Basal ganglia influences on brain stem trigeminal neurons

Spontaneous eye blink rate as predictor of dopamine-related cognitive function-A review

An extensive body of research suggests the spontaneous eye blink rate (EBR) is a non-invasive indirect marker of central dopamine (DA) function, with higher EBR predicting higher DA function. In the present review we provide a comprehensive overview of this literature. We broadly divide the available research in studies that aim to disentangle the dopaminergic underpinnings of EBR, investigate its utility in diagnosis of DA-related disorders and responsivity to drug treatment, and, lastly, investigate EBR as predictor of individual differences in DA-related cognitive performance. We conclude (i) EBR can reflect both DA receptor subtype D1 and D2 activity, although baseline EBR might be most strongly related to the latter, (ii) EBR can predict hypo- and hyperdopaminergic activity as well as normalization of this activity following treatment, and (iii) EBR can reliably predict individual differences in performance on many cognitive tasks, in particular those related to reward-driven behavior and cognitive flexibility. In sum, this review establishes EBR as a useful predictor of DA in a wide variety of contexts.

The clinical use of brainstem reflexes and hand-muscle reflexes

Brainstem reflexes and hand-muscle reflexes can be elicited and recorded with routine EMG equipment. Not all these reflexes are useful in clinical neurology. But those that are - the subject of this review - exhibit distinct patterns of abnormality that have clinical diagnostic and localizing value in various diseases, including cranial neuropathies, focal lesions within the cervical cord, brainstem, and brain, movement disorders, and pain.

Evidence for an abnormal cortical sensory processing in dystonia: selective enhancement of lower limb P37-N50 somatosensory evoked potential

We evaluated brain stem P30, contralateral frontal N37, and the vertex-ipsilateral central P37, N50 somatosensory evoked potentials (SEPs) obtained in response to stimulation of the tibial nerve in 10 patients with idiopathic dystonia. Results were compared with those obtained in 10 healthy subjects matched for age and sex. The amplitude of the brain stem P30 potential and of the contralateral frontal N37 response in dystonic patients was not significantly different from that recorded in normal subjects. The vertex- ipsilateral central P37-N50 complex, which is thought to originate in the pre-rolandic cortex, was significantly enhanced in patients compared with the control group. These results suggest the enhancement of the vertex-ipsilateral central P37-N50 complex might reflect an abnormal response to somatosensory inputs of a precentral cortex which is excessively activated because of a disorder of the basal ganglia. Such inefficient sensory processing in motor areas might contribute to motor impairment in dystonia.

Comparison of swallowing function in Parkinson's disease and progressive supranuclear palsy

Dysphagia is common in both Parkinson's disease (PD) and progressive supranuclear palsy (PSP). Although it is believed to be more common in PSP, there are no controlled data and no comparison of swallowing function between these two disorders. Our aim was to assess dysphagia and swallow function in patients with PSP and PD. Seven patients with PSP were matched to seven patients with PD on the basis of disease duration. Self-rated dysphagia, movement disorder disability, modified barium swallow results, and abnormalities noted on manometry of the lower esophageal sphincter, esophageal body, upper esophageal sphincter, and pharynx were compared between the two groups. Neither severity nor duration of dysphagia differed between the two groups. Patients with PSP had a significantly greater degree of disability [median (range) Hoehn & Yahr score, 4 (3-5) vs. 2 (1-2); P < 0.002]. Manometric abnormalities were similar for the two groups. Oral-phase abnormalities on modified barium swallow were significantly more frequent in PSP (four patients with PSP vs. no patients with PD; p < 0.005). Pharyngeal abnormalities did not differ. Modified barium-swallow scores correlated well with self-reported dysphagia severity for patients with PSP (r = 0.93; p < 0.05) but not for those with PD (r = 0.42; p = NS). The frequency of abnormalities noted during the oral phase was significantly increased in PSP. It is hypothesized that the sensory information conveyed due to this may account for the better correlation between symptoms and swallowing abnormalities and the belief that swallowing problems are more common in PSP.

Median nerve somatosensory evoked potentials. Apomorphine-induced transient potentiation of frontal components in Parkinson's disease and in parkinsonism

Somatosensory evoked potentials (SEPs) to median nerve stimulation have been recorded from parietal and frontal districts in 43 parkinsonians, 17 patients with parkinsonism and 35 healthy controls matched for age and sex. Latency/amplitude characteristics of the parietal P14-N20-P25 and of the frontal P20-N30-P40 wave complexes before and after (10, 20, 30 and 60 min) subcutaneous administration of apomorphine chloride were evaluated in all the 60 patients and in 3 controls. The frontal waves N30 and P40 were either absent or significantly smaller than normal in 31 patients with Parkinson's disease (PD) (72.1%) and in 9 with parkinsonism in baseline records (56.3%). Following apomorphine, the parietal deflections did not significantly vary in amplitude. On the contrary, the frontal complex showed a significant amplitude increase in 27 PD and 8 parkinsonisms (respectively 62.8 and 47.1%); 79.1% of PD and 35.3% of parkinsonisms were improved clinically. Amplitude increase was evident at 10 min after apomorphine, in parallel with clinical improvement, and vanished nearly in coincidence with the end of the clinical effect.

A single report of hemiplegic arm stretching related to yawning: further investigation using apomorphine administration

We observed a stroke patient with an infarct of the internal capsule interrupting the pyramidal tract who stretched his hemiplegic arm during spontaneous and apomorphine-induced yawning. The putative mechanism by which yawning can induce the paradoxical motor response of the plegic arm in the patient might be the functional efficiency of a pathway projecting directly from the stimulated basal ganglia to lower motor systems in the brainstem.

Basal ganglia: functional anatomy and physiology. Part 2

Advances in knowledge about basal ganglia function and circuitry are reviewed. Despite the voluminous available literature on this subject, the role of basal ganglia in health and disease remains controversial. Experimental data on the effects of stimulation and ablation of the basal ganglia are summarized. The roles of the basal ganglia in the preparation for and execution of cortically initiated movement are described. Newer roles ascribed to the basal ganglia in sensory-motor gating, cognition, emotion, and motivation are discussed. The old and current concepts of information flow between the cerebral cortex, striatum, pallidum, thalamus, and back to the cerebral cortex are reviewed. The "funnel" system of information flow has been discarded in favor of several parallel and largely segregated loops pertaining to motor, oculomotor, cognitive, and limbic functions. The anatomic substrate of each of these loops is described. The specific roles of the striatum, pallidum, substantia nigra, and thalamus in information flow as related to movement are described. The roles of the basal ganglia in reinforcing wanted behavior and suppressing unwanted behavior via direct and indirect striatal loops are discussed. The implications of these loops in the genesis of Parkinson's disease and Huntington's chorea are described. Alteration in basal ganglia neurotransmitters and neuromodulators in Huntington's chorea, Tourette's syndrome, and Parkinson's disease are described.

Polymodal sensory and motor convergence in substantia nigra neurons of the awake monkey

Responses of substantia nigra (SN) pars compacta (SNc) and reticulata (SNr) neurons to sensory stimulation and movement were investigated in awake Macaca fascicularis. Concern was assigned to polysensory and sensory/motor convergence on the same cell, which were found in 12% and 9% of the neurons, respectively. Others were modality specific (35%) or unresponsive (44%). The convergence lends support to the notion that SN plays an important role in sensory-motor integration.

Changes in motoneuron excitability of masseter muscle following exteroceptive stimuli in Parkinson's disease

Changes in motoneuron activity of masseter muscle to exteroceptive stimuli were evaluated in parkinsonian patients. Two different electrophysiological procedures were applied, consisting of exteroceptive suppression of the masseter or excitability curves of the masseteric reflex obtained by using exteroceptive conditioning stimuli. Seven patients not yet treated with dopaminergic or anticholinergic drugs were compared with 10 age-matched normal volunteers. Only the second phase of exteroceptive suppression was examined because correct measurement of the first phase was impossible due to the stimulus artefact. No significant differences were observed in exteroceptive suppression between parkinsonian patients and normals. Early and late inhibitory phases of the excitability curve of the masseteric reflex were obtained in both normals and patients. However, parkinsonians showed less inhibitory change than normals in both early and late phase of the curve. This study confirms that reduced inhibition of the masseteric reflex to exteroceptive stimuli is present in Parkinson's disease. The excitability curve of the masseteric reflex represents a more reliable method than exteroceptive suppression in detecting these abnormalities.

Abnormalities of somatosensory evoked potentials in the quinolinic acid model of Huntington's disease: evidence that basal ganglia modulate sensory cortical input

Intrastriatal injection of quinolinic acid (QA) in rats provides an animal model that mimics some of the neuropathological and neurochemical alterations observed in the striatum of patients with Huntington's disease (HD). One of the very early neurophysiological signs in HD is a diminution of amplitude of early somatosensory evoked potentials (SEPs) recorded over the parietal cortex. The present study investigated whether the QA model exhibits similar neurophysiological abnormalities. Two weeks after unilateral intrastriatal injection of QA (240 nmol) or of the solvent, early SEPs were recorded with chronically implanted electrodes from the somatosensory cortex or from the ventrobasal nucleus of the thalamus of lightly pentobarbital-anesthetized rats, in response to single-shock electrical stimulation of the contralateral forepaw. Whereas intrastriatal injection of solvent did not influence SEPs, the striatal QA lesion significantly reduced the amplitude of early cortical SEPs by about 40% without affecting the latency. SEPs recorded from the ventrobasal nucleus were unchanged after QA lesion. Histological examination and glial fibrillary acid protein staining after intrastriatal injection of QA revealed no evidence for damage in the somatosensory system. It is concluded that (1) the QA animal model of HD mimics some of the SEP abnormalities of patients, and (2) a striatal lesion modulates somatosensory transmission to the cortex in rats.

Masseter inhibitory reflex in movement disorders. Huntington's chorea, Parkinson's disease, dystonia, and unilateral masticatory spasm

Evoked by electrical stimulation of the mental nerve, the masseter inhibitory reflex consists of an early and a late silent period (SP1 and SP2), which interrupt the voluntary electromyographic (EMG) activity in the masseter muscle. We recorded the masseter inhibitory reflex and measured its latency, depth of suppression, duration and recovery cycle to paired stimuli, in patients with Huntington's chorea. Parkinson's disease, dystonia, or unilateral masticatory spasm. In patients with Huntington's chorea the reflex data and recovery cycle were normal. In patients with Parkinson's disease or dystonia, although the reflex data were normal, SP2 recovered far more rapidly than it did in control subjects. This is possibly due to hypoactivity of an inhibitory control of the polysynaptic chain of ponto-medullary interneurons that mediate SP2. In patients with unilateral masticatory spasm, both SP1 and SP2 were absent. Suppression is probably absent because this involuntary movement originates at a point along the peripheral course of the nerve.

Lesch-Nyhan syndrome with delayed onset of self-mutilation: hyperactivity of interneurons at the brainstem and blink reflex

We studied a case of Lesch-Nyhan syndrome with delayed onset of self-mutilation. Athetotic cerebral palsy and mental retardation were diagnosed at 1 year old, but the disease was not suspected until age 8 years when he began biting his lips and fingers. There was no obvious alteration of catecholamine in urine and CSF. We attempted to induce a series of blink reflexes by electric, mechanical and photic procedures. The R1 amplitude increased and the latency of the R2 shortened compared with controls. This shows that not only orbicularis motoneuron itself, but also uncrossed interneurons, are in a state of hyperexcitability. The contralateral R2 was poor which was in favour of hypoexcitability of the crossed interneurons at the brainstem. The significant large response was obtained by photic procedure which was in favour of hyperexcitability of the motoneurons. Therefore, it is demonstrated that a thorough examination of blink reflexes provides a useful method for examination of a state of the underlying neural activity.

Influences of dopaminergic systems on the blink reflex

The effect of the anti-dopaminergic drug haloperidol (6 mg/day i.m. for 2 days) on the blink reflex elicited by electric stimulation of supraorbital nerves was investigated in 12 adult volunteers. A significant increase in amplitude of the early component (R1) of the reflex was observed. This increase disappeared within 5 days of stopping the drug. Possible neural systems which might be involved in these effects are considered.

Blink reflex in children with neurological disorders: analysis of ipsilateral early component R1 and late component R2

The blink reflex was studied in 101 children with neurological disorders, especially with regard to alterations in the ipsilateral early component R1 and the late component R2. As a whole any kind of abnormality in the latency and/or amplitude of R1 or R2 was detectable in patients of cerebral, brainstem and peripheral lesions. There were neither specific findings with respect to localization of the lesions nor differences among each age group except for in patients of brainstem disorders. In the patients with increased intracranial pressure, the blink reflex sensitively reflected the high intracranial pressure. In motor impairment cases, even severely affected, the blink reflex was within normal range in late infancy. The blink reflex is influenced by the brain maturation, the underlying etiology and pathophysiology. R2 is more closely correlated with the clinical findings than R1.

Response properties of the perioral reflex in Parkinson's disease

Analyses of the response magnitudes of the short-latency perioral reflex were made in a group of Parkinson disease patients and control subjects. As a group, the parkinsonian subjects manifested reflex magnitudes which were increased relative to normal. For low-acceleration, mechanical displacements of perioral tissue (less than 500 cm/s2), the perioral reflex was not elicited in normal controls. However, such low-acceleration stimuli did elicit the perioral reflex in more than half of the parkinsonian subjects studied. These findings are consistent with earlier findings of increased sensitivity of facial and perioral reflexes associated with disturbances of the basal ganglia. These results contribute to the understanding of specific stimulus-response characteristics of the facial reflex and the role of the basal ganglia in orofacial motor control. The finding of increased sensitivity to mechanical stimuli in Parkinson's disease supports the hypothesis of basal ganglia gating or regulation of afferent information.

The organization of the nucleus basalis-neostriatum complex of the mallard (Anas platyrhynchos L.) and its connections with the archistriatum and the paleostriatum complex

The pattern of connections between the nucleus basalis, neostriatum, hyperstriatum ventrale, paleostriatum complex and archistriatum in the mallard has been analysed using Nissl material and a combination of neuroanatomical tracing procedures (autoradiography, horseradish peroxidase and horseradish peroxidase-wheat germ agglutinin histochemistry, lesion/degeneration technique). The frontal part of the mallard's telencephalon is characterized by its multilayered organization and the predominantly vertical arrangement of the connecting fiber systems. The nucleus basalis, endstation of the ascending sensory trigeminal system, is a large laminar cell area with a dorsal and a ventral layer. The overlying neostriatum frontale can be subdivided into a medial, a dorsal and a ventral intermediate, and a lateral area. The nucleus basalis has distinct connections with the ventral layer and sparse connections with the dorsal layer of the intermediate neostriatum, and abundant reciprocal connections with the ventral layer of the hyperstriatum ventrale. The ventral intermediate neostriatum also has reciprocal connections with the hyperstriatum ventrale; its projections overlap partly with those from the nucleus basalis. The ventral layer of the intermediate neostriatum frontale has a distinct projection upon the paleostriatum augmentatum. The dorsal layer sends fibers to the lateral neostriatum, to the rostral "sensorimotor" part of the archistriatum and to the lateral zone of the lobus parolfactorius. Another source of archistriatal afferents is the paleostriatum ventrale, an area that may also send fibers to the brainstem. Figure 21 summarizes the connections described in this paper. The functional significance of this organization is discussed in relation to its possible role in the guidance of pecking and other feeding behaviors in the mallard. Differences in the organization of the systems in pigeon and mallard are related to the differing degrees of visual and tactile (trigeminal) contributions to feeding in the two birds. It is suggested that the pattern of reciprocal connections between the hyperstriatum ventrale and the nucleus basalis and ventral intermediate neostriatum frontale forms the neuroanatomical substrate for a "comparator-system".

Corneal and blink reflexes in Parkinson's disease with "on-off" fluctuations

In 13 patients with Parkinson's disease and "on-off" fluctuations and in a control group, the electrically evoked blink (R1 and R2 component) and corneal reflexes (CR), the habituation of the glabellar reflex, and the blink rate were studied. Latency, amplitude, and recovery cycle of R1 was normal. CR latency, but not R2 latency, was significantly shorter in patients than in normal subjects. R2 recovery cycle, but not CR recovery cycle, was facilitated in "off" patients in comparison to normal subjects. CR and R2 duration was longer in "off" than in "on" patients. R2 recovery cycle became similar to that of normal subjects after fluctuation from "off" to "on" period, but CR recovery cycle varied only slightly. The habituation of the glabellar reflex and the blink rate were decreased in "off" patients. These findings indicate that the enhanced excitability of R2 is related to the central dopamine activity levels. The differences between the recovery cycles of CR and R2 may be explained with the smaller number of interneurons subserving CR than R2 circuit. The shorter latency of CR, but not of R2, both in "on" and "off" patients, may suggest that in Parkinson's disease basal ganglia exert a different control of incoming sensory input transmitted via beta and delta fibers.

Interactions between the basal ganglia, the pontine parabrachial region, and the trigeminal system in cat

Anatomical studies utilizing wheat germ lectin-bound horseradish peroxidase demonstrated direct connections between the pontine parabrachial region and the substantia nigra pars reticulata and to a lesser extent, the entopeduncular nucleus as well as a number of other forebrain regions including the amygdala, hypothalamus, thalamus, bed nucleus stria terminalis and substantia innominata. The pontine parabrachial region was also shown to receive direct inputs from the spinal trigeminal system and to send axons to areas surrounding trigeminal and hypoglossal motor areas. Once the anatomical connections were determined, electrophysiological studies were undertaken to investigate some of the functional aspects of these connections between the pontine parabrachial, basal ganglia and trigeminal systems. Extracellular single unit recordings were obtained from 228 cells in the dorsal pontine parabrachial region of the cat. These cells were tested for responsiveness to trigeminal sensory stimulation and activation of basal ganglia outputs (i.e. substantia nigra and entopeduncular nucleus). Twenty-two percent of pontine parabrachial cells responded to only trigeminal stimulation; 4% responded to entopeduncular nucleus only; 37% responded to substantia nigra only, and 28% responded to both substantia nigra and trigeminal stimulation. Furthermore, 43% of pontine parabrachial cells with both substantia nigra and sensory response had the sensory response altered by a preceding stimulus to the substantia nigra. Thus, the substantia nigra is shown to exert influences on both the spontaneous activities and afferent responses of pontine parabrachial neurons. The significance of these findings are discussed in relation to the importance of descending basal ganglia influences and ascending influences from the pontine parabrachial region on various sensorimotor activities.

Swallowing and speech production in Parkinson's disease

Videofluoroscopy was used to examine movement patterns during swallowing and speech production in 6 parkinsonian subjects and 6 age-matched controls. Motility patterns for liquid and semisolid swallows were documented. We performed temporospatial analyses of oropharyngeal structures, particularly the velum, which is prominently involved in both motor speech production and swallowing. Differences were found between groups and conditions. All of the parkinsonian subjects exhibited abnormal oropharyngeal movement patterns and timing during the volitional oral as well as the pharyngeal stage of swallowing; only 50% of these subjects admitted to any swallowing difficulty upon questioning. Two of the subjects with Parkinson's disease aspirated liquids. Duration of velar movement during speech production significantly differentiated the groups (p less than 0.01), reflecting reduced range of velar motion. Our findings suggest that rigidity and bradykinesia underlie the volitional speech abnormality as well as the disordered oral and pharyngeal stages of swallowing. Findings indicate that parkinsonian patients may be "silent aspirators" with decreased cough reflexes and lack of awareness of aspiration. The clinical value of videofluoroscopic monitoring of swallowing is that aspiration may be detected and managed early.

The role of the tactile-pressure afferents in the habituation phenomenon of trigemino-facial reflex

In ten healthy subjects the trigemino-facial reflex was elicited by double shock (delta t = 0.5-1 s). The first stimulus was subliminal for pain and the second supramaximal for it. The percentage integral values, with respect to single shock, of the direct and consensual conditioned responses obtained in all subjects were averaged and compared with those conditioned by supramaximal stimuli for pain fibres. Significant differences between subliminal and supramaximal conditioning stimuli for pain fibres is revealed for only consensual R3 with delta t = 1 s: greater inhibition with painful stimuli. There were no significant differences in any of the other values. Our results show that a subliminal conditioning stimulus for pain threshold can inhibit the late responses to the test stimulus, both for R2 and especially for R3, suggesting that this mechanism can contribute to the trigemino-facial reflex habituation phenomenon.

Changes in the recruitment pattern of single motor units in the blink reflex of patients with parkinsonism and hemiplegia

The recruitment pattern of single motor units (SMUs) was studied in the early (R1) and late (R2) blink reflex components in normal subjects (15), patients with parkinsonism (10) and with hemiplegia due to hemispheral lesions (5). Reflexes were evoked by constant current stimuli applied to the supraorbital nerve. SMU discharges were recorded in the preseptal part of the lower eyelid using a bipolar needle electrode. Thresholds of R1 and R2, latencies at the thresholds and the number of discharges in R2 were determined. In parkinsonism, the recruitment of SMUs in R1 was impaired, suggesting that the malfunction of the basal ganglia in this disorder is associated with a reduced excitability of neurons in the pontine brain-stem. In hemiplegia, the recruitment in both R1 and R2 could be impaired. The orderly function of neurones in the pontine and medullary pathways of these components appears to require facilitatory hemispheral influences. Signs of disinhibition occasionally found in R1 may point to an imbalance between facilitatory and inhibitory hemispheral influences upon the pontine pathway.

A consideration of sensory factors involved in motor functions of the basal ganglia

There is a sizeable literature concerning basal ganglia (BG) functioning that is based on data from experiments employing a method of analysis that is traditionally used with other motor areas. A brief review of this literature is presented and the following conclusion is reached: as compared to the success of traditional methodologies in elucidating the workings of other motor systems, their use in BG investigations has proven disappointing. A possible reason for the shortcomings of traditional analyses in BG research is discussed. The remainder of this review concerns an alternative approach to the study of the BG that follows from consideration of a variety of clinical and experimental findings. The literature suggests that sensory aspects of BG functioning must be taken into account to fully appreciate the role of this system in motor control. A review of the literature concerning the latter suggests two points: The BG function as sensory analyzer for motor systems. That is, the BG convert sensory data from a form that is receptor oriented to a form that is relevant for guiding movement. The BG ultimately affect movement by gating sensory inputs into other motor areas rather than by directly affecting these areas. This sensory-based model of BG functioning explains a number of apparent discrepancies in the literature. In addition, seemingly anomalous findings are reconciled with the overwhelming evidence that the BG are a motor system. In particular, the suggestions of a BG role in attention and cognition are viewed as being intrinsic rather than orthogonal to the role of the BG in movement.

Connections of the mesencephalic locomotor region (MLR) III. Intracellular recordings

The responses of neurons in the area of the cat mesencephalic locomotor region (MLR) following stimulation of the entopeduncular nucleus (EN) were recorded intracellularly. At the end of each experiment a precollicular-postmamillary brainstem transection was performed and stimulation of the recording site(s) was employed to induce locomotion on a treadmill. This procedure was assumed to establish that intracellularly studied cells in the vicinity of a locomotion-inducing site were MLR neurons. About 10% of MLR neurons were found to respond to stimulation of the EN at short latencies. Stimulation of MLR efferent pathways was used to identify output neurons by antidromic activation. Very few MLR output neurons were found to receive EN projections (i.e. to respond at short latency following EN stimulation). These experiments support previous results describing a sparse projection from the EN to the MLR. This projection appears to be functionally varied (EPSP, IPSP and EPSP-IPSP responses were observed in MLR neurons following EN stimulation) and to exert its major influence on interneurons, not on output neurons, of the MLR.

Connections of the mesencephalic locomotor region (MLR) II. Afferents and efferents

Injections of a tritiated amino acid-fluorescent dye mixture were made unilaterally into the area of the mesencephalic locomotor region (MLR). After allowing for retrograde and anterograde transport, the same site was electrically stimulated to induce locomotion on a treadmill following a precollicular-postmamillary transection. The tritiated amino acid transported anterogradely primarily was found autoradiographically to descend in the area of Probst's tract and to ascend to the centremedian nucleus (CM) of the thalamus. Neurons labeled retrogradely by the fluorescent dye in the same injection-stimulation site were observed in the substantia nigra, entopeduncular nucleus, sub- and hypothalamus and amygdala. In subsequent experiments, injections of fluorescent tracers were made into the area of Probst's tract and CM. Neurons in the mesencephalic trigeminal root, cuneiform nucleus, nucleus tegmenti pedunculopontinus (NTPP), dorsal locus coeruleus and lateral central gray were labeled from Probst's tract injections. Neurons in medial and lateral central gray, as well as NTPP, were labeled from CM injections.

Unilateral reduction of the early and late blink reflex component in hemiparkinson syndrome

Electrically evoked blink reflexes were recorded in 10 patients with unilateral tremor and/or rigor, mostly diagnosed as hemiparkinson syndrome. Five of the patients could be investigated before and after stereotaxic thalamo-subthalamotomy. The EMG activity of the early and late components was quantified by means of averaging and integrations techniques. In addition, the latencies of the reflex components were determined. The major finding was a unilateral decrease of the EMG activity of both the early and late components confined to the clinically affected side. This pattern points to a lowered state of excitability of neurons in or close to the facial nucleus, probably due to a dysfunction of contralateral EPMS structures. A loss of facilitatory influences from EPMS centers, e.g. the nigro-striatal system, on brain stem neurons in the area of the facial nucleus appears most probable. The latencies of the early and late components were mostly normal. After stereotaxic surgery, the BR activity was decreased bilaterally. The difference between the affected and unaffected sides, however, was nearly unchanged. At present an unspecific postoperative effect cannot be excluded.

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.

Neural mechanisms of tardive dyskinesia

Tardive dyskinesia is a disabling movement disorder, caused by antipsychotic medications, that occurs frequently and is not responsive to treatment. It is not known how the brain damage underlying tardive dyskinesia produces abnormal movement. We propose that altered sensory flow to motor systems results in this syndrome. Verification of such a mechanism could lead to early detection and improved treatment of tardive dyskinesia.