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Jansen TS, Güney G, Ganse B, Monje MHG, Schulz JB, Dafotakis M, Hoog Antink C, Braczynski AK. Video-based analysis of the blink reflex in Parkinson's disease patients. Biomed Eng Online 2024; 23:43. [PMID: 38654246 PMCID: PMC11036732 DOI: 10.1186/s12938-024-01236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
We developed a video-based tool to quantitatively assess the Glabellar Tap Reflex (GTR) in patients with idiopathic Parkinson's disease (iPD) as well as healthy age-matched participants. We also video-graphically assessed the effect of dopaminergic medication on the GTR in iPD patients, as well as the frequency and blinking duration of reflex and non-reflex blinks. The Glabellar Tap Reflex is a clinical sign seen in patients e.g. suffering from iPD. Reliable tools to quantify this sign are lacking. METHODS We recorded the GTR in 11 iPD patients and 12 healthy controls (HC) with a consumer-grade camera at a framerate of at least 180 images/s. In these videos, reflex and non-reflex blinks were analyzed for blink count and blinking duration in an automated fashion. RESULTS With our setup, the GTR can be extracted from high-framerate cameras using landmarks of the MediaPipe face algorithm. iPD patients did not habituate to the GTR; dopaminergic medication did not alter that response. iPD patients' non-reflex blinks were higher in frequency and higher in blinking duration (width at half prominence); dopaminergic medication decreased the median frequency (Before medication-HC: p < 0.001, After medication-HC: p = 0.0026) and decreased the median blinking duration (Before medication-HC: p = 0.8594, After medication-HC: p = 0.6943)-both in the direction of HC. CONCLUSION We developed a quantitative, video-based tool to assess the GTR and other blinking-specific parameters in HC and iPD patients. Further studies could compare the video data to electromyogram (EMG) data for accuracy and comparability, as well as evaluate the specificity of the GTR in patients with other neurodegenerative disorders, in whom the GTR can also be present. SIGNIFICANCE The video-based detection of the blinking parameters allows for unobtrusive measurement in patients, a safer and more comfortable option.
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Affiliation(s)
- Talisa S Jansen
- Department of Neurology, RWTH University Hospital, Aachen, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Gökhan Güney
- KIS*MED (AI Systems in Medicine Lab) Technische Universität Darmstadt, Darmstadt, Germany
| | - Bergita Ganse
- Innovative Implant Development, Saarland University, Homburg, Germany
| | - Mariana H G Monje
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Jörg B Schulz
- Department of Neurology, RWTH University Hospital, Aachen, Germany
- Jülich Aachen Research Alliance (JARA), JARA-Institute Molecular Neuroscience and Neuroimaging, FZ Jülich and RWTH University, Jülich, Germany
| | - Manuel Dafotakis
- Department of Neurology, RWTH University Hospital, Aachen, Germany
| | - Christoph Hoog Antink
- KIS*MED (AI Systems in Medicine Lab) Technische Universität Darmstadt, Darmstadt, Germany.
| | - Anne K Braczynski
- Department of Neurology, RWTH University Hospital, Aachen, Germany
- Institut für Physikalische Biologie, Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
- Institute of Biological Information Processing (IBI-7: Structural Biochemistry), Forschungszentrum Jülich, Jülich, Germany
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Jang Y, Jung KH, Lee ST, Chu K, Lee SK. A novel indicator, the "Jinx sign," is associated with an altered frontal-basal ganglionic connection. J Neurol Sci 2017; 379:306-307. [PMID: 28716268 DOI: 10.1016/j.jns.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/06/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Yoonhyuk Jang
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea.
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
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McDiarmid TA, Bernardos AC, Rankin CH. Habituation is altered in neuropsychiatric disorders-A comprehensive review with recommendations for experimental design and analysis. Neurosci Biobehav Rev 2017; 80:286-305. [PMID: 28579490 DOI: 10.1016/j.neubiorev.2017.05.028] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/29/2017] [Indexed: 02/03/2023]
Abstract
Abnormalities in the simplest form of learning, habituation, have been reported in a variety of neuropsychiatric disorders as etiologically diverse as Autism Spectrum Disorder, Fragile X syndrome, Schizophrenia, Parkinson's Disease, Huntington's Disease, Attention Deficit Hyperactivity Disorder, Tourette's Syndrome, and Migraine. Here we provide the first comprehensive review of what is known about alterations in this form of non-associative learning in each disorder. Across several disorders, abnormal habituation is predictive of symptom severity, highlighting the clinical significance of habituation and its importance to normal cognitive function. Abnormal habituation is discussed within the greater framework of learning theory and how it may relate to disease phenotype either as a cause, symptom, or therapy. Important considerations for the design and interpretation of habituation experiments are outlined with the hope that these will aid both clinicians and basic researchers investigating how this simple form of learning is altered in disease.
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Affiliation(s)
- Troy A McDiarmid
- Graduate Program in Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Rm F221, 2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Aram C Bernardos
- Graduate Program in Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Rm F221, 2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Catharine H Rankin
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Rm F221, 2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada.
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Zoetmulder M, Biernat HB, Nikolic M, Korbo L, Jennum PJ. Sensorimotor gating deficits in multiple system atrophy: Comparison with Parkinson's disease and idiopathic REM sleep behavior disorder. Parkinsonism Relat Disord 2014; 20:297-302. [DOI: 10.1016/j.parkreldis.2013.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 10/22/2013] [Accepted: 11/30/2013] [Indexed: 01/20/2023]
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de la Espriella RA, Hernández JF, Espejo LM. [Cortical Release Signs in Patients with Schizophrenia, Depressive Disorders, and Bipolar Affective Disorder]. REVISTA COLOMBIANA DE PSIQUIATRIA 2013; 42:311-319. [PMID: 26573115 DOI: 10.1016/s0034-7450(13)70027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/28/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Determining the presence of cortical release signs associated with white matter damage, is a clinically easy method to perform. The objective of this study is to determine the presence of cortical release signs in patients with mental illnesses and cerebrovascular disease, as well as its clinical usefulness, given that it indicates cortical damage. MATERIAL AND METHODS A review was made of cortical release signs in patients hospitalized in clinical psychiatry and general hospitals with bipolar affective disorder (40), depression (37), schizophrenia (33), cardiovascular disease (33) and dementia (37). RESULTS The signs of cortical release do not have the same importance as cortical damage. For example, the glabellar reflex was found in all the groups, that of paratonia, particularly in the group with schizophrenia, and others signs in the group of patients with dementia. CONCLUSIONS It is suggested that these signs imply subcortical white matter damage. The appearance of these signs shows the need for a follow up of patients diagnosed with bipolar affective disorder, depression and schizophrenia.
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Affiliation(s)
- Ricardo Andrés de la Espriella
- Médico especialista en Psiquiatría, terapeuta sistémico, magíster en epidemiología clínica; Docente en Departamento de Psiquiatría, Universidad Pontificia Javeriana; Gestor de Docencia e Investigación, Clínica Nuestra Señora de La Paz, Bogotá, Colombia.
| | | | - Lina María Espejo
- Médico especialista en Psiquiatría, Clínica Nuestra Señora de La Paz, Bogotá, Colombia
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Kobayashi S, Maki T, Kunimoto M. Clinical symptoms of bilateral anterior cerebral artery territory infarction. J Clin Neurosci 2010; 18:218-22. [PMID: 21159512 DOI: 10.1016/j.jocn.2010.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 05/05/2010] [Indexed: 12/01/2022]
Abstract
Bilateral anterior cerebral artery (ACA) territory infarction is rare and its associated symptoms are still not well understood. We evaluated the clinical symptoms of four patients with bilateral ACA infarction. The common clinical features were various primitive reflexes and parkinsonian symptoms including akinesia, rigidity and hypophonia. Frontal release signs were present in all patients with ACA infarction even without direct involvement of the prefrontal cortex. Enhanced glabellar tap response, previously not reported in patients with ACA infarction, was the most consistent finding, and electrophysiological studies confirmed hyperexcitability of the late component of the blink reflex. The bilateral lesions in the deep white matter may be associated with the observed symptoms, reflecting functional disconnection of the medial prefrontal-subcortical circuitry.
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Affiliation(s)
- Shunsuke Kobayashi
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
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7
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Abstract
OBJECTIVE To review the role of cortical release signs (CRS) in neuropsychiatry. METHOD A thorough literature review was conducted using Medline and Psychlit databases, and other relevant references available to the authors. RESULTS A number of neurological abnormalities are reported at elevated rates in neuropsychiatric conditions. CRS are a group of primitive reflexes that are present in the neonate but become inhibited as the infant central nervous system (CNS) develops, only to later re-emerge in the context of CNS disease. The clinical elicitation and interpretation of each CRS is described with reference to its neurobiology. The prevalence of CRS in schizophrenia, affective disorder, obsessive-compulsive disorder, Alzheimer's disease, vascular dementia, frontotemporal dementia and other neuropsychiatric illness allows for their use in the clinical management of these patients, including diagnostic assessment, treatment monitoring and prognosis. CONCLUSIONS A number of issues complicate their interpretation in neuropsychiatric illness, including the apparent high base rate of some CRS in non-clinical populations, their increasing prevalence with age, lack of specificity and uncertainty over what constitutes an 'abnormal' response. In some circumstances, CRS may assist in diagnostic differentiation and illness staging.
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Affiliation(s)
- Mark Walterfang
- Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia.
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Gabrielli L, Nocita P, Pasetti C, Bonuccelli U, Dell'Agnello G, Chiara Carboncini M, Rossi B. Impaired attention modulation of the blink reflex R3 component in Parkinson's disease: a non-task warning paradigm study. Int J Psychophysiol 2002; 44:83-91. [PMID: 11852159 DOI: 10.1016/s0167-8760(01)00195-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE the aim of this experimental study was to evaluate the attention modulating actions on the polysynaptic component of blink reflex responses and especially of the R3 component in patients suffering from Parkinson's Disease (PD). To this end, a non-task warning paradigm was adopted. METHODS attention processing was evaluated by means of a non-task paradigm in 55 patients suffering from PD. Subjects were presented with a visual 'warning' prestimulus and the blink reflex (BR) analyzed with special regard for any modulation of its polysynaptic components (R2-R3). RESULTS The mean amplitude of the post-warning R3 component (PW-R3c) of 'de novo' PD patients was 62% of the corresponding component following unannounced stimuli, a figure which differs significantly from both treated PD patients (18.9%) and control subjects (15.4%). De novo patients subsequently started on L-dopa therapy exhibited a more pronounced inhibition of the R3 component after warning stimulus, as the PW-R3c percentage decreased. Inversely, treated patients whose therapy was withheld showed decreased inhibition of this component. Regarding R2, the mean PW-R2c in the de novo patients differed slightly from that of the treated patients (P<0.05), but not from that of the control subjects. Such a finding may be attributable to a specific effects on the excitability of the polysynaptic responses. CONCLUSIONS Attention disorders in PD have been well documented by means of this kind of non-task warning paradigm, which appears to probe the modulation of the BR R3 component, even if the interpretation of this R3 changes suggesting a specific alteration of attention processing must be put forward extremely carefully, because something similar, but less evident, appears also for R2.
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Affiliation(s)
- Luciano Gabrielli
- Section of Neurology, Department of Neuroscience, University of Pisa, Via Roma 67, 56100 Pisa, Italy
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9
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Deuschl G, Goddemeier C. Spontaneous and reflex activity of facial muscles in dystonia, Parkinson's disease, and in normal subjects. J Neurol Neurosurg Psychiatry 1998; 64:320-4. [PMID: 9527141 PMCID: PMC2169979 DOI: 10.1136/jnnp.64.3.320] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The blink rate is an index which can be easily obtained during the clinical examination, but it has not yet been properly standardised. The present study was undertaken to collect data on the age dependent development of this index and on possible abnormalities in Parkinson's disease and dystonia. METHODS The blink rate and the rate of perioral movements were measured in 156 normal controls, 51 patients with Parkinson's disease, 48 patients with spasmodic torticollis, 14 patients with generalised dystonia, and 12 patients with focal hand or leg dystonias and have been correlated with the results of testing the orbicularis oculi reflex, the palmomental reflex, and the perioral reflex. RESULTS No age related effects were found for the blink rate and perioral movements but all the reflexes showed age dependent variations. It is sufficient to measure the blink rate for one minute, provided standardised conditions are applied. Blink rate and perioral movement rate were positively correlated in patients and controls. The blink rate was significantly increased in spasmodic torticollis and decreased in Parkinson's disease. In generalised dystonia the blink rate was increased but in hand and leg dystonia the blink rate was normal. The reflex tests did not significantly differ between the subject groups except for the orbicularis oculi reflex, which was hyperexcitable in Parkinson's disease. CONCLUSION Measuring the blink rate can assist the diagnosis of extrapyramidal disorders as a soft sign, but is not very sensitive. The group differences found indicate a decrease of the blink rate and perioral movements in hypokinetic and an increase in hyperkinetic extrapyramidal disorders such as spasmodic torticollis and generalised dystonias. This may be of interest for future pathophysiological studies.
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Affiliation(s)
- G Deuschl
- Department of Neurology, University of Kiel, Germany.
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10
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Abstract
A standardised protocol for the examination of 15 primitive reflexes in which the amplitude and the persistence were scored separately, was applied to 25 patients with Parkinson's disease and an equal number of healthy matched control subjects. Most reflexes were found considerably more often in the patients than in the control subjects, especially the snout, the glabellar tap, and its variant, the nasopalpebral reflex. Only the mouth open finger spread reflex was present more often in the control subjects. For all reflexes except this last, the scores for amplitude and persistence of the reflexes for the control group never exceeded the scores for the patient group. Reflexes persisted more often in the patients than in the control subjects. Parkinsonism alone can explain a large number of primitive reflexes, irrespective of the severity or duration of the disease. In contrast, the number of reflexes was related more closely to cognitive scales. It is concluded that such reflexes may be helpful in diagnosing Parkinson's disease. In addition, a standardised protocol for eliciting and scoring is essential for the study of these reflexes in parkinsonism and other neuropsychiatric conditions.
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Affiliation(s)
- F W Vreeling
- University of Limburg, Maastricht, The Netherlands
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Vreeling FW, Jolles J, Verhey FR, Houx PJ. Primitive reflexes in healthy, adult volunteers and neurological patients: methodological issues. J Neurol 1993; 240:495-504. [PMID: 8263556 DOI: 10.1007/bf00874119] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A study was made to determine whether two experienced clinicians elicited and scored primitive reflexes (PR) differently and whether reliability could be improved by standardization. Three studies were carried out, using a protocol for the examination of 14 PR. In the first study with 31 healthy young subjects, two investigators found virtually no difference in the routine neurological examination. However, the interobserver agreement was very poor, indicating the need for a further improvement of the PR protocol. In the second study, 30 neurological patients were examined with an improved, more explicit and standardized protocol, in which the amplitude and the persistence of the reflex were scored separately. Interobserver agreement improved considerably, and was high for amplitude as well as persistence. In the third study, 36 neurological patients were examined twice by one investigator within 2 weeks. Good to excellent intraobserver agreement was found. No pathognomonic or strictly localizing reflex could be distinguished.
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Affiliation(s)
- F W Vreeling
- Department of Neurology, University of Limburg, Maastricht, The Netherlands
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12
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Hantraye P, Varastet M, Peschanski M, Riche D, Cesaro P, Willer JC, Maziere M. Stable parkinsonian syndrome and uneven loss of striatal dopamine fibres following chronic MPTP administration in baboons. Neuroscience 1993; 53:169-78. [PMID: 8469305 DOI: 10.1016/0306-4522(93)90295-q] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The progressive degeneration of dopamine neurons observed in idiopathic Parkinson's disease was mimicked by injecting low doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) to baboons, on a chronic basis. Five Papio papio baboons were treated on two different regimens (chronic intravenous administration at weekly intervals for 20-21 months or, daily MPTP treatment for five days followed five to six months later by chronic weekly injections for 5-21.5 months). All animals were assessed for motor symptoms during and after neurotoxic treatment. Both regimens invariably resulted in the appearance of a progressive and irreversible syndrome characterized by action and resting tremor, cogwheel rigidity, postural impairments, hypokinesia and bradykinesia. In some animals, symptoms of resting tremor and rigidity initially restricted to one side of the body became bilateral within a few months of treatment. Subtle abnormalities that may be found in idiopathic Parkinson's disease such as alterations of the blink reflex response were also noted. Neuropathological examination of caudate nucleus, putamen, substantia nigra and ventral tegmental area in brain sections stained for tyrosine hydroxylase showed a typical uneven striatal dopamine fibre loss and a neuronal depletion in the dopaminergic mesencephalic cell groups that reproduce those observed in idiopathic Parkinson's disease. Immunocytochemical observations and behavioural data show that chronic rather than acute MPTP injection regimens can replicate most of the neuropathological and the clinical features typical of idiopathic Parkinson's disease, possibly by increasing the ability of this neurotoxin to target specific subpopulations of mesencephalic dopaminergic neurons.
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Affiliation(s)
- P Hantraye
- CNRS URA 1285, Service Hospitalier Frédéric Joliot, DRIPP, CEA, Orsay, France
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Evinger C, Basso MA, Manning KA, Sibony PA, Pellegrini JJ, Horn AK. A role for the basal ganglia in nicotinic modulation of the blink reflex. Exp Brain Res 1993; 92:507-15. [PMID: 8454014 DOI: 10.1007/bf00229040] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In humans and rats we found that nicotine transiently modifies the blink reflex. For blinks elicited by stimulation of the supraorbital branch of the trigeminal nerve, nicotine decreased the magnitude of the orbicularis oculi electromyogram (OOemg) and increased the latency of only the long-latency (R2) component. For blinks elicited by electrical stimulation of the cornea, nicotine decreased the magnitude and increased the latency of the single component of OOemg response. Since nicotine modified only one component of the supraorbitally elicited blink reflex, nicotine must act primarily on the central nervous system rather than at the muscle. The effects of nicotine could be caused by direct action on lower brainstem interneurons or indirectly by modulating descending systems impinging on blink interneurons. Since precollicular decerebration eliminated nicotine's effects on the blink reflex, nicotine must act through descending systems. Three lines of evidence suggest that nicotine affects the blink reflex through the basal ganglia by causing dopamine release in the striatum. First, stimulation of the substantia nigra mimicked the effects of nicotine on the blink reflex. Second, haloperidol, a dopamine (D2) receptor antagonist, blocked the effect of nicotine on the blink reflex. Third, apomorphine, a D2 receptor agonist, mimicked the effects of nicotine on the blink reflex.
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Affiliation(s)
- C Evinger
- Department of Neurobiology and Behavior, State University of New York, Stony Brook 11794
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Matsumoto H, Noro H, Kaneshige Y, Chiba S, Miyano N, Motoi Y, Yanada Y. A correlation study between blink reflex habituation and clinical state in patients with Parkinson's disease. J Neurol Sci 1992; 107:155-9. [PMID: 1564513 DOI: 10.1016/0022-510x(92)90283-q] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The neurologic states and activities of daily life of patients with Parkinson's disease were evaluated using a rating scale with subitems, and subsequently the neurologic disturbance scores and the daily activity impairment scores were obtained. Subjects consisted of 19 normal controls, and 55 ambulatory patients without marked dyskinesia who were on various anti-parkinsonian drugs. Blink reflex was elicited by paired electrical stimulation over the supraorbital nerve. The interval time between the conditioning stimulation and the test stimulation was set at 200 ms, and 5 serial ipsilateral maximal R2 amplitudes on the stimulated side were measured. The mean of the paired maximal R2 amplitude ratio (test/conditioning), expressed as a percentage, was defined as the habituation index. The habituation indices in normal controls and those with Parkinson's disease were 17.1 +/- 7.6 and 51.9 +/- 29.3, respectively (P less than 0.01). The degree of akinesia, rigidity, balance/gait and dysarthria was positively correlated with the habituation index (P less than 0.01), while tremor was not. On the whole the habituation index was found to have a significant correlation not only with the neurologic disturbance score but also with the daily activity impairment score (P less than 0.01).
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Affiliation(s)
- H Matsumoto
- Department of Rehabilitation and Neurology, Sapporo Medical College, Japan
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15
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Abstract
Alterations in blink rate have been reported in several neuropsychiatric disorders presumed to result from abnormal central dopaminergic functions. Increased blink rate in schizophrenia, Tardive dyskinesia, Tourette's syndrome and Meige's disease are associated with enhanced dopaminergic functions. Parkinson's disease is associated with reduced dopaminergic functions and decreased blink rate. Thus, blink rate may reflect striatal and mesolimbic dopaminergic activity. Since acute light exposure suppresses melatonin production and darkness stimulates melatonin secretion, blinking may serve to regulate light-dark exposure to the pineal gland and thus to 'fine tune' melatonin production. As there is evidence to suggest that melatonin inhibits the release of dopamine in the striatum and limbic system, increased blink rate may serve to reduce light exposure, increase melatonin secretion and attenuate dopaminergic functions. Conversely, decreased blinking (as is observed in patients with Parkinson's disease) could reflect a compensatory mechanism to increase light exposure, reduce melatonin production and ultimately increase dopamine functions. This model is novel in that for the first time it suggests a functional link among blink rate, melatonin secretion and striatal dopaminergic functions in movement disorders.
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Affiliation(s)
- R Sandyk
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, NY
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Raffaele R, Emery P, Palmeri A, Ricca G, Perciavalle V. Influences of dopaminergic systems on the blink reflex. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1988; 9:351-4. [PMID: 3220710 DOI: 10.1007/bf02333998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- R Raffaele
- Clinica Neurologica, Università di Catania
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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; 3:281-9. [PMID: 2974927 DOI: 10.1002/mds.870030401] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- R Agostino
- Dipartimento di Scienze Neurologiche, Università di Roma, La Sapienza, Italy
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Mölsä PK, Säkö E, Paljärvi L, Rinne JO, Rinne UK. Alzheimer's disease: neuropathological correlates of cognitive and motor disorders. Acta Neurol Scand 1987; 75:376-84. [PMID: 3630634 DOI: 10.1111/j.1600-0404.1987.tb05465.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Correlations between clinical symptoms and changes in brain neuropathology were investigated in 34 patients with Alzheimer's disease, who were compared with 17 non-demented, age-matched controls. The patients were originally found in a community survey of dementia and were followed up prospectively until death. A highly significant correlation emerged between the severity of dementia and the numbers of plaques and tangles in the material as a whole, but no essential difference was found between severely and less severely demented patients. Low brain weight correlated highly with many clinical symptoms and signs and the severity of dementia. A multiple regression model consisting of plaques and tangles in amygdala, gyrus frontalis medius, gyrus angularis, and gyrus temporalis medius, plaques of gyrus rectus, tangles of the hippocampus, gyrus precentralis and gyrus cinguli together with brain weight, emerged to link dementia to neuropathological changes at the level of maximum significance. Dyskinetic movements were associated with damage of several brain areas, implying a multiple etiology.
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Agostino R, Berardelli A, Cruccu G, Stocchi F, Manfredi M. Corneal and blink reflexes in Parkinson's disease with "on-off" fluctuations. Mov Disord 1987; 2:227-35. [PMID: 3504552 DOI: 10.1002/mds.870020401] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
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.
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Affiliation(s)
- R Agostino
- Dipartimento di Scienze Neurologiche, Universita' di Roma La Sapienza, Italia
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Dengler R, Kossev A, Struppler A. Unilateral reduction of the early and late blink reflex component in hemiparkinson syndrome. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1982; 54:689-98. [PMID: 6183102 DOI: 10.1016/0013-4694(82)90123-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
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Ferguson IT, Lenman JA, Johnston BB. Habituation of the orbicularis oculi reflex in dementia and dyskinetic states. J Neurol Neurosurg Psychiatry 1978; 41:824-8. [PMID: 151127 PMCID: PMC493162 DOI: 10.1136/jnnp.41.9.824] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The habituation index is a quantitative expression of the ability of the orbicularis oculi (blink reflex) to adapt to a series of electrical stimuli applied to the supraorbital region. This parameter has been studied in a group of normal control subjects, and the results compared with those in cases of idiopathic and drug-induced Parkinsonism, states of dementia, and dyskinesias such as Huntington's chorea and senile chorea. Patients with Huntington's chorea showed a tendency for the reflex to habituate readily in contrast to patients with dementia caused by cortical atrophy and those with Parkinson's disease. Younger patients with Huntington's chorea had indices within the normal range. It seems unlikely that this test will prove of value in the detection of clinically unaffected relatives. Where dementia was associated with a reversible intracranial lesion, the habituation index was studied before and after treatment. Failure of habituation in this condition appears to be due to the release of a primitive protective reflex.
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Botvin JG, Keith RA, Johnston MV. Relationship between primitive reflexes in stroke patients and rehabilitation outcome. Stroke 1978; 9:256-8. [PMID: 644625 DOI: 10.1161/01.str.9.3.256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The reappearance of developmental reflexes in the aged has been found to be associated with severe, diffuse cerebral damage. This study examined the relationship between the presence of such reflexes in stroke patients and the outcome of rehabilitation. Tests for the presence of snout, suck, jaw-jerk and palmomental reflexes were tested in 106 consecutive stroke patients admitted for rehabilitation treatment. A mental status test was also included in the usual medical admission examination. Functional status ratings for self-care and mobility at discharge, and the setting to which the patient was discharged, were used as outcome criteria. All of the reflex signs were negatively related to a favorable outcome, but the correlations were not high enough for predictive value. The mental status measures were more highly related to rehabilitation outcome than were the presence of developmental reflexes.
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Abstract
Abnormal responses to 13 questions from a typical mental status examination and 32 signs of neurological dysfunction were correlated with increasing degrees of cognitive impairment as measured by the Halstead-Reitan Neuropsychological Battery. Thirteen of these factors were found to be useful predictors of diffuse cerebral dysfunction when combined into a brief screening examination for application at the bedside.
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Messina C, Di Rosa AE, Tomasello F. Habituation of blink reflexes in parkinsonian patients under levodopa and amantadine treatment. J Neurol Sci 1972; 17:141-8. [PMID: 4340932 DOI: 10.1016/0022-510x(72)90136-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Penders CA, Delwaide PJ. Blink reflex studies in patients with Parkinsonism before and during therapy. J Neurol Neurosurg Psychiatry 1971; 34:674-8. [PMID: 5158781 PMCID: PMC1083500 DOI: 10.1136/jnnp.34.6.674] [Citation(s) in RCA: 78] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Electrophysiological analysis of the blink reflex makes it possible to quantitate the reflex changes observed in pathology. The authors therefore propose a `habituation index' to be determined by recording the electromyographic reflex response during stimulation at controlled frequencies. Several populations of subjects were tested. It was confirmed that marked differences in blink reflex habituation exist between normals and patients with Parkinson's disease. It was also found that when patients with Parkinsonism were treated with the classical anticholinergic drugs their habituation index remained virtually unchanged. However, treatment with either l-dopa or amantadine caused a rise in the index in almost all patients tested. On the basis of these findings it is suggested that these two new drugs have a highly similar mechanism of action.
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Hughes RC, Polgar JG, Weightman D, Walton JN. L-dopa in Parkinsonism and the influence of previous thalamotomy. BRITISH MEDICAL JOURNAL 1971; 1:7-13. [PMID: 4923653 PMCID: PMC1794736 DOI: 10.1136/bmj.1.5739.7] [Citation(s) in RCA: 44] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A double-blind cross-over trial over 24 weeks (10 weeks on the active remedy, 4 weeks off treatment, and 10 weeks on placebo) of the effect of L-dopa on idiopathic Parkinsonism (paralysis agitans) has shown no difference in the response obtained in patients who had undergone previous stereotaxic ventrolateral thalamotomy and in those who had not. Of the 34 patients (18 men and 16 women) in the trial 18 had been operated on (nine unilateral, nine bilateral operations) and 16 had not. All patients entering the trial were taking anticholinergic drugs in stable dosage and these were continued throughout. The only factor which seemed to limit the response to treatment was pre-existing hypertension. Of 31 patients who completed the 10-week treatment period, 12 showed marked improvement, 15 moderate improvement, and 4 and mild or negligible change. It seems that previous ventrolateral thalamotomy affords some protection against the development of L-dopa-induced involuntary limb movements on the side contralateral to the operation. As found by others, maximum benefit was seen in bradykinesia and rigidity and related features but a significant reduction in tremor was also noted during treatment. Side effects (nausea, hypotension, and involuntary movements) were common but rarely limited the therapeutic response.
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