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
2
Russworth G.
Observations on blink reflexes.
J Neurol Neurosurg Psychiatry.
1962;
25
95-108
3
Kimura J.
Disorder of interneurons in Parkinsonism. The orbicularis oculi reflex to paired stimuli.
Brain.
1973;
96
87-96
4
Hopf H C.
Topodiagnostic value of brainstem reflexes.
Muscle Nerve.
1994;
17
475-484
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
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
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
8
Lindquist C, Martensson A.
Mechanisms involved in the cat's blink reflex.
Acta Physiol Scand.
1970;
80
149-159
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
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
11
Ellrich J, Bromm B, Hopf H C.
Pain evoked blink reflex.
Muscle Nerve.
1997;
764
214-220
12
Kimura J.
Alteration of the orbicularis oculi reflex by pontine lesions: Study in multiple sclerosis.
Arch Neurol.
1970;
22
156-161
13
Kimura J.
Electrically elicited blink reflex in diagnosis of multiple sclerosis.
Brain.
1975;
98
413-426
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
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
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
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
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
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
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
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
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
23
Namerow N S.
The orbicularis oculi reflex in multiple sclerosis.
Neurology.
1970;
20
1200-1203
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
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
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
27
Hirakoa M, Shimamura M.
Neural mechanisms of the corneal blinking reflex in cats.
Brain Res.
1977;
125
265-275
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
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
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
31
Tackmann W, Ettlin T, Barth R.
Blink reflexes elicited by electrical, acoustic and visual stimuli.
Eur Neurol.
1982;
21
210-216
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
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
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
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
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
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
38 Kimura J. Electrodiagnosis in diseases of nerve and muscle: principles and practices. 2. Auflage. Philadelphia; F.A. Davis 1989: 307-331
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
40
Hess K, Kern S, Schiller H H.
Blink reflex in trigeminal sensory neuropathy.
Electromyogr Clin Neurophysiol.
1984;
24
185-190
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
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
43
Hopf H C, Ellrich J, Hundemer H.
The pterygoid reflex in man and its clinical application.
Muscle Nerve.
1992;
15
1278-1283
44
Kimura J, Rodnitzky R L, Okawara S H.
Electrophysiologic analysis of aberrant regeneration after facial nerve paralysis.
Neurology.
1975;
25
989-993
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
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
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
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
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
50
Berardelli A, Rothwell J C, Day B L, Marsden C D.
Pathophysiology of blepharospasm and oromandibular dystonia.
Brain.
1985;
108
593-608
51
Hopf H C, Tettenborn B, Krämer G.
Pontine supranuclear facial palsy.
Stroke.
1990;
21
1754-1757
52
Shahani B T, Young R R.
Human orbicularis oculi reflexes.
Neurology.
1972;
22
149-152
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
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
55
Metha A J, Seshia S S.
Orbicularis oculi reflex in brain death.
J Neurol Neurosurg Psychiatry.
1976;
39
784-787
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
Dr. med. Jürgen J. Marx
Klinik und Poliklinik für Neurologie · Universität Mainz
Langenbeckstraße 1
55101 Mainz
Email: marx@neurologie.klinik.uni-mainz.de