Functional MRI of brain activation by eye blinking

Dry eye disease and blinking behaviors: A narrative review of methodologies for measuring blink dynamics and inducing blink response

Dry eye disease (DED) is a leading cause of ophthalmology clinical encounters with prevalence ranging from 8.7% to 64% in various populations. Blinking is an endogenous process to refresh the tear film, clear debris and maintain quality vision. Altered blinking behavior is a common feature of DED and is implicated in the pathology of the disease. However, lack of a comprehensive review on the relationship between altered blinking behavior and DED is notable in the literature. Blinking behavior may be an effect of DED due to an unstable tear film sensitizing a motor response or be its cause due to destabilization of the tear film in conditions such as benign essential blepharospasm. In this comprehensive review, we summarize the current models and theories of tear film dynamics and blinking behavior to better understand their connection to DED and introduce contemporary technologies and measurement tools used in the evaluation and induction of blinking behavior. We also describe future directions of research to better understand the relationship between DED and blinking and explore therapies that address the abnormal blinking component of DED.

Distinguishing intentional from nonintentional actions through eeg and kinematic markers

How can an intentional movement be distinguished from the same movement done nonintentionally? How can this distinction be drawn without asking the subject, or in patients who are unable to communicate? Here we address these questions, by focusing on blinking. This is one of the most frequent spontaneous actions in our daily life, but it can also be done intentionally. Furthermore, blinking is often spared in patients with severe brain injuries, and for some, it is the only way to report complex meanings. Using kinematic and EEG-based measures, we found that intentional and spontaneous blinking are preceded by different brain activities, even when they are indistinguishable. Unlike spontaneous ones, intentional blinks are characterized by a slow negative EEG drift, resembling the classic readiness potential. We investigated the theoretical implication of this finding in stochastic decision models as well as the practical significance of using brain-based signals to improve the discrimination between intentional and nonintentional actions. As proof of principle, we considered three brain-injured patients with rare neurological syndromes characterized by motor and communicative impairments. Although further research is needed, our results indicate that brain-based signals can offer a feasible way to infer intentionality even in absence of overt communication.

Cortico-basal ganglia networks dysfunction associated with disease severity in patients with idiopathic blepharospasm

Background

Structural changes occur in brain regions involved in cortico-basal ganglia networks in idiopathic blepharospasm (iBSP); whether these changes influence the function connectivity patterns of cortico-basal ganglia networks remains largely unknown. Therefore, we aimed to investigate the global integrative state and organization of functional connections of cortico-basal ganglia networks in patients with iBSP.

Methods

Resting-state functional magnetic resonance imaging data and clinical measurements were acquired from 62 patients with iBSP, 62 patients with hemifacial spasm (HFS), and 62 healthy controls (HCs). Topological parameters and functional connections of cortico-basal ganglia networks were evaluated and compared among the three groups. Correlation analyses were performed to explore the relationship between topological parameters and clinical measurements in patients with iBSP.

Results

We found significantly increased global efficiency and decreased shortest path length and clustering coefficient of cortico-basal ganglia networks in patients with iBSP compared with HCs, however, such differences were not observed between patients with HFS and HCs. Further correlation analyses revealed that these parameters were significantly correlated with the severity of iBSP. At the regional level, the functional connectivity between the left orbitofrontal area and left primary somatosensory cortex and between the right anterior part of pallidum and right anterior part of dorsal anterior cingulate cortex was significantly decreased in patients with iBSP and HFS compared with HCs.

Conclusion

Dysfunction of the cortico-basal ganglia networks occurs in patients with iBSP. The altered network metrics of cortico-basal ganglia networks might be served as quantitative markers for evaluation of the severity of iBSP.

Blinking characterization for each eye from EEG analysis using wavelets

Eye blinks can be used to perform monitoring tasks such as drowsiness detection, attention measurement or other biological measurement mainly using video data. With the developement of brain computer interfaces (BCI) eye movements and blinks could be used to perform control tasks such as pointer activation or communications. This work aims to prove that it is possible to characterize eye blinks for each eye separately using only electroencephalography (EEG) signal acquired through non invasive portable device and dry electroencephalography.

Gray Matter Structural and Functional Alterations in Idiopathic Blepharospasm: A Multimodal Meta-Analysis of VBM and Functional Neuroimaging Studies

Background

Neuroimaging studies have shown gray matter structural and functional alterations in patients with idiopathic blepharospasm (iBSP) but with variations. Here we aimed to investigate the specific and common neurostructural/functional abnormalities in patients with iBSP.

Methods

A systematic literature search from PubMed, Web of Science and Embase was conducted to identify relevant publications. We conducted separate meta-analysis for whole-brain voxel-based morphometry (VBM) studies and for functional imaging studies, and a multimodal meta-analysis across VBM and functional studies in iBSP, using anisotropic effect size-based signed differential mapping.

Results

The structural database comprised 129 patients with iBSP and 144 healthy controls whilst the functional database included 183 patients with iBSP and 253 healthy controls. The meta-analysis of VBM studies showed increased gray matter in bilateral precentral and postcentral gyri, right supplementary motor area and bilateral paracentral lobules, while decreased gray matter in right superior and inferior parietal gyri, left inferior parietal gyrus, left inferior temporal gyrus, left fusiform gyrus and parahippocampal gyrus. The meta-analysis of functional studies revealed hyperactivity in right dorsolateral superior frontal gyrus, left thalamus and right fusiform gyrus, while hypoactivity in left temporal pole, left insula, left precentral gyrus, bilateral precuneus and paracentral lobules, right supplementary motor area and middle frontal gyrus. The multimodal meta-analysis identified conjoint anatomic and functional changes in left precentral gyrus, bilateral supplementary motor areas and paracentral lobules, right inferior occipital gyrus and fusiform gyrus.

Conclusions

The patterns of conjoint and dissociated gray matter alterations identified in the meta-analysis may enhance our understanding of the pathophysiological mechanisms underlying iBSP.

The ultrafast snap of a finger is mediated by skin friction

The snap of a finger has been used as a form of communication and music for millennia across human cultures. However, a systematic analysis of the dynamics of this rapid motion has not yet been performed. Using high-speed imaging and force sensors, we analyse the dynamics of the finger snap. We discover that the finger snap achieves peak angular accelerations of 1.6 × 10⁶° s^-2 in 7 ms, making it one of the fastest recorded angular accelerations the human body produces (exceeding professional baseball pitches). Our analysis reveals the central role of skin friction in mediating the snap dynamics by acting as a latch to control the resulting high velocities and accelerations. We evaluate the role of this frictional latch experimentally, by covering the thumb and middle finger with different materials to produce different friction coefficients and varying compressibility. In doing so, we reveal that the compressible, frictional latch of the finger pads likely operates in a regime optimally tuned for both friction and compression. We also develop a soft, compressible friction-based latch-mediated spring actuated model to further elucidate the key role of friction and how it interacts with a compressible latch. Our mathematical model reveals that friction plays a dual role in the finger snap, both aiding in force loading and energy storage while hindering energy release. Our work reveals how friction between surfaces can be harnessed as a tunable latch system and provides design insight towards the frictional complexity in many robotic and ultra-fast energy-release structures.

Eye movement-related brain potentials during assisted navigation in real-world environments

Conducting neuroscience research in the real-world remains challenging because of movement- and environment-related artifacts as well as missing control over stimulus presentation. The present study overcame these restrictions by mobile electroencephalography (EEG) and data-driven analysis approaches during a real-world navigation task. During assisted navigation through an unfamiliar city environment, participants received either standard or landmark-based auditory navigation instructions. EEG data were recorded continuously during navigation. Saccade- and blink-events as well as gait-related EEG activity were extracted from sensor level data. Brain activity associated with the navigation task was identified by subsequent source-based cleaning of non-brain activity and unfolding of overlapping event-related potentials. When navigators received landmark-based instructions compared to those receiving standard navigation instructions, the blink-related brain potentials during navigation revealed higher amplitudes at fronto-central leads in a time window starting at 300 ms after blinks, which was accompanied by improved spatial knowledge acquisition tested in follow-up spatial tasks. Replicating improved spatial knowledge acquisition from previous experiments, the present study revealed eye movement-related brain potentials to point to the involvement of higher cognitive processes and increased processing of incoming information during periods of landmark-based instructions. The study revealed neuronal correlates underlying visuospatial information processing during assisted navigation in the real-world providing a new analysis approach for neuroscientific research in freely moving participants in uncontrollable real-world environments.

Differential neural processing of spontaneous blinking under visual and auditory sensory environments: An EEG investigation of blink-related oscillations

Blink-related oscillations (BROs) are a recently discovered neurophysiological response associated with spontaneous blinking, distinct from the well-known oculomotor and visual suppression effects. BROs strongly activate the bilateral precuneus along with other cortical regions involved in visuospatial processing and associative episodic memory, and are believed to represent environmental monitoring processes that occur following blink-induced visual interruptions. Although these responses have been reported across multiple imaging modalities under both resting and cognitive loading conditions, it is yet unknown whether these responses also exist under external sensory stimulation conditions. To address this, we investigated BRO responses in healthy adults using 64-channel electroencephalography (EEG), while participants underwent passive external auditory and visual stimulation. Our results showed that BRO responses are present under both auditory and visual stimulation conditions (p ​< ​0.05), with similar temporal and spectral features compared to rest. However, visual stimulation did result in decreased BRO amplitude compared to auditory and resting conditions (p ​< ​0.05), suggesting decreased neuronal resources for processing blink-related information in the visual but not auditory environment. There were also additional pre-blink spectral changes in the visual condition compared to rest (p ​< ​0.05), which suggest that passive visual stimulation induces neural preparatory processes occurring in anticipation of the upcoming blink event. Together, these findings provide new and compelling evidence that blink-related neural processes are modulated not only by the internal cognitive loading due to simultaneous task demands, but also by competing external sensory requirements. This highlights the link between blinking and cognition, and further demonstrates the importance of BROs as a new window into brain function.

Loss of Concentration May Occur by Blink Inhibition in DED Simulation Models

Purpose: Patients with dry eye disease (DED) often suffer productivity loss and distress due to bothersome symptoms. The aim of this study was to objectively quantify and compare productivity-related emotional states obtained from brain waveforms in natural and simulated DED conditions. Method: 25 healthy adults (6 females and 19 males; mean age ± standard deviation, 22.6 ± 8.3 years) were recruited for the study, which included an electroencephalogram (EEG), measurements of interblinking time, and questionnaires. DED was simulated by suppressing blinking, while spontaneous blinking served as a control. Elements of concentration, stress, and alertness were extracted from the raw EEG waveforms and the values were compared during spontaneous and suppressed blinking. The relation with DED-related parameters was then explored. Written informed consent was obtained from all participants. Results: All participants successfully completed the experimental protocol. Concentration significantly decreased during suppressed blinking in 20 participants (80%), when compared with spontaneous blinking, whereas there were no or small differences in stress or alertness between spontaneous and suppressed blinking. The change in concentration was correlated with interblinking time (β = −0.515, p = 0.011). Conclusion: Loss of concentration was successfully captured in an objective manner using the EEG. The present study may enable us to understand how concentration is affected during blink suppression, which may happen in office work, particularly during computer tasks. Further study using detailed ocular evaluation is warranted to explore the effect of different interventions.

Glucose hypometabolism in the visual cortex proportional to disease severity in patients with essential blepharospasm

Essential blepharospasm (EB) causes difficulty in eyelid opening because of involuntary movements of the orbicularis oculi muscle. Patients with EB have functional visual loss due to sustained eyelid closure. We examined cerebral glucose metabolism in 39 patients with EB (12 men and 27 women; mean age, 52.1 years) by using positron emission tomography with ¹⁸F-fluorodeoxyglucose. Forty-eight eye open healthy subjects and 48 eye close healthy subjects served as controls. We analyzed and compared the data between the patients and controls by using both statistical parametric mapping (SPM) and regions of interest (ROIs). We defined ROIs on both sides of the posterior striate cortex, anterior striate cortex, extrastriate cortex, and thalamus. In SPM analysis, glucose hypometabolism were observed in both sides of the extrastriate cortex compared to eye open controls but not to eye close controls. We also observed a significant negative correlation between the Jankovic Rating Scale (JRS) sum score and relative glucose metabolism level in the striate cortex of these patients. ROI analysis, a significant correlation was observed between the JRS sum score and glucose metabolism level in the posterior (right: r = −0.53, P = .0005; left: r = −0.65, P = .00001) and anterior (right: r = −0.33, P = .04; left: r = −0.37, P = .02) striate cortices of patients with EB. We surmise that the interruption of visual input cause glucose hypometabolism in the visual cortex of patients with EB.

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Glucose hypometabolism (GM) in the visual cortex in patients with blepharospasm was observed.

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GM level in the visual cortex of blepharospasm was same as that of eye close healthy subjects.

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Negative correlation was observed between severity and GM level in the striate cortex of patients.

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The results of this study reflect the visual symptoms of patients with blepharospasm.

Cognitive loading via mental arithmetic modulates effects of blink-related oscillations on precuneus and ventral attention network regions

Blink-related oscillations (BROs) have been linked with environmental monitoring processes associated with blinking, with cortical activations in the bilateral precuneus. Although BROs have been described under resting and passive fixation conditions, little is known about their characteristics under cognitive loading. To address this, we investigated BRO effects during both mental arithmetic (MA) and passive fixation (PF) tasks using magnetoencephalography (n =20), while maintaining the same sensory environment in both tasks. Our results confirmed the presence of BRO effects in both MA and PF tasks, with similar characteristics including blink-related increase in global field power and blink-related activation of the bilateral precuneus. In addition, cognitive loading due to MA also modulated BRO effects by decreasing BRO-induced cortical activations in key brain regions including the bilateral anterior precuneus. Interestingly, blinking during MA-but not PF-activated regions of the ventral attention network (i.e., right supramarginal gyrus and inferior frontal gyrus), suggesting possible recruitment of these areas for blink processing under cognitive loading conditions. Time-frequency analysis revealed a consistent pattern of BRO-related effects in the precuneus in both tasks, but with task-related functional segregation within the anterior and posterior subregions. Based on these findings, we postulate a potential neurocognitive mechanism for blink processing in the precuneus. This study is the first investigation of BRO effects under cognitive loading, and our results provide compelling new evidence for the important cognitive implications of blink-related processing in the human brain.

Objective Ocular Discomfort: Noninvasive Evaluation by Functional Near-Infrared Ray Spectroscopy

Purpose

Patients express their discomfort by subjective complaints, which may not clearly express the extent of their discomfort. This study noninvasively and objectively quantified ocular discomfort, a form of feeling, from the prefrontal cortex by functional near-infrared ray spectroscopy topography.

Methods

This case-controlled study enrolled six dry eye patients (male:female, 1:1; 51.8 ± 15.9 years) with ocular discomfort and six normal controls (male:female, 1:1; 48.8 ± 15.2 years). Ocular discomfort was created by Schirmer 1 test in normal controls. The extent of prefrontal cortex activity was evaluated as the number of signal-positive channels using the system by using an eye-opening task with spontaneous blinking in the dark. Changes in the signal-positive channels count by lubricant or anesthetics instillation were analyzed.

Results

Low prefrontal cortex activation was detected in normal controls without ocular discomfort, and high activation was detected in both normal controls and dry eye with ocular discomfort. Prefrontal cortex activity was confirmed with ocular discomfort when the eyes were open, decreased with lubricant, and almost disappeared with anesthetic for all participants.

Conclusions

These changes in the prefrontal cortex activity exhibited a significant correlation to subjective complaint scores, suggesting that such discomfort may be objectively quantifiable, independent of subjective expressions.

Spontaneous Blinks Activate the Precuneus: Characterizing Blink-Related Oscillations Using Magnetoencephalography

Spontaneous blinking occurs 15–20 times per minute. Although blinking has often been associated with its physiological role of corneal lubrication, there is now increasing behavioral evidence suggesting that blinks are also modulated by cognitive processes such as attention and information processing. Recent low-density electroencephalography (EEG) studies have reported so-called blink-related oscillations (BROs) associated with spontaneous blinking at rest. Delta-band (0.5–4 Hz) BROs are thought to originate from the precuneus region involved in environmental monitoring and awareness, with potential clinical utility in evaluation of disorders of consciousness. However, the neural mechanisms of BROs have not been elucidated. Using magnetoencephalography (MEG), we characterized delta-band BROs in 36 healthy individuals while controlling for background brain activity. Results showed that, compared to pre-blink baseline, delta-band BROs resulted in increased global field power (p < 0.001) and time-frequency spectral power (p < 0.05) at the sensor level, peaking at ~250 ms post-blink maximum. Source localization showed that spontaneous blinks activated the bilateral precuneus (p < 0.05 FWE), and source activity within the precuneus was also consistent with sensor-space results. Crucially, these effects were only observed in the blink condition and were absent in the control condition, demonstrating that results were due to spontaneous blinks rather than as part of the inherent brain activity. The current study represents the first MEG examination of BROs. Our findings suggest that spontaneous blinks activate the precuneus regions consistent with environmental monitoring and awareness, and provide important neuroimaging support for the cognitive role of spontaneous blinks.

Improvement of Orbitofrontal Cortex Function Associated with Blephrospasm Symptom Remission

OBJECTIVE

To determine whether orbitofrontal cortex (OFC) function improves with blepharospasm (BSP) symptom remission using a verbal fluency task and near-infrared spectroscopy (NIRS).

METHODS

Nineteen BSP patients and 9 healthy controls (HCs) matched by gender and education were examined using NIRS. The BSP patients were divided into 2 groups based on the onset or remission of BSP symptoms. A covariance analysis was conducted to analyze the differences among the 3 groups to avoid the influence of different ages. The least significant difference was used to process the post hoc test.

RESULTS

The hemoglobin concentration and cerebral blood flow of the bilateral orbitofrontal area (channels 27, 31, 34, 37, and 39) were not significantly different between the BSP remission and HC groups (p > 0.05); however, both groups were significantly increased compared with the BSP onset group (BSP remission group vs. BSP onset group: p = 0.003, p = 0.018, p = 0.013, p = 0.001, and p = 0.011, respectively; BSP remission group vs. BSP onset group: p = 0.037, p = 0.044, p = 0.023, p = 0.016, and p = 0.025, respectively).

CONCLUSION

This is the first investigation to control for symptom stages in BSP patients examined via NIRS. Cognitive ability and OFC function improve with BSP symptom remission. Thus, the OFC may be inter-connected with motor and cognitive symptoms in BSP.

Looking for Creativity: Where Do We Look When We Look for New Ideas?

Recent work using the eye movement monitoring technique has demonstrated that when people are engaged in thought they tend to disengage from the external world by blinking or fixating on an empty portion of the visual field, such as a blank wall, or out the window at the sky. This 'looking at nothing' behavior has been observed during thinking that does not explicitly involve visual imagery (mind wandering, insight in problem solving, memory encoding and search) and it is associated with reduced analysis of the external visual environment. Thus, it appears to indicate (and likely facilitate) a shift of attention from external to internal stimuli that benefits creativity and problem solving by reducing the cognitive load and enhancing attention to internally evolving activation. We briefly mention some possible reasons to collect eye movement data in future studies of creativity.

Altered regional spontaneous neuronal activity in blepharospasm: a resting state fMRI study

The resting state amplitude of low-frequency fluctuations (ALFF) in functional magnetic resonance imaging (fMRI) is believed to reflect spontaneous cerebral neural activity. The pathophysiology of blepharospasm (BSP), which is characterized by motor symptoms and also sensory symptoms, remains unclear. The present study aims to localize possible cerebral functional abnormalities in BSP patients using resting state fMRI, and explore their possible associations with clinical variables. Voxel-based analysis was used to characterize the difference of ALFF between eighteen BSP patients and eighteen matched healthy controls. Separate correlation analyses were conducted to explore the possible association between ALFF values of significantly different areas and clinical measures including onset age, disease duration, symptom severity evaluated by Jankovic rating scale (JRS), and presence of geste antagoniste. The whole-brain analysis indicated that the BSP group had significantly decreased ALFF in the left thalamus while increased ALFF in the left orbitofrontal areas extending from middle frontal gyrus to inferior frontal gyrus. The mean ALFF in the left thalamus was negatively correlated with the subscore of JRS-frequency (r = -0.484, p = 0.042) and JRS total score (r = -0.477, p = 0.045). A borderline positive correlation was detected between the mean ALFF in the left orbitofrontal area and disease duration(r = 0.485, p = 0.049). Our findings suggest sensorimotor integration is abnormal in BSP, and dysfunctional activity of thalamus may be used to measuring symptom severity in BSP patients.

Anatomical correlates of blepharospasm

Background

Focal dystonia is a neurological disorder characterized by unwanted muscle spasms. Blepharospasm is a focal dystonia producing an involuntary closure of the eyelid. Its etiology is unknown.

Objective

To investigate if there are structural changes in the white and grey matter of blepharospasm patients, and if the changes are related to disease features.

Methods

T1 and diffusion-weighted magnetic resonance imaging scans were collected from 14 female blepharospasm patients and 14 healthy matched controls. Grey matter volumes, fractional anisotropy (FA), and mean diffusivity maps were compared between the groups. Based on grey matter differences within the facial portion of the primary motor cortex, the corticobulbar tract was traced and compared between groups.

Results

Changes in grey matter in patients included the facial portion of the sensorimotor area and anterior cingulate gyrus. These changes did not correlate with disease duration. Corticobulbar tract volume and peak tract connectivity were decreased in patients compared with controls. There were no significant differences in FA or mean diffusivity between groups.

Conclusions

Grey matter changes within the primary sensorimotor and the anterior cingulate cortices in blepharospasm patients may help explain involuntary eyelid closure and the abnormal sensations often reported in this condition.

Neural correlates of blink suppression and the buildup of a natural bodily urge

Neuroimaging studies have elucidated some of the underlying physiology of spontaneous and voluntary eye blinking; however, the neural networks involved in eye blink suppression remain poorly understood. Here we investigated blink suppression by analyzing fMRI data in a block design and event-related manner, and employed a novel hypothetical time-varying neural response model to detect brain activations associated with the buildup of urge. Blinks were found to activate visual cortices while our block design analysis revealed activations limited to the middle occipital gyri and deactivations in medial occipital, posterior cingulate and precuneus areas. Our model for urge, however, revealed a widespread network of activations including right greater than left insular cortex, right ventrolateral prefrontal cortex, middle cingulate cortex, and bilateral temporo-parietal cortices, primary and secondary face motor regions, and visual cortices. Subsequent inspection of BOLD time-series in an extensive ROI analysis showed that activity in the bilateral insular cortex, right ventrolateral prefrontal cortex, and bilateral STG and MTG showed strong correlations with our hypothetical model for urge suggesting these areas play a prominent role in the buildup of urge. The involvement of the insular cortex in particular, along with its function in interoceptive processing, helps support a key role for this structure in the buildup of urge during blink suppression. The right ventrolateral prefrontal cortex findings in conjunction with its known involvement in inhibitory control suggest a role for this structure in maintaining volitional suppression of an increasing sense of urge. The consistency of our urge model findings with prior studies investigating the suppression of blinking and other bodily urges, thoughts, and behaviors suggests that a similar investigative approach may have utility in fMRI studies of disorders associated with abnormal urge suppression such as Tourette syndrome and obsessive-compulsive disorder.

In the blink of an eye: neural responses elicited to viewing the eye blinks of another individual

Facial movements have the potential to be powerful social signals. Previous studies have shown that eye gaze changes and simple mouth movements can elicit robust neural responses, which can be altered as a function of potential social significance. Eye blinks are frequent events and are usually not deliberately communicative, yet blink rate is known to influence social perception. Here, we studied event-related potentials (ERPs) elicited to observing non-task relevant blinks, eye closure, and eye gaze changes in a centrally presented natural face stimulus. Our first hypothesis (H1) that blinks would produce robust ERPs (N170 and later ERP components) was validated, suggesting that the brain may register and process all types of eye movement for potential social relevance. We also predicted an amplitude gradient for ERPs as a function of gaze change, relative to eye closure and then blinks (H2). H2 was only partly validated: large temporo-occipital N170s to all eye change conditions were observed and did not significantly differ between blinks and other conditions. However, blinks elicited late ERPs that, although robust, were significantly smaller relative to gaze conditions. Our data indicate that small and task-irrelevant facial movements such as blinks are measurably registered by the observer's brain. This finding is suggestive of the potential social significance of blinks which, in turn, has implications for the study of social cognition and use of real-life social scenarios.

PVT lapses differ according to eyes open, closed, or looking away

STUDY OBJECTIVES

A lapse during the psychomotor vigilance task (PVT) is usually defined as a response longer than 500 ms; however, it is currently unknown what psychobiological phenomena occur during a lapse. An assessment of what a participant is doing during a lapse may depict varying levels of "disengagement" during these events and provide more insight into the measurement of both a lapse and sleepiness.

DESIGN

Repeated measures.

SETTING

Participants underwent extended 30-min PVT sessions twice, at 22:00 and 04:00, under: (i) typical non-distractive laboratory conditions, and (ii) an additional distractive condition.

PARTICIPANTS

Twenty-four healthy young adults (mean age: 23.2 y +/- 2 y; range 21-25 y [12 m; 12 f]) without any sleep or medical problems and without any prior indication of daytime sleepiness.

INTERVENTIONS

One night of sleep loss. Distraction comprised a TV located at 90 degrees in the visual periphery showing a popular TV program. For the non-distraction condition, the TV was turned off.

MEASUREMENTS & RESULTS

Video data (bird's-eye and frontal view) were used to classify each lapse (> or = 500 ms) as occurring with eyes open (EO), eyes closed (EC), or due to a head turn (HT). EO lapses were more prevalent, with all lapses (EO, EC, and HT) increasing with sleepiness. There was a significant effect of distraction for HT lapses which was exacerbated when sleepy. For lapse duration there was little effect of sleepiness for EO lapses but a significant effect for EC and HT. The 95% confidence intervals for lapse duration and associated behavior showed those lapses greater than 2669 ms were 95% likely to be EC, whereas those 500-549 ms were 95% likely to be EO. Response times of 1217 ms had a 50:50 probability of being EO:EC.

CONCLUSIONS

Discriminating the varying causes of lapses whether due to visual inattention (eyes open), microsleep (eyes closed), or distraction (head turn) may provide further insight into levels of disengagement from the PVT and further insight into developing sleepiness.

An FMRI study of frontostriatal circuits during the inhibition of eye blinking in persons with Tourette syndrome

OBJECTIVE

The authors sought to study activity in neural circuits that subserve the inhibition of a semi-involuntary motor behavior, eye blinking, in children and adults with Tourette syndrome and in healthy comparison subjects.

METHOD

Functional magnetic resonance imaging was used to scan 120 participants (51 with Tourette syndrome and 69 comparison subjects) as they either blinked normally or successfully inhibited eye blinking. The authors compared the blood-oxygen-level dependent signal during these two conditions across the Tourette and comparison groups.

RESULTS

Relative to comparison subjects, patients with Tourette syndrome activated more strongly the frontal cortex and striatum during eye blink inhibition. Activation increased more with age in the dorsolateral and inferolateral prefrontal cortex and caudate nucleus in the Tourette group relative to comparison subjects. In addition, the Tourette group more strongly activated the middle frontal gyrus, dorsal anterior cingulate, and temporal cortices. The severity of tic symptoms in the Tourette group correlated inversely with activation in the putamen and inferolateral prefrontal cortex.

CONCLUSIONS

Frontostriatal activity is increased in persons with Tourette syndrome during the inhibition of eye blinks. Activation of frontostriatal circuits in this population may help to maintain regulatory control over semi-involuntary behaviors, whether these are tics or eye blinks.

Spontaneous eye blinks are entrained by finger tapping

We studied the mutual cross-talk between spontaneous eye blinks and continuous, self-paced unimanual and bimanual tapping. Both types of motor activities were analyzed with regard to their time-structure in synchronization-continuation tapping tasks which involved different task instructions, namely "standard" finger tapping (Experiment 1), "strong" tapping (Experiment 2) requiring more forceful finger movements, and "impulse-like" tapping (Experiment 3) where upward-downward finger movements had to be very fast. In a further control condition (Experiment 4), tapping was omitted altogether. The results revealed a prominent entrainment of spontaneous blink behavior by the manual tapping, with bimanual tapping being more effective than unimanual tapping, and with the "strong" and "impulse-like" tapping showing the largest effects on blink timing. Conversely, we found no significant effects of the tapping on the timing of the eye blinks across all experiments. The findings suggest a functional overlap of the motor control structures responsible for voluntary, rhythmic finger movements and eye blinking behavior.

Signal quality of simultaneously recorded invasive and non-invasive EEG

Both invasive and non-invasive electroencephalographic (EEG) recordings from the human brain have an increasingly important role in neuroscience research and are candidate modalities for medical brain-machine interfacing. It is often assumed that the major artifacts that compromise non-invasive EEG, such as caused by blinks and eye movement, are absent in invasive EEG recordings. Quantitative investigations on the signal quality of simultaneously recorded invasive and non-invasive EEG in terms of artifact contamination are, however, lacking. Here we compared blink related artifacts in non-invasive and invasive EEG, simultaneously recorded from prefrontal and motor cortical regions using an approach suitable for detection of small artifact contamination. As expected, we find blinks to cause pronounced artifacts in non-invasive EEG both above prefrontal and motor cortical regions. Unexpectedly, significant blink related artifacts were also found in the invasive recordings, in particular in the prefrontal region. Computing a ratio of artifact amplitude to the amplitude of ongoing brain activity, we find that the signal quality of invasive EEG is 20 to above 100 times better than that of simultaneously obtained non-invasive EEG. Thus, while our findings indicate that ocular artifacts do exist in invasive recordings, they also highlight the much better signal quality of invasive compared to non-invasive EEG data. Our findings suggest that blinks should be taken into account in the experimental design of ECoG studies, particularly when event related potentials in fronto-anterior brain regions are analyzed. Moreover, our results encourage the application of techniques for reducing ocular artifacts to further optimize the signal quality of invasive EEG.

Involvement of insula and cingulate cortices in control and suppression of natural urges

The physiology of control and suppression of natural urges is not well understood. We used [(15)O]H(2)O positron-emission tomography imaging to identify neural circuits involved in suppression of spontaneous blinking as a model of normal urges. Suppression of blinking was associated with prominent activation of bilateral insular-claustrum regions, right more than left; activation was also found in bilateral anterior cingulate cortex (ACC), supplementary motor areas, and the face area of the primary motor cortex bilaterally. These results suggest a central role for the insula possibly together with ACC in suppression of blinking.

Spontaneous Eye Blink Rates vary according to individual differences in generalized control perception

This study tested the hypothesis that individual differences in generalized control perception for 43 undergraduate adults may be reflected in Spontaneous Eye Blink Rates during conversation in an interview. Control perception was assessed by means of Rotter's internal-external Locus of Control questionnaires, while Spontaneous Eye Blink Rates were computed from filmed videos of interviews consisting of a series of questions which could presumably have triggered different mental states. Pearson correlations and linear regression analyses indicated that the individual differences in Spontaneous Eye Blink Rates did not differ significantly across different questions, but that Spontaneous Eye Blink Rates measured over the entire interview correlated positively and significantly with an internal Locus of Control (r = .26). This could be interpreted as modest but corroborative evidence that a personality trait reflecting control perception may have a biological component. The possible roles of dopamine neurotransmission and frontal cortex involvement in higher cognition and Locus of Control are discussed.

Spontaneous blinking behaviour in persistent vegetative and minimally conscious states: Relationships with evolution and outcome

There is evidence that spontaneous blinking correlates with cognitive functions. This arises from the observation that blinking rate (BR) is modulated by arousal levels, basic cognitive processes (e.g., attention, information processing, memory, etc.) and more complex cognitive functions (e.g., reading, speaking, etc.). The aim of this work was to test the role of BR evaluation in the assessment of cognitive network functioning in awake patients with consciousness deficits. Thirteen patients were recruited for the study, and were assessed by the Glasgow coma scale (GCS) and Glasgow outcome scale (GOS) on admittance and discharge, respectively. A level of cognitive functioning scale (LCFS) score was assigned at every change in awareness or at least every 2 weeks. At the same time as the clinical tests, the BR was observed for a 5-min period. Ten healthy subjects, observed throughout three non-consecutive days, formed the control group. The BR underwent a different temporal behaviour in the two diagnostic categories. In the persistent vegetative state (PVS) group it remained stable throughout time and linked with the clinical conditions of the patients; whereas in the non-persistent vegetative state (NPVS) group it decreased over time as the cognitive conditions improved. Moreover, a strong inverse correlation was found between overall BR values and LCFS scores. We have concluded that the blinking behaviour changes manifested in PVS and NPVS patients reflect different evolution phases of a cholinergic-dopaminergic imbalance, and that a reduced BR characterizes the early stages of consciousness recovery.

Visual deprivation effects on human motor cortex excitability

Single and paired-pulse transcranial magnetic stimulation (TMS) were applied to the motor cortex of 12 healthy volunteers, who were instructed to relax under eyes-open and eyes-closed conditions with room lights on and after 30 min of blindfolding. Compared to the eyes-open condition, significantly larger motor-evoked potentials and less intracortical inhibition were observed during blindfolding. Visual deafferentation changes resting human motor cortex excitability and might be a novel way to promote brain plasticity. These results raise the issue of how widespread the effects of temporary deafferentation may be and whether they are mediated by discrete or diffuse systems. These findings also illustrate an important potential confound in TMS studies of the motor cortex.

Blinking suppresses the neural response to unchanging retinal stimulation

Blinks profoundly interrupt visual input but are rarely noticed, perhaps because of blink suppression, a visual-sensitivity loss that begins immediately prior to blink onset. Blink suppression is thought to result from an extra-retinal signal that is associated with the blink motor command and may act to attenuate the sensory consequences of the motor action. However, the neural mechanisms underlying this phenomenon remain unclear. They are challenging to study because any brain-activity changes resulting from an extra-retinal signal associated with the blink motor command are potentially masked by profound neural-activity changes caused by the retinal-illumination reduction that results from occlusion of the pupil by the eyelid. Here, we distinguished direct top-down effects of blink-associated motor signals on cortical activity from purely mechanical or optical effects of blinking on visual input by combining pupil-independent retinal stimulation with functional MRI (fMRI) in humans. Even though retinal illumination was kept constant during blinks, we found that blinking nevertheless suppressed activity in visual cortex and in areas of parietal and prefrontal cortex previously associated with awareness of environmental change. Our findings demonstrate active top-down modulation of visual processing during blinking, suggesting a possible mechanism by which blinks go unnoticed.

Two distinct neural effects of blinking on human visual processing

Humans blink every few seconds, yet the changes in retinal illumination during a blink are rarely noticed, perhaps because visual sensitivity is suppressed. Furthermore, despite the loss of visual input, visual experience remains continuous across blinks. The neural mechanisms in humans underlying these two phenomena of blink suppression and visual continuity are unknown. We investigated the neural basis of these two complementary behavioural effects using functional magnetic resonance imaging to measure how voluntary blinking affected cortical responses to visual stimulation. Two factors were independently manipulated in a blocked design; the presence/absence of voluntary blinking, and the presence/absence of visual stimulation. To control for the simple loss of visual input caused by eyelid closure, we created a fifth condition where external darkenings were dynamically matched to each subjects' own blinks. Areas of lateral occipital cortex, including area V5/MT, showed suppression of responses to visual stimulation during blinking, consistent with the known loss in visual sensitivity. In contrast, a medial parieto-occipital region, homologous to macaque area V6A, showed responses to blinks that increased when visual stimulation was present. Our data are consistent with a role for this region in the active maintenance of visual continuity across blinks. Moreover, both suppression in lateral occipital and activation in medial parieto-occipital cortex were greater during blinks than during matched external darkenings of the visual scene, suggesting that they result from an extra-retinal signal associated with the blink motor command. Our findings therefore suggest two distinct neural correlates of blinking on human visual processing.

Representation of facial muscles in human motor cortex

Whether there is a projection from the primary motor cortex (M1) to upper facial muscles and how the facial M1 area is modulated by intracortical inhibitory and facilitatory circuits remains controversial. To assess these issues, we applied transcranial magnetic stimulation (TMS) to the M1 and recorded from resting and active contralateral (C-OOc) and ipsilateral orbicularis oculi (I-OOc), and contralateral (C-Tr) and ipsilateral triangularis (I-Tr) muscles in 12 volunteers. In five subjects, the effects of stimulating at different scalp positions were assessed. Paired TMS at interstimulus intervals (ISIs) of 2 ms were used to elicit short interval intracortical inhibition (SICI) and ISI of 10 ms for intracortical facilitation (ICF). Long interval intracortical inhibition (LICI) was evaluated at ISIs between 50 and 200 ms, both at rest and during muscle activation. The silent period (SP) was also determined. C-OOc and I-OOc responses were recorded in all subjects. The optimal position for eliciting C-OOc responses was lateral to the hand representation in all subjects and MEP amplitude markedly diminished when the coil was placed 2 cm away from the optimal position. For the I-OOc, responses were present in more scalp sites and the latency decreased with more anterior placement of the coil. C-Tr response was recorded in 10 out of 12 subjects and the I-Tr muscle showed either no response or low amplitude response, probably due to volume conduction. SICI and ICF were present in the C-OOc and C-Tr, but not in the I-OOc muscle. Muscle activation attenuated SICI and ICF. LICI at rest showed facilitation at 50 ms ISI in all muscles, but there was no significant inhibition at other ISIs. There was no significant inhibition or facilitation with the LICI protocol during muscle contraction. The SP was present in the C-OOc, C-Tr and I-OOc muscles and the mean durations ranged from 92 to 104 ms. These findings suggest that the I-OOc muscle response is probably related to the first component (R1) of the blink reflex. There is M1 projection to the contralateral upper and lower facial muscles in humans and the facial M1 area is susceptible to cortical inhibition and facilitation, similar to limb muscles.

Why your "head is in the clouds" during thinking: the relationship between cognition and upper space

Higher-order cognition in humans has not generally been viewed as closely entwined with the brain mechanisms mediating more basic perceptual-motor interactions in 3-D space. However, recent findings suggest that perceptual and oculomotor mechanisms that are biased toward the upper field (which disproportionately represents radially distant space) are activated during complex mental operations, ranging from semantic processing to mental arithmetic and memory search. The particularly close affinity with upward conjugate eye deviations--further confirmed in a study of 24 schoolchildren who responded to various mental questions and demands--suggests that active, abstract thinking in humans may have expropriated the focal-extrapersonal brain systems involved in saccadic exploration of the distant environment in other primates.

Endogenous eye blinks in preadolescents: relationship to information processing and performance

Endogenous blinks--those occurring without apparent provocation--are regulated in adults with respect to the presentation, cognitive loading, and response demands of stimuli. This investigation determined the extent to which similar regulatory and response-related relationships were evident in preadolescents during a visual continuous performance task (CPT). As in adults, increased blink incidence on task, longer blink deferral following stimuli with greater cognitive loading, and blink-facilitated motor responses to imperative stimuli were observed. Reaction times significantly decreased when the button press (BP) occurred near (+/- 200 ms) blink onset and increased across the task period on blink-free but not blink-associated trials. More blinks occurred before motor responses in females, and a reaction time (RT) advantage for males on blink-free trials was maintained across blink-associated conditions. From these results, an interpretation is developed arguing that endogenous blinks are a meaningful and integral component of sensory-motor processing, indexing times of facilitated attentional and motor response capability.

Positron emission tomography scanning in essential blepharospasm

PURPOSE

To localize in the brain using positron emission tomography neuroimaging with (18)fluorodeoxyglucose [PET ((18)FDG)] differences in glucose metabolism between patients with essential blepharospasm (EB) and controls.

DESIGN

Prospective case-control study.

METHODS

Positron emission tomography neuroimaging with (18)fluorodeoxyglucose was performed in 11 patients with EB and 11 controls matched for age and gender. Global analysis of images was used to localize differences in glucose metabolism between groups.

RESULTS

Multiple cortical and subcortical abnormalities were observed in EB patients in comparison with controls. Cortical areas with the largest and most significant clusters of increased glucose uptake were the inferior frontal gyri, right posterior cingulate gyrus, left middle occipital gyrus, fusiform gyrus of the right temporal lobe, and left anterior cingulate gyrus. Cortical areas with the largest and most significant clusters of decreased glucose uptake were the inferior frontal gyri, ventral to the area of increased glucose metabolism. Subcortical abnormalities, consisting of increased glucose uptake, involved the right caudate and consisting of decreased glucose uptake, involved the left inferior cerebellar hemisphere and thalamus.

CONCLUSIONS

Global analysis of positron emission tomography neuroimaging with (18)fluorodeoxyglucose neuroimaging in EB patients in comparison with controls demonstrates a pattern of abnormalities involving several cortical and subcortical areas that control blinking, including the inferior frontal lobe, caudate, thalamus, and cerebellum.

Functional MRI of brain activation evoked by intentional eye blinking

Eye blinking is not only a reflexive action to protect the ocular surface from injury and desiccation; it can also be done intentionally. However, only a few studies have investigated the brain mechanism controlling intentional blinking, and there are still inconsistencies among the reported activation patterns in the human brain evoked by intentional blinking. In monkeys, some areas where blinking is evoked by electrical microstimulation have been found in the premotor areas and in the posterior parietal cortex. But there have been no reports about neuronal activity related to blinking in the cerebral cortex. In the present study, the brain activation evoked by intentional blinking was examined in humans by using fMRI, and the activations were found in the middle precentral gyrus, but not in the posterior parietal cortex, suggesting that the premotor areas, rather than the posterior parietal cortex, are important for controlling intentional blinking.

A functional magnetic resonance imaging study in patients with benign essential blepharospasm

OBJECTIVE To identify blinking-induced functional magnetic resonance imaging (fMRI) activation patterns in five benign essential blepharospasm (BEB) patients and five age-matched control subjects. METHODS fMRI brain activation maps were obtained during repeated conditions of spontaneous and voluntary blinking in BEB and control groups. Blood oxygen level-dependent intensity images were collected from two separate runs as 16 axial and 16 coronal, 8 mm thick slices using a T2-star weighted gradient echo EPI sequence, coregistered with anatomic images. Spatially normalized and isotropically blurred activation maps for each subject were combined within groups of BEB patients and control subjects to generate maps of the intersubject mean fractional signal change.RESULTS Substantially greater activation during spontaneous and voluntary blinking was seen in BEB patients compared with control subjects in the anterior visual cortex, anterior cingulate cortex, primary motor cortex, central region of the thalamus, and superior cerebellum. In both groups, activations were generally greater for voluntary than for spontaneous blinking. CONCLUSIONS The activations observed might represent a hyperactive cortical circuit linking visual cortex, limbic system, supplementary motor cortex, cerebellum, and supranuclear motor pathways innervating the periorbital muscles.

Functional magnetic resonance imaging for the evaluation of the motor system: primary and secondary brain areas in different motor tasks

Functional magnetic resonance imaging was used to characterize the primary and secondary motor system in subjects performing different motor tasks. Nine right-handed subjects performed simple motor tasks using hand, foot, knee, tongue, lips, eyes and the diaphragm-pelvis. All tasks revealed significant activation in primary and secondary motor areas. In the average across subjects, only the activity in the precentral gyrus was statistically distinctive for each motor task and followed the distribution of the motor homunculus. We consider these results as a possible basis of presurgical planning, extending the currently used procedures over a broader spectrum of motor tasks and brain structures leading to a more precise evaluation of functional areas for intracerebral interventions.

Functional magnetic resonance imaging and its clinical utility in patients with visual disturbances

Functional magnetic resonance imaging (fMRI) is a powerful, non-invasive technique for mapping human brain function. Because of the robust signal intensity changes associated with visual stimuli, fMRI is particularly useful for studying visual cortex (including both striate and extrastriate cortex). Also, activation of the lateral geniculate nuclei has been successfully demonstrated by fMRI. Therefore, fMRI may be potentially useful in patients with visual deficits by providing a non-invasive method for assessing the afferent visual pathways and higher cortical areas. Although there have been several reviews on fMRI, few have highlighted its clinical applicability in patients with visual disturbances. Our article will review fMRI principles and methodology, then focus on the possible applications and limitations of this technique in clinical ophthalmology.

Right lateralized motor cortex activation during volitional blinking

Using H2 15O positron emission tomography in 6 healthy volunteers, we found that self-initiated and externally cued blinking activated the right primary motor cortex and supplementary motor area (SMA). The left dorsolateral prefrontal cortex (DLPFC) and the rostral SMA showed greater activation during the self-initiated task compared to the externally cued task. This study confirms the hypothesis of right hemispheric lateralization of volitional blinking derived from observations in stroke patients. Furthermore, it underscores the role of DLPFC and rostral SMA in self-initiated movements, which has been found in similar experiments with hand movements.