of the blink reflex allows evaluation of the different segments of the polysynaptically transmitted blinking response. The electromyographic response of the orbicularis oculi muscle to electrical stimulation of the trigeminal nerve consists of an early response ipsilateral to electrical stimulation (R1) and a late response ipsi- and contralateral to stimulation (R2). The reflex is especially useful in the diagnosis of functional lesions of the central part of the reflex loop in the pons and the medulla oblongata. The present papers reviews the anatomical and physiological basis of the reflex loop and the technique of electrophysiological reflex testing. Moreover, the clinical applications of the investigation are described, especially concerning the topodiagnosis of functional brainstem lesions.

Key words

Blink reflex - brainstem topodiagnosis - electrophysiological testing

Literatur

  • 1 Kugelberg E. Facial reflexes.  Brain. 1952;  75 385-396
    PubMedSearch in Google Scholar
  • 2 Russworth G. Observations on blink reflexes.  J Neurol Neurosurg Psychiatry. 1962;  25 95-108
    PubMedSearch in Google Scholar
  • 3 Kimura J. Disorder of interneurons in Parkinsonism. The orbicularis oculi reflex to paired stimuli.  Brain. 1973;  96 87-96
    PubMedSearch in Google Scholar
  • 4 Hopf H C. Topodiagnostic value of brainstem reflexes.  Muscle Nerve. 1994;  17 475-484
    PubMedSearch in Google Scholar
  • 5 Gregoric M. Habituation of the blink reflex. In: Desmeth JE (ed) New developments in electromyography and clinical neurophysiology. Basel; Karger 1973 3: 673-677
    Search in Google Scholar
  • 6 Penders C A, Delwaide P J. Physiological approach to the human blink reflex. In: Desmedt JE (ed) New developments in electromyography and clinical neurophysiology. Basel; Karger 1976 3: 649-657
    Search in Google Scholar
  • 7 Rossi B, Pasca S L, Sartucci F, Siciliano G, Murri L. Trigemino-cervical reflex in pathology of the brain stem and of the first cervical cord segments.  Electromyogr Clin Neurophysiol. 1989;  29 67-71
    PubMedSearch in Google Scholar
  • 8 Lindquist C, Martensson A. Mechanisms involved in the cat's blink reflex.  Acta Physiol Scand. 1970;  80 149-159
    PubMedSearch in Google Scholar
  • 9 Shahani B T, Young R R. The cutaneous nature of the first component of the monkey's blink reflex.  Neurology. 1972;  22 438-443
    PubMedSearch in Google Scholar
  • 10 Cruccu G, Inghilleri M, Fraioli B, Guidetti B, Manfredi M. Neurophysiological assessment of trigeminal function after surgery for trigeminal neuralgia.  Neurology. 1987;  37 631-638
    PubMedSearch in Google Scholar
  • 11 Ellrich J, Bromm B, Hopf H C. Pain evoked blink reflex.  Muscle Nerve. 1997;  764 214-220
    PubMedSearch in Google Scholar
  • 12 Kimura J. Alteration of the orbicularis oculi reflex by pontine lesions: Study in multiple sclerosis.  Arch Neurol. 1970;  22 156-161
    PubMedSearch in Google Scholar
  • 13 Kimura J. Electrically elicited blink reflex in diagnosis of multiple sclerosis.  Brain. 1975;  98 413-426
    PubMedSearch in Google Scholar
  • 14 Iwata H, Kitai S T, Olsen S. Afferent component of the facial nerve: its relation to the spinal trigeminal and facial nucleus.  Brain Res. 1972;  43 662-667
    CrossrefPubMedSearch in Google Scholar
  • 15 Kaplan P E, Kaplan C. Blink reflex: review of methodology and its application to patients with stroke syndrome.  Arch Phys Med Rehabil. 1980;  61 30-33
    PubMedSearch in Google Scholar
  • 16 Krämer G, Lowitzsch K, Besser R, Hopf H C. Isolierte R1-Veränderungen des Blinkreflexes. In: Lowitzsch K (Hrsg) Hirnstammreflexe, Methodik und klinische Anwendung. Stuttgart; Thieme 1986: 124-131
    Search in Google Scholar
  • 17 Trontelj M A, Trontelj J V. Reflex arc of first component of the human blink reflex: a single motoneuron study.  J Neurol Neurosurg Psychiatry. 1978;  41 538-547
    PubMedSearch in Google Scholar
  • 18 Ongerboer de Visser B W, Kuypers H GJM. Late blink reflex changes in lateral medullary lesions. An electrophysiological and neuro-anatomical study of Wallenberg's syndrome.  Brain. 1978;  101 281-294
    PubMedSearch in Google Scholar
  • 19 Kimura J, Lyon L W. Orbicularis oculi reflex in the Wallenberg syndrome: alteration of the late reflex by lesion of the spinal tract and nucleus of the trigeminal nerve.  J Neurol Neurosurg Psychiatry. 1972;  35 228-233
    PubMedSearch in Google Scholar
  • 20 Fitzek S, Fitzek C, Marx J, Speckter H, Urban P P, Thömke F, Stoeter P, Hopf H C. Blink Reflex R2 Changes in Lower Brain Stem - An electrophysiological and MR-imaging study.  J Neurol Neurosurg Psychiatry. 1999;  67 630-636
    PubMedSearch in Google Scholar
  • 21 Ongerboer de Visser B W. Anatomical and functional organisation of reflexes involving the trigeminal system in man: Jaw reflex, blink reflex, corneal reflex and exteroceptive suppression.  Adv Neurol. 1983;  39 729-738
    PubMedSearch in Google Scholar
  • 22 Marx J J, Thoemke F, Fitzek S, Vucurevic G, Fitzek C, Mika-Grüttner A, Urban P P, Stoeter P, Hopf H C. Topodiagnostic value of blink reflex R1 changes - A digital postprocessing MRI correlation study.  Muscle Nerve. 2001;  24 1327-1331
    PubMedSearch in Google Scholar
  • 23 Namerow N S. The orbicularis oculi reflex in multiple sclerosis.  Neurology. 1970;  20 1200-1203
    PubMedSearch in Google Scholar
  • 24 Willer L C, Boulu P, Bratzlavsky M. Electrophysiological evidence for crossed oligosynaptic trigemino-facial connections in normal man.  J Neurol Neurosurg Psychiatry. 1984;  47 87-90
    PubMedSearch in Google Scholar
  • 25 Fisher M A, Shahani B T, Young R R. Assessing segmental excitability after acute rostral lesions: the blink reflex.  Neurology. 1979;  29 45-50
    PubMedSearch in Google Scholar
  • 26 Raffaele R, Emery P, Palmeri A, Perciavalle V. Influences on blink reflex induced by IA afferents in human subjects.  Eur Neurol. 1986;  25 373-380
    PubMedSearch in Google Scholar
  • 27 Hirakoa M, Shimamura M. Neural mechanisms of the corneal blinking reflex in cats.  Brain Res. 1977;  125 265-275
    CrossrefPubMedSearch in Google Scholar
  • 28 Holstege G, Kuypers H GJM. Propriobulbar fibre connection to the trigeminal, facial and hypoglossal motor nuclei. I. An anterograde degeneration study in the cat.  Brain. 1977;  100 239-264
    PubMedSearch in Google Scholar
  • 29 Holstege G, Kuypers H GJM, Decker J J. The organisation of the bulbar fibre connections to the trigeminal, facial and hypoglossal nuclei. II. An autographic tracing study in the cat.  Brain. 1977;  100 265-286
    PubMedSearch in Google Scholar
  • 30 Aramideh M, Ongerboer de Visser B W, Koelman J H, Majoie C B, Holstege G. Late blink reflex response abnormality due to lesion of the lateral tegmental field.  Brain. 1997;  120 1685-1692
    CrossrefPubMedSearch in Google Scholar
  • 31 Tackmann W, Ettlin T, Barth R. Blink reflexes elicited by electrical, acoustic and visual stimuli.  Eur Neurol. 1982;  21 210-216
    PubMedSearch in Google Scholar
  • 32 Berardelli A, Accornero N, Cruccu G, Fabiano F, Guerini V, Manfredi M. The orbicularis oculi response after hemispheral damage.  J Neurol Neurosurg Psychiatry. 1983;  46 837-843
    PubMedSearch in Google Scholar
  • 33 Dengler R, Kossev A, Gippner C, Struppler A. Quantitative analysis of blink reflexes in patients with hemiplegic disorders.  Electroencephalogr Clin Neurophysiol. 1982;  53 513-524
    PubMedSearch in Google Scholar
  • 34 Ongerboer de Visser B W, Cruccu G. Neurophysiological examination of the trigeminal, facial, hypoglossal and spinal accessory nerves in cranial neuropathies and brain stem disorders. In: Brown WF, Bolton CF (eds) Clinical electromyography. Boston; Butterworth-Heinemann 1993: 61-92
    Search in Google Scholar
  • 35 Kimura J, Harada O. Excitability of the orbicularis oculi reflex in all night sleep: its suppression in non-rapid eye movement and recovery in rapid eye movement sleep.  Electroencephalogr Clin Neurophysiol. 1972;  33 369-377
    PubMedSearch in Google Scholar
  • 36 Rimpel J, Geyer D, Hopf H C. Changes of the blink responses to combined trigeminal, acoustic and visual repetitive stimulation studied in the human subject.  Electroencephalogr Clin Neurophysiol. 1982;  54 552-560
    PubMedSearch in Google Scholar
  • 37 Rossi A, Scarpini C. Gating of trigemino-facial reflex from low-threshold trigeminal and extratrigeminal cutaneous fibres in humans.  J Neurol Neurosurg Psychiatry. 1992;  55 774-780
    PubMedSearch in Google Scholar
  • 38 Kimura J. Electrodiagnosis in diseases of nerve and muscle: principles and practices. 2. Auflage. Philadelphia; F.A. Davis 1989: 307-331
    Search in Google Scholar
  • 39 Hopf H C, Thömke F, Gutman L. Midbrain versus pontine medial longitudinal fasciculus lesions: the utilization of masseter and blink reflexes.  Muscle Nerve. 1991;  14 326-330
    PubMedSearch in Google Scholar
  • 40 Hess K, Kern S, Schiller H H. Blink reflex in trigeminal sensory neuropathy.  Electromyogr Clin Neurophysiol. 1984;  24 185-190
    PubMedSearch in Google Scholar
  • 41 Kimura J, Yamada T, Nitz D M. Blink reflex as a test for lesions of the trigeminal nerve.  Muscle Nerve. 1980;  3 184-188
    PubMedSearch in Google Scholar
  • 42 Kimura J, Daube J, Burke D, Hallett M, Cruccu G, Ongerboer de Visser B W, Yanagisawa N, Shimamura M, Rodwell J. Human reflexes and late responses. Report of an IFCN committee.  Electroenceph Clin Neurophysiol. 1994;  90 393-430
    CrossrefPubMedSearch in Google Scholar
  • 43 Hopf H C, Ellrich J, Hundemer H. The pterygoid reflex in man and its clinical application.  Muscle Nerve. 1992;  15 1278-1283
    PubMedSearch in Google Scholar
  • 44 Kimura J, Rodnitzky R L, Okawara S H. Electrophysiologic analysis of aberrant regeneration after facial nerve paralysis.  Neurology. 1975;  25 989-993
    CrossrefPubMedSearch in Google Scholar
  • 45 Valls-Solé J, Graus F, Font J, Pou A, Tolosa E S. Normal proprioceptive afferents in patients with Sjögren's syndrome and sensory neuropathy.  Ann Neurol. 1990;  28 786-790
    CrossrefPubMedSearch in Google Scholar
  • 46 Agostino R, Berardelli A, Cruccu G, Pauletti G, Stocchi F, Manfredi M. Correlation between facial involuntary movements and abnormalities of blink and corneal reflexes in Huntington's chorea.  Mov Disord. 1988;  3 281-289
    CrossrefPubMedSearch in Google Scholar
  • 47 Berardelli A, Noth J, Thompson P D, Bollen E L, Curra A, Deuschl G, van Dijk J G, Topper R, Schwarz M, Roos R A. Pathophysiology of chorea and bradykinesia in Huntington's disease.  Mov Disord. 1999;  14 398-403
    CrossrefPubMedSearch in Google Scholar
  • 48 Cruccu G, Ferracuti S, Leardi M G, Feliciani M, Manfredi M. Nociceptive quality of the orbicularis oculi reflexes as evaluated by distinct opiate- and benzodiazepine-induced changes in man.  Brain Res. 1991;  556 209-217
    CrossrefPubMedSearch in Google Scholar
  • 49 Basso M A, Evinger C. An explanation for reflex blink hyperexcitability in Parkinson's disease. I. Superior colliculus.  J Neurosci. 1996;  16 7318-7330
    PubMedSearch in Google Scholar
  • 50 Berardelli A, Rothwell J C, Day B L, Marsden C D. Pathophysiology of blepharospasm and oromandibular dystonia.  Brain. 1985;  108 593-608
    PubMedSearch in Google Scholar
  • 51 Hopf H C, Tettenborn B, Krämer G. Pontine supranuclear facial palsy.  Stroke. 1990;  21 1754-1757
    PubMedSearch in Google Scholar
  • 52 Shahani B T, Young R R. Human orbicularis oculi reflexes.  Neurology. 1972;  22 149-152
    PubMedSearch in Google Scholar
  • 53 Kimura J, Wilkinson J T, Damasio H, Adams H R, Shivapour E, Yamada T. Blink reflex in patients with hemispheric cerebrovascular accident (CVA).  J Neurol Sci. 1985;  67 15-28
    CrossrefPubMedSearch in Google Scholar
  • 54 Lyon L W, Kimura J, McCormick W F. Orbicularis oculi reflex in coma: clinical, electrophysiological and pathological correlation.  J Neurol Neurosurg Psychiatry. 1972;  35 582-588
    PubMedSearch in Google Scholar
  • 55 Metha A J, Seshia S S. Orbicularis oculi reflex in brain death.  J Neurol Neurosurg Psychiatry. 1976;  39 784-787
    PubMedSearch in Google Scholar
  • 56 Kano T, Shimoda O, Morioka T, Yagishita Y, Hashiguchi A. Evaluation of the central nervous function in resuscitated comatose patients by multilevel evoked potentials.  Resuscitation. 1992;  23 235-248
    CrossrefPubMedSearch in Google Scholar

Dr. med. Jürgen J. Marx

Klinik und Poliklinik für Neurologie · Universität Mainz

Langenbeckstraße 1

55101 Mainz

Email: marx@neurologie.klinik.uni-mainz.de