Blink reflex in end-stage-renal disease patients undergoing hemodialysis.

This study analyses the blink reflex in 20 adult male patients with terminal chronic renal failure undergoing hemodialysis. Abnormalities were found in ten patients (50%), eight of them with conduction studies showing axonal peripheral neuropathy. Dialysis time was longer for patients with blink reflex alterations (median 55.1 months) than for patients with normal blink reflex (median 36.3 months). Different types of early R1 and late R2 component abnormalities were recorded. The late response abnormalities may indicate subclinical functional or anatomical impairment of the low brainstem reticular formation in patients with chronic renal failure.     

Abnormal Control of Orbicularis Oculi Reflex Excitability in Multiple Sclerosis

Brain lesions in patients with multiple sclerosis may lead to abnormal excitability of brainstem reflex circuits because of impairment of descending control pathways. We hypothesized that such abnormality should show in the analysis of blink reflex responses in the form of asymmetries in response size. The study was done in 20 patients with relapsing-remitting multiple sclerosis and 12 matched healthy subjects. We identified first patients with latency abnormalities (AbLat). Then, we analyzed response size by calculating the R2c/R2 ratio to stimulation of either side and the mean area of the R2 responses obtained in the same side. Patients with significantly larger response size with respect to healthy subjects in at least one side were considered to have abnormal response excitability (AbEx). We also examined the blink reflex excitability recovery (BRER) and prepulse inhibition (BRIP) of either side in search for additional indices of asymmetry in response excitability. Neurophysiological data were correlated with MRI-determined brain lesion-load and volume. Eight patients were identified as AbLat (median Expanded Disability Status Scale–EDSS = 2.75) and 7 of them had ponto-medullary lesions. Nine patients were identified as AbEx (EDSS = 1.5) and only 2 of them, who also were AbLat, had ponto-medullary lesions. In AbEx patients, the abnormalities in response size were confined to one side, with a similar tendency in most variables (significantly asymmetric R1 amplitude, BRER index and BRIP percentage). AbEx patients had asymmetric distribution of hemispheral lesions, in contrast with the symmetric pattern observed in AbLat. The brainstem lesion load was significantly lower in AbEx than in AbLat patients (p = 0.04). Asymmetric abnormalities in blink reflex response excitability in patients with multiple sclerosis are associated with lesser disability and lower tissue loss than abnormalities in response latency. Testing response excitability could provide a reliable neurophysiological index of dysfunction in early stages of multiple sclerosis.     

Neuron activities of the motor cortex during conditioned eye blink reflex in rabbits (author's transl)]

Effects of the tone (CS) on neurons of the motor cortex were investigated in naive, pseudoconditioned, and conditioned rabbits. Conditioning to eye blink reflex was made by a combination of CS and air puff (US). Effects of electrical stimulation of the subcortical structures were also observed on the cortical neurons associated with the conditioned reflex. The results were as follows. (1) Proportion of neurons which significantly increased the firing rate in response to the CS, type E, was higher in the conditioned group than in other two groups. On the other hand, no group difference was found in the proportion of neurons which significantly decreased the firing rate to the stimulus, type I. (2) Most of the type E neurons in the conditioned rabbits began to fire at latencies of about 50 to 100 msec after the CS, preceding about 200 msec to the appearance of the peripheral conditioned responses (EMG). (3) Most of the type E neurons in the conditioned animals were more easily affected by stimulation of the medial geniculate body and the brain stem reticular formation. Based on the results mentioned above, it is concluded that in the rabbits conditioned to the eye blink reflex, excitability of neurons in the motor cortex is enhanced by the tone (CS), and by electrical stimulation to the medial geniculate body and the brain stem reticular formation.     

Role of L-DOPA in spinal nociceptive reflex activity: higher sensitivity of Aδ versus C fibre-evoked nociceptive reflexes to L-DOPA

The role of L-DOPA in spinal nociceptive reflex activity has been re-evaluated. In high spinal cats, with supraspinal loops being excluded, the onset of reflex facilitation induced by noxious radiant heat is delayed after injection of L-DOPA by 4 to 10 s, i.e. the early component of nociceptive reflex facilitation is blocked, while the late component persisted. Further investigations have shown that the early component of reflex facilitation induced by noxious radiant heat is mediated by Adelta-fibres and the late component by C-fibres. Therefore, it can be assumed that L-DOPA, like opioids, preferentially blocks the transmission in nociceptive reflex pathways from Adelta-fibres.     

Blink test results in patients with central sleep apnea syndrome

Sleep and Biological Rhythms - The aim of the study was to evaluate whether there was a problem in the interneuronal junctions of patients with central sleep apnea using the blink reflex test....     

Associative stimulation of the supraorbital nerve fails to induce timing-specific plasticity in the human blink reflex

Background

Associative high-frequency electrical stimulation (HFS) of the supraorbital nerve in five healthy individuals induced long-term potentiation (LTP)-like or depression (LTD)-like changes in the human blink reflex circuit according to the rules of spike timing-dependent plasticity (Mao and Evinger, 2001). HFS given at the onset of the R2 component of the blink reflex (HFS_LTP) produced a lasting facilitation of the R2, whereas HFS given shortly before R2 (HFS_LTD) caused a lasting suppression of the R2. In patients with benign essential blepharospasm (BEB), a focal dystonia affecting the orbicularis oculi muscles, HFS_LTP induced excessive LTP-like associative plasticity relative to healthy controls, which was normalized after botulinum toxin (BTX) injections (Quartarone et al, 2006).

Methodology/Principal Findings

We used HFS conditioning of the supraorbital nerve to study homeostatic metaplasticity of the blink reflex circuit in healthy subjects and dystonic patients. On separate days, we tested the conditioning effects on the R2 response and paired-pulse R2 inhibition after (i) HFS_LTP, (ii) HFS_LTP followed by HFS_LTP, and (iii) HFS_LTP followed by HFS_LTD. Controls also received (iv) HFS_LTD alone and (v) a non-intervention protocol. In BEB patients, HFS_LTP followed by HFS_LTD was given before and after BTX treatment. We were not able to replicate the bidirectional timing-dependent effects of HFS_LTP and HFS_LTD alone. All HFS protocols produced a non-specific reduction of the R2 response and a relative decrease in paired-pulse inhibition. These R2 changes also occurred in controls when no HFS was applied. There was also no trace of a homeostatic response pattern in BEB patients before or after BTX treatment.

Conclusion/Significance

Our data challenge the efficacy of associative HFS to produce bidirectional plasticity in the human blink reflex circuit. The non-specific decrease of the R2 response might indicate habituation of the blink reflex following repeated electrical supraorbital stimulation. The increase of inhibition after paired pulse stimulation might reflect homeostatic behaviour to prevent further down regulation of the R2 response to preserve the protection of this adverse-effects reflex.     

Localization of intraspinal longitudinal systems participating in the spreading of viscerosomatic activity.

In experiments on the cats the relationship was studied of individual columns of the spinal cord to irradiation of the early (propriospinal) and late component of viscerosomatic reflex responses. It was found that the intraspinal systems involved in the descending spread of activity forming the early and the late component of the splanchnic response along the spinal cord were localized mainly in the anterolateral quadrants of the white matter. The descending systems are bilateral and cross at the segmental level. The pathways participating in the spread of the two-component somatomotor discharge evoked by intercostal nerve stimulation are localized in the same area. A bilateral lesion of the dorsal part of the lateral columns of segments C1 to C3 strongly inhibited the late component of the reflex responses. Inhibition was reversible, showing that systems modifying the development and course of the late component are localized in this region. Lesion-induced changes in viscerosomatic reflex responses were parallel with changes in somatomotor discharges. This finding supports the opinion that the pathways involved are localized close together and that their action is modified by similar factors.     

Endogenous cortisol suppression with metyrapone enhances acoustic startle in healthy subjects

Previous human studies have shown that excess cortisol sufficient to fully occupy central nervous system (CNS) corticosteroid receptors may reduce startle eye blink. The present study tested whether cortisol depletion and the resulting reduction in activity of CNS corticosteroid receptors has the opposite effect. In a single-blind, placebo-controlled, randomized study, eye blink EMG responses to 105 dB acoustic startle stimuli were assessed in 25 healthy subjects who received oral metyrapone (1500 mg) to suppress endogenous cortisol production, while 24 controls received oral placebo. As expected, metyrapone significantly reduced salivary cortisol, indicating effective endogenous cortisol suppression. Startle eye blink responses were significantly increased in the metyrapone group. Short-term habituation of the startle reflex was not different between groups. Our results suggest that startle is enhanced during depletion of cortisol. This effect may be mediated by CNS mechanisms controlling cortisol feedback.     

Electrophysiological analysis of facial reflex in monkeys: trigemino-naso-labial reflex]

Electrical stimulation of the awake monkey's supra orbital nerve, elicits two successive reflex discharge in both naso-labialis muscles (NL). The responses have a similar high threshold. Similar responses are also elicited on electrical stimulation of the facial skin, whereas flash, click or tapping on the muscle belly are ineffective. These responses bear some resemblances to those obtained in orbicularis oculi muscles ; but the higher threshold and the different organization of the NL responses would suggest that such reflexes may serve a different function from that of the blink reflex.     

The stimulating effects of contralateral glossopharyngeal and hypoglossal afferent fibers on the glossopharyngeo-hypoglossal reflex activities in the frog]

American Bullfrogs, Rana catesbiana, immobilized with suxamethonium chloride (20 mg/kg b. w., i. p.), were used. By stimulating the glossopharyngeal (IX) nerve, reflex activities, composed of early (10-20 ms in latency) and late (greater than 20 ms) components, were evoked in both protoractor branch (P. br.) and retractor branch (R. br.) of the ipsilateral hypoglossal (XII) nerve. Contralateral IXth nerve stimulation increased the reflex activities of both components in the P. br. elicited ipsilaterally by the homonymous nerve. Whereas, it increased the reflex activities of the early component in the R. br. but, decreased that of the late component. On the other hand, stimulation of P. br. in the contralateral XIIth nerve increased the activities of both components in the P. br. and those of the late component in the R. br., but did not affect the activities of the early component in the R. br. The time course of these effects was similar to that by contralateral IXth nerve stimulation. The present findings strongly suggest the existence of afferent fibers in the XIIth nerve.     

Modulation using racemic and levo-rotary baclofen of the trigeminal reflex in man

Baclofen (Lioresal), a muscle relaxant, exerts a specific action on the trigeminal system by depressing excitatory synaptic transmission in the spinal trigeminal nucleus. To evaluate the effects of racemic and L-baclofen on the human trigeminal reflexes, the area of the blink reflex was measured in seven normal subjects, before and after i.v. administration of racemic baclofen (25 mg.) and oral administration of L-baclofen (15 mg.). The blink reflex is a trigeminal facial reflex consisting of two components (R1 and R2): R1 has a shorter latency and is mediated by an oligosynaptic pontine circuit; R2 has a longer latency and is believed to be relayed via a polysynaptic circuit through the lateral bulbar reticular system. Whereas the R1 response was scarcely affected by administration of racemic baclofen, it was significantly reduced by L-baclofen (P less than 0.01). R2 was depressed by both drugs (P less than 0.01). These results indicate that both racemic and L-baclofen inhibit trigeminal transmission in man, probably because they interfere with excitatory transmission through the interneurons of the lateral reticular formation. In addition, since L-baclofen reduced both R1 and R2 this form of the drug presumably has a more powerful effect than its racemic counterpart, on the few interneurons of the short latency component.     

Rostral ventral medulla 5-HT1A receptors selectively inhibit the somatosympathetic reflex

The role of the 5-hydroxytryptamine (5-HT1A) receptors in the rostral ventrolateral medulla (RVLM) on somatosympathetic, baroreceptor, and chemoreceptor reflexes was examined in anesthetized rats. Microinjection of the selective 5-HT1A agonist 8-hydroxy-di-n-propylamino tetralin (8-OH-DPAT) decreased arterial blood pressure and splanchnic sympathetic nerve activity (SNA). Electrical stimulation of the hindlimb evoked early and late excitatory sympathetic responses. Bilateral microinjection in the RVLM of 8-OH-DPAT markedly attenuated both the early and late responses. This potent inhibition of the somatosympathetic reflex persisted even after SNA and arterial blood pressure returned to preinjection levels. Preinjection of the selective 5-HT1A antagonist NAN-190 in the RVLM blocked the sympathoinhibitory effect of 8-OH-DPAT and attenuated the inhibitory effect on the somatosympathetic reflex. 8-OH-DPAT injected in the RVLM did not affect baroreceptor or chemoreceptor reflexes. Our findings suggest that activation of 5-HT1A receptors in the RVLM exerts a potent, selective inhibition on the somatosympathetic reflex.     

Study of tonic and evoked electrical activity in efferent fibers of the sympathetic nerve in white rats

In anaesthetised Wistar rats, electrical sympathetic activity and a somatosympathetic reflex in the cervical sympathetic trunk elicited by a single electrical shock to forelimb or hindlimb afferent nerves, were recorded. The spontaneous activity was shown to conform with the pulse and respiratory waves of arterial pressure. Somatosympathetic reflex consists of early and late discharges evoked by somatic myelinated afferent fibres stimulation, and C-response elicited by stimulation of unmyelinated afferent fibres in spinal nerves.     

Blink Perturbation Effects on Saccades Evoked by Microstimulation of the Superior Colliculus

Current knowledge of saccade-blink interactions suggests that blinks have paradoxical effects on saccade generation. Blinks suppress saccade generation by attenuating the oculomotor drive command in structures like the superior colliculus (SC), but they also disinhibit the saccadic system by removing the potent inhibition of pontine omnipause neurons (OPNs). To better characterize these effects, we evoked the trigeminal blink reflex by delivering an air puff to one eye as saccades were evoked by sub-optimal stimulation of the SC. For every stimulation site, the peak and average velocities of stimulation with blink movements (SwBMs) were lower than stimulation-only saccades (SoMs), supporting the notion that the oculomotor drive is weakened in the presence of a blink. In contrast, the duration of the SwBMs was longer, consistent with the hypothesis that the blink-induced inhibition of the OPNs could prolong the window of time available for oculomotor commands to drive an eye movement. The amplitude of the SwBM could also be larger than the SoM amplitude obtained from the same site, particularly for cases in which blink-associated eye movements exhibited the slowest kinematics. The results are interpreted in terms of neural signatures of saccade-blink interactions.     

Neurophysiological mechanisms of the reflex lacrimation

Neurophysiological mechanisms of the reflex lacrimation were analyzed in anesthetized rabbits. The secretory pattern of the lacrimation elicited by stimulation of the cornea consisted of two phases, that is, a rapid flow phase during stimulation and the subsequent slow flow phase in post-stimulus time. Parasympathetic nerve activities are closely related to the secretory volume in the rapid flow phase of the reflex lacrimation. On the other hand, excitation of the sympathetic nerve depressed the secretion in the rapid flow phase, while it facilitated slightly the secretion in the slow flow phase. The postganglionic parasympathetic fibers innervating the lacrimal gland showed two responses, i.e., the early and late discharges, when a single electrical shock was applied to the cornea. Their latencies were 68.7 +/- 8.7 msec and 173.3 +/- 14.2 msec, respectively. The threshold of the late response was about 10 times greater than that of the early one. With moderate anesthesia by pentobarbital or with transection of lateral 1/3 of medulla oblongata at the rostral level of the subnucleus caudalis of the spinal trigeminal nucleus, the late response was abolished whereas the early one was left almost unaffected. It is assumed that the early response is elicited by afferent impulses transmitted via the rostral part of the trigeminal sensory nuclear complex and the late one via the caudal part of the complex and also possibly the reticular formation.     

Kinematic and Diffusion Tensor Imaging Definition of Familial Marcus Gunn Jaw-Winking Synkinesis

Background

Marcus Gunn jaw-winking synkinesis (MGJWS) is characterized by eyelid ptosis, which disappears during jaw movement. Familial MGJWS is an extremely rare condition. Some authors suggested that MGJWS is due to neural misdirection in the brainstem whereas others suggested that aberrant reinnervation or ephapse may be responsible for synkinetic activity. Pathogenesis of this condition is therefore still unclear.

Methodology/Principal Findings

To investigate pathogenetic mechanism in familial MGJWS we performed neurophysiological (EMG, Blink Reflex, Recovery cycle of the R2 component of the blink reflex, Masseter inhibitory reflex, BAEPS and kinematic analysis) and neuroradiological (MRI, Diffusion Tensor Imaging) investigations in a member of a multigenerational family with autosomal dominant Marcus Gunn jaw-winking synkinesis (MGJWS). Kinematic analysis of eyelid and jaw movements disclosed a similar onset and offset of the eyelid and jaw in both the opening and closing phases. The excitability of brainstem circuits, as assessed by the blink reflex recovery cycle and recovery index, was normal. Diffusion Tensor Imaging revealed reduced fractional anisotropy within the midbrain tegmentum.

Conclusions/Significance

Kinematic and MRI findings point to a brainstem structural abnormality in our familial MGJWS patient thus supporting the hypothesis of a neural misdirection of trigeminal motor axons to the elevator palpebralis muscle.     

The role of adenosine in the anoxic survival of the epaulette shark, Hemiscyllium ocellatum

The epaulette shark (Hemiscyllium ocellatum) is among the few vertebrates that can tolerate extreme hypoxia for prolonged periods and, as shown here, anoxia. We examined how anoxia affected this shark's level of responsiveness, concentration of brain ATP and adenosine -- an endogenous neuronal depressant. In addition, we investigated how these variables were affected by aminophylline, an adenosine receptor antagonist. Epaulette sharks placed in an anoxic environment (<0.02 mg O2 l(-1)) lost their righting reflex after 46.3 +/- 2.8 min, but immediately regained vigilance upon return to normoxia. Then 24 h later, the same sharks were injected with either saline or aminophylline (30 mg kg(-1)) in saline and re-exposed to anoxia. In this second anoxic episode, controls sharks showed a 56% decrease in the time taken to lose their righting reflex but maintained their brain ATP levels; conversely, aminophylline-treated epaulette sharks displayed a 46% increase in the time to loss of righting reflex and had significantly lower brain ATP levels. Since anoxia also caused a 3.5-fold increase in brain adenosine levels, these results suggest that adenosine receptor activation had a pre-emptive role in maintaining brain ATP levels during anoxia. Perhaps because adenosine receptor activation initiates metabolic depression, indicated by the early loss of responsiveness (righting reflex), such a mechanism would serve to reduce ATP consumption and maintain brain ATP levels.     

Efferent activity in the phrenic nerve during startle reflex in chloralose anesthetized cats

Efferent activity was investigated in the phrenic nerve during startle reflex manifesting as somatic nerve discharges (lower intercostal nerves and the nerve endings) in chloralose anesthetized cats. Inhibition (usually of short duration, lasting 23–36 msec) of inspiration activity was found to be the main component of response in the phrenic nerve in the shaping of "low threshold" startle reflex produced by acoustic and tactile stimuli and stimulation of low threshold peripheral afferents. Reflex discharge prevailed amongst the response patterns produced in the phrenic nerve by stimulating high threshold afferents, i.e., early (propriospinal) and late (suprasegmental, arising from stimulating intercostal nerve) or late only (when stimulating the hindlimb nerves). Two patterns of late response could be distinguished, one on inspiration (found in roughly 3 out of 4 experiments) and other on exhalation — the respiratory homologs of somatic startle reflex. Response pattern is described throughout the respiratory cycle. Structure and respiratory modulation of reflex responses produced in the phrenic nerve by stimulating bulbar respiratory structure are also examined. Possible neurophysiological mechanisms underlying phrenic response during the shaping of startle reflex are discussed.A. A. Bogomolets Institute of Physiology, Academy of Sciences of the Ukrainian SSR, Kiev. Translated from Neirofiziologiya, Vol. 19, No. 4, pp. 473–482, July–August, 1987.     

Changes in the RIII response of the flexion reflex with painful maneuvers

In the search for reliable indirect indices of pain sensation, interest has recently focused on the nociceptive flexion reflex and late components of the brain evoked potentials. In ten volunteers with sciatica, the nociceptive flexion reflex (RIII) and the late component (N150-P220) of the evoked potentials were recorded, with the subjects at rest and during pain produced by the Lasegue manoeuvre. In recordings with the subjects at rest, both responses were stable. During the Lasegue manoeuvre, the RIII response was markedly suppressed, with a mean reduction in area of 40% (P less than 0.001). In contrast, the amplitude of the N150-P220 components did not change significantly. Our results indicate that, of the two parameters tested, RIII alone is a reliable index for measuring pain sensation.     

Brainstem excitability is not influenced by blood lactate levels

The influence of blood lactate on brainstem excitability was tested by using the blink reflex (BR) recovery cycle on 18 sprinters. Blood lactate was measured before maximal cycling, at the end, as well as 5 and 10?min after the exhaustion. Blood lactate was associated with a decrement of R2 whereas only small changes were observed after an intravenous infusion of lactate. It seems, therefore, that lactate influences BR mainly by acting at the cortical level.