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Effect of Occipital Nerve Stimulation (ONS) on the Orbicularis Oculi Reflex Triggered by a Standardized Air Flow in Patients with Chronic Migraine-A Prospective, Randomized, Interventional Study. Pain Ther 2021; 10:567-576. [PMID: 33630252 PMCID: PMC8119542 DOI: 10.1007/s40122-021-00242-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Occipital nerve stimulation (ONS) is a specific form of peripheral neuromodulation used in the treatment of chronic pain disorders. A particular field of application is in the therapy of treatment-refractory headaches, especially of chronic migraine. The precise mode of action is unknown. It is presumed that central and peripheral sensitization are reduced in patients with chronic headache. The aim of this study was to examine the effect of ONS on pain-modulatory mechanisms in the trigeminocervical area in patients with chronic migraine. Methods In a balanced repeated measurements design in eight patients with chronic migraine with and without active ONS, we analyzed which effects ONS had on the orbicularis oculi reflex dynamically elicited by corneal air flow. Results The orbicularis oculi reflex in active ONS (7.38 ± 20.14 eyelid closures/minute) compared to inactive ONS (18.73 ± 14.30 eyelid closures/minute) is significantly reduced (p = 0.021). Conclusions The results show that under active ONS compared to inactive ONS in patients with chronic migraine, the orbicularis oculi reflex, dynamically triggered by a standardized air flow, is significantly reduced. This suggests that ONS is able to directly counteract the trigeminally mediated central sensitization in chronic migraine and protectively reduce the effects of aversive peripheral stimulation.
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Ferreira A, Vide S, Felgueiras J, Cardoso M, Nunes C, Mendes J, Amorim P. Electromyographic assessment of blink reflex throughout the transition from responsiveness to unresponsiveness during induction with propofol and remifentanil. J Clin Monit Comput 2020; 35:1279-1289. [PMID: 33001401 DOI: 10.1007/s10877-020-00593-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
Abstract
General anesthesia is a reversible drug-induced state of altered arousal characterized by loss of responsiveness due to brainstem inactivation. Precise identification of the moment in which responsiveness is lost during the induction of general anesthesia is extremely important to provide information regarding an individual's anesthetic requirements and help intraoperative drug titration. To characterize the transition from responsiveness to unresponsiveness more objectively, we studied neurophysiologic-derived parameters of electromyographic records of electrically evoked blink reflex as a means of identifying the precise moment of loss of responsiveness. Twenty-five patients received a slow infusion of propofol until loss of corneal reflex while successive blink reflexes were elicited and recorded every 6 s. The level of anesthesia was assessed using an adapted version of the Richmond Agitation-Sedation Scale. Different variables of the blink reflex components were calculated and compared to the adapted version of the Richmond Agitation-Sedation score and the estimated effect-site propofol concentration. Baselines of the blink reflex responses were similar to those in literature. After propofol infusion started, the most susceptible component of the blink reflex to propofol was R2 (EC50 = 1.358 (95% CI 1.321, 1.396) µg/mL) and the most resistant was R1 (EC50 = 3.025 (95% CI 2.960, 3.090) µg/mL). Most of the patients (24 out of 25) lost the R1 component when they were still responsive to shaking and shouting and corneal reflex could be elicited clinically (time = 102.48 ± 33.00 s). Habituation was present in R2 but not in R1. The R1 component of the blink reflex was found to have a strong correlation with the adapted version of the Richmond Agitation-Sedation Scale, with amplitude correlating better than areas (ρ = - 0.721 (0.123) versus ρ = - 0.688 (0.165)). We found a strong correlation between the R1 component with the estimated propofol effect-site concentration, with amplitude correlating better than areas (ρ = - 0.838 (0.113) versus ρ = - 0.823 (0.153)) and between the clinical scale and the propofol concentration (ρ = 0.856 (0.060)). The area and amplitude of the R1 component showed to be indicators of predicting different levels of anesthesia (Pk = 0.672 (0.183) versus Pk = 0.709 (0.134)) and these are connected to the propofol concentrations (Pk = 0.593 (0.10)). Our results suggest that electrically evoked blink reflex could be used during the induction of anesthesia as a surrogate of the Richmond Agitation-Sedation Scale to provide an objective endpoint as far as a - 4. At this point, at the moment of loss of R1, the propofol infusion may be stopped, as overshooting increases slightly the effect-site concentration afterward and eventually reaching loss of responsiveness. If the desired target is not achieved, the infusion can then be resumed.
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Affiliation(s)
- Ana Ferreira
- LAETA/INEGI, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal. .,Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar do Porto, Porto, Portugal.
| | - Sérgio Vide
- Departamento de Anestesia, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Senhora da Hora, Portugal
| | - João Felgueiras
- Serviço de Neurofisiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Márcio Cardoso
- Serviço de Neurofisiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Catarina Nunes
- Departamento de Ciências e Tecnologia, Universidade Aberta, Delegação do Porto, Porto, Portugal
| | - Joaquim Mendes
- LAETA/INEGI, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Pedro Amorim
- Departamento de Anestesia, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Senhora da Hora, Portugal
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Trigeminal nociceptive function and oral somatosensory functional and structural assessment in patients with diabetic peripheral neuropathy. Sci Rep 2019; 9:169. [PMID: 30655584 PMCID: PMC6336810 DOI: 10.1038/s41598-018-37041-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/28/2018] [Indexed: 02/04/2023] Open
Abstract
This case-control study primarily compared the trigeminal nociceptive function, the intraoral somatosensory profile and possible structural nerve changes between diabetic peripheral neuropathy (DPN, n = 12) patients and healthy participants (n = 12). The nociceptive blink reflex (nBR) was recorded applying an electrical stimulation over the entry zone of the right supraorbital (V1R), infraorbital (V2R) and mental (V3R) and left infraorbital (V2L) nerves. The outcomes were: individual electrical sensory (I0) and pain thresholds (IP); root mean square (RMS), area-under-the-curve (AUC) and onset latencies of R2 component of the nBR. Furthermore, a standardized full battery of quantitative sensory testing (QST) and intraepidermal nerve fibre density (IENFD) or nerve fibre length density (NFLD) assessment were performed, respectively, on the distal leg and oral mucosa. As expected, all patients had altered somatosensory sensitivity and lower IENFD in the lower limb. DPN patients presented higher I0, IP, RMS and AUC values (p < 0.050), lower warm detection thresholds (WDT) (p = 0.004), higher occurrence of paradoxical heat sensation (PHS) (p = 0.040), and a lower intraoral NFLD (p = 0.048) than the healthy participants. In addition, the presence of any abnormal intraoral somatosensory finding was more frequent in the DPN patients when compared to the reference group (p = 0.013). Early signs of trigeminal nociceptive facilitation, intraoral somatosensory abnormalities and loss of intraoral neuronal tissue can be detected in DPN patients.
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Rahman M, Shiozaki K, Okamoto K, Thompson R, Bereiter DA. Trigeminal brainstem modulation of persistent orbicularis oculi muscle activity in a rat model of dry eye. Neuroscience 2017; 349:208-219. [PMID: 28288901 PMCID: PMC5408357 DOI: 10.1016/j.neuroscience.2017.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/23/2017] [Accepted: 03/02/2017] [Indexed: 01/16/2023]
Abstract
Altered corneal reflex activity is a common feature of dry eye disease (DE). Trigeminal sensory nerves supply the ocular surface and terminate at the trigeminal interpolaris/caudalis (ViVc) transition and spinomedullary (VcC1) regions. Although both regions contribute to corneal reflexes, their role under dry eye conditions is not well defined. This study assessed the influence of local inhibitory and excitatory amino acid neurotransmission at the ViVc transition and VcC1 regions on hypertonic saline (HS) evoked orbicularis oculi muscle activity (OOemg) in urethane-anesthetized male rats after exorbital gland removal (DE). HS increased the magnitude of long-duration OOemg activity (OOemgL, >200ms) in DE compared to sham rats, while short-duration OOemg activity (OOemgS, <200ms) was similar for both groups. Inhibition of the ViVc transition by muscimol, a GABAA receptor agonist, greatly reduced HS-evoked OOemgL activity in DE rats, whereas injections at the VcC1 region had only minor effects in both groups. Blockade of GABAA receptors by bicuculline methiodide at the ViVc transition or VcC1 region increased HS-evoked OOemgL activity in DE rats. Blockade of N-methyl-D-aspartate (NMDA) receptors at either region reduced HS-evoked OOemgL activity in DE and sham rats. GABAαβ3 receptor density was reduced at the ViVc transition, while NMDA receptor density was increased at both regions in DE rats. Loss of GABAergic inhibition at the ViVc transition coupled with enhanced NMDA excitatory amino acid neurotransmission at the ViVc transition and the VcC1 region likely contribute to altered corneal reflexes under dry eye conditions.
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Affiliation(s)
- Mostafeezur Rahman
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Moos Tower 18-186, 515 Delaware St. SE, Minneapolis, MN 55455, USA.
| | - Kazunari Shiozaki
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Moos Tower 18-186, 515 Delaware St. SE, Minneapolis, MN 55455, USA
| | - Keiichiro Okamoto
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Moos Tower 18-186, 515 Delaware St. SE, Minneapolis, MN 55455, USA
| | - Randall Thompson
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Moos Tower 18-186, 515 Delaware St. SE, Minneapolis, MN 55455, USA
| | - David A Bereiter
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Moos Tower 18-186, 515 Delaware St. SE, Minneapolis, MN 55455, USA
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Katsarava Z, Limmroth V, Baykal O, Akguen D, Diener HC, Kaube H. Differences of Anti-Nociceptive Mechanisms of Migraine Drugs on the Trigeminal Pain Processing during and Outside Acute Migraine Attacks. Cephalalgia 2016; 24:657-62. [PMID: 15265054 DOI: 10.1111/j.1468-2982.2004.00730.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to investigate central anti-nociceptive mechanisms of i.v. acetylsalicylic acid (ASA) and oral zolmitriptan (ZOL) in migraine patients and healthy subjects using the ‘nociceptive’ blink reflex (nBR). Twenty-eight migraine patients received ASA ( n = 14, 1000 mg i.v) or ZOL ( n = 14, 5 mg p.o) during the acute migraine attack and interictally. Thirty healthy subjects received either ASA or ZOL vs. placebo using a double blind cross over design. nBR was recorded in all patients and subjects before, 60 and 90 min after treatment. ASA and ZOL did not inhibit nBR responses in healthy subjects. Both ASA and ZOL suppressed nBR responses (ASA by 68%, ZOL by 78%) only during the acute attack but not interictally. The data suggest, that the anti-nociceptive effects of migraine drugs on the trigeminal nociceptive processing are different during and outside an acute migraine attack.
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Affiliation(s)
- Z Katsarava
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
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Abstract
The second exteroceptive suppression period (ES2) of masseter or temporalis muscle activity may be reduced in adults with chronic tension-type headache. In adults with migraine, ES2 was found normal or tended to be protracted. To date, no studies on exteroceptive suppression in children and adolescents with headaches have been published. We investigated the exteroceptive suppression of masseter muscle activity in 14 migraineurs and 19 controls between 6 and 18 years of age. It was elicited by electrical stimulation at the labial commissure. No differences were found regarding the first suppression period, but ES2 was significantly longer in the migraine group than in controls. The results of the migraine group suggest overactivity of the interneurons of the reflex loop due to impaired inhibitory control from superior antinociceptive systems already at the beginning of this headache disorder.
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Affiliation(s)
- F Ebinger
- University Paediatric Hospital, Department of Child Neurology, University of Heidelberg, Heidelberg, Germany.
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Marin JCA, Gantenbein AR, Paemeleire K, Kaube H, Goadsby PJ. Nociception-specific blink reflex: pharmacology in healthy volunteers. J Headache Pain 2015; 16:87. [PMID: 26449227 PMCID: PMC4598330 DOI: 10.1186/s10194-015-0568-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The physiology and pharmacology of activation or perception of activation of pain-coding trigeminovascular afferents in humans is fundamental to understanding the biology of headache and developing new treatments. METHODS The blink reflex was elicited using a concentric electrode and recorded in four separate sessions, at baseline and two minutes after administration of ramped doses of diazepam (final dose 0.07 mg/kg), fentanyl (final dose 1.11 μg/kg), ketamine (final dose 0.084 mg/kg) and 0.9 % saline solution. The AUC (area under the curve, μV*ms) and the latency (ms) of the ipsi- and contralateral R2 component of the blink reflex were calculated by PC-based offline analysis. Immediately after each block of blink reflex recordings certain psychometric parameters were assessed. RESULTS There was an effect due to DRUG on the ipsilateral (F 3,60 = 7.3, P < 0.001) AUC as well as on the contralateral (F 3,60 = 6.02, P < 0.001) AUC across the study. A significant decrement in comparison to placebo was observed only for diazepam, affecting the ipsilateral AUC. The scores of alertness, calmness, contentedness, reaction time and precision were not affected by the DRUG across the sessions. CONCLUSION Previous studies suggest central, rather than peripheral changes in nociceptive trigeminal transmission in migraine. This study demonstrates a robust effect of benzodiazepine receptor modulation of the nociception specific blink reflex (nBR) without any μ-opiate or glutamate NMDA receptor component. The nociception specific blink reflex offers a reproducible, quantifiable method of assessment of trigeminal nociceptive system in humans that can be used to dissect pharmacology relevant to primary headache disorders.
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Affiliation(s)
- J C A Marin
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
| | - A R Gantenbein
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
- Current address: Neurorehabilitation Center, RehaClinic, Bad Zurzach, Switzerland
- Current address: University of Zurich, Zürich, Switzerland
| | - K Paemeleire
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
- Current address: Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - H Kaube
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
- Neurology and Headache Center, Munich, Germany
| | - P J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK.
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
- Wellcome Foundation Building, King's College Hospital, London, SE5 9PJ, UK.
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Lerman IR, Chen JL, Hiller D, Souzdalnitski D, Sheean G, Wallace M, Barba D. Novel High-Frequency Peripheral Nerve Stimulator Treatment of Refractory Postherpetic Neuralgia: A Brief Technical Note. Neuromodulation 2015; 18:487-93; discussion 493. [PMID: 25832898 DOI: 10.1111/ner.12281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/14/2015] [Accepted: 01/21/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study aims to describe an ultrasound (US)-guided peripheral nerve stimulation implant technique and describe the effect of high-frequency peripheral nerve stimulation on refractory postherpetic neuralgia. MATERIALS AND METHODS Following a cadaver pilot trial using US and confirmatory fluoroscopic guidance, a 52-year-old man with refractory left supraorbital neuralgia underwent combined US and fluoroscopic-guided supraorbital peripheral nerve stimulator trial. The patient was subsequently implanted with a percutaneous lead over the left supraorbital and supratrochlear nerve utilizing a high-frequency stimulation paradigm. RESULTS At 9 months follow-up, the pain intensity had declined from a weekly average of 8/10 to 1/10 on the pain visual analog scale (VAS). After implant, both nerve conduction and blink reflex studies were performed, which demonstrated herpetic nerve damage and frequency-specific peripheral nerve stimulation effects. The patient preferred analgesia in the supraorbital nerve distribution accomplished with high-frequency paresthesia-free stimulation (HFS) at an amplitude of 6.2 mA, a frequency of 100-1200 Hz, and a pulse width of 130 μsec, to paresthesia-mediated pain relief associated with low-frequency stimulation. CONCLUSION We report the implant of a supraorbital peripheral nerve stimulating electrode that utilizes a high-frequency program resulting in sustained suppression of intractable postherpetic neuralgia.
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Affiliation(s)
| | | | - David Hiller
- University of California San Diego, San Diego, CA, USA
| | | | | | - Mark Wallace
- University of California San Diego, San Diego, CA, USA
| | - David Barba
- University of California San Diego, San Diego, CA, USA
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Rahman M, Okamoto K, Thompson R, Bereiter DA. Trigeminal pathways for hypertonic saline- and light-evoked corneal reflexes. Neuroscience 2014; 277:716-23. [PMID: 25086311 DOI: 10.1016/j.neuroscience.2014.07.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/03/2014] [Accepted: 07/04/2014] [Indexed: 11/18/2022]
Abstract
Cornea-evoked eyeblinks maintain tear film integrity on the ocular surface in response to dryness and protect the eye from real or potential damage. Eyelid movement following electrical stimulation has been well studied in humans and animals; however, the central neural pathways that mediate protective eyeblinks following natural nociceptive signals are less certain. The aim of this study was to assess the role of the trigeminal subnucleus interpolaris/caudalis (Vi/Vc) transition and subnucleus caudalis/upper cervical cord (Vc/C1) junction regions on orbicularis oculi electromyographic (OOemg) activity evoked by ocular surface application of hypertonic saline or exposure to bright light in urethane anesthetized male rats. The Vi/Vc and Vc/C1 regions are the main sites of termination for trigeminal afferent nerves that supply the ocular surface, while hypertonic saline (saline=0.15-5M) and bright light (light=5k-20klux) selectively activate ocular surface and intraocular trigeminal nerves, respectively, and excite second-order neurons at the Vi/Vc and Vc/C1 regions. Integrated OOemg activity, ipsilateral to the applied stimulus, increased with greater stimulus intensities for both modalities. Lidocaine applied to the ocular surface inhibited OOemg responses to hypertonic saline, but did not alter the response to light. Lidocaine injected into the trigeminal ganglion blocked completely the OOemg responses to hypertonic saline and light indicating a trigeminal afferent origin. Synaptic blockade by cobalt chloride of the Vi/Vc or Vc/C1 region greatly reduced OOemg responses to hypertonic saline and bright light. These data indicate that OOemg activity evoked by natural stimuli known to cause irritation or discomfort in humans depends on a relay in both the Vi/Vc transition and Vc/C1 junction regions.
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Affiliation(s)
- M Rahman
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Moos Tower 18-186, 515 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - K Okamoto
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Moos Tower 18-186, 515 Delaware Street SE, Minneapolis, MN 55455, USA
| | - R Thompson
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Moos Tower 18-186, 515 Delaware Street SE, Minneapolis, MN 55455, USA
| | - D A Bereiter
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Moos Tower 18-186, 515 Delaware Street SE, Minneapolis, MN 55455, USA
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Choi SI, Kim MW, Park DY, Huh R, Jang DH. Electrophysiologic investigation during facial motor neuron suppression in patients with hemifacial spasm: possible pathophysiology of hemifacial spasm: a pilot study. Ann Rehabil Med 2013; 37:839-47. [PMID: 24466519 PMCID: PMC3895524 DOI: 10.5535/arm.2013.37.6.839] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the pathophysiological mechanism of hemifacial spasm (HFS), we performed electrophysiological examinations, such as supraorbital nerve stimulation with orbicularis oris muscle recording and lateral spread tests, after suppressing the patient's central nervous system by administering intravenous diazepam. Methods Six patients with HFS were recruited. Supraorbital nerve stimulation with orbicularis oris muscle recording and the lateral spread test were performed, followed by intravenous application of 10 mg diazepam to achieve facial motor neuron suppression. Subsequently, we repeated the two electrophysiological experiments mentioned above at 10 and 20 minutes after the patients had received the diazepam intravenously. Results Orbicularis oris muscle responses were observed in all patients after supraorbital nerve stimulation and lateral spread tests. After the diazepam injection, no orbicularis oris muscle response to supraorbital nerve stimulation was observed in one patient, and the latencies of this response were evident as a slowing tendency with time in the remaining five patients. However, the latencies of the orbicularis oris muscle responses were observed consistently in all patients in the lateral spread test. Conclusion Our results suggest that ectopic excitation/ephaptic transmission contributes to the pathophysiological mechanisms of HFS. This is because the latencies of the orbicularis oris muscle responses in the lateral spread test were observed consistently in the suppressed motor neuron in our patients.
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Affiliation(s)
- Soo In Choi
- Department of Rehabilitation Medicine, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Dong Yoon Park
- Department of Rehabilitation Medicine, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Ryoong Huh
- Department of Neurosurgery, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, Incheon St. Mary's hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
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de Tommaso M, Sardaro M, Pecoraro C, Di Fruscolo O, Serpino C, Lamberti P, Livrea P. Effects of the remote C fibres stimulation induced by capsaicin on the blink reflex in chronic migraine. Cephalalgia 2007; 27:881-90. [PMID: 17593297 DOI: 10.1111/j.1468-2982.2007.01357.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to test the function of the diffuse noxious inhibitory control system (DNIC) in chronic and episodic migraine, exploring the blink reflex (BR) modifications induced by topical application of capsaicin on the hand. We evaluated 11 migraine without aura (MA) and nine chronic migraine (CM) patients during the not symptomatic phase; they were compared with 14 non-headache subjects (N). The BR was elicited by weak electrical stimuli delivered to the right supraorbital nerve; it was obtained 10 min and 20 min after the application of 1 ml of 3% capsaicin in a cream base (Teofarma) on the skin of the dorsum of the right hand, and 60 min after capsaicin removal. The subjective pain sensation induced by capsaicin was significantly increased in CM with respect to both MA patients and normal subjects; the R2 area was increased in CM patients during capsaicin application, with respect to controls and MA patients, who did not exhibit any reflex alterations. These results may suggest a failure of DNIC and a disturbed control of the trigeminal reflex at the central level, linked with migraine frequency.
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Affiliation(s)
- M de Tommaso
- TIRES (Centre of Innnovative Technologies for Signal Detection and Processing), Bari, Italy.
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Mourisse J, Lerou J, Struys M, Zwarts M, Booij L. Multi-level approach to anaesthetic effects produced by sevoflurane or propofol in humans: 1. BIS and blink reflex †. Br J Anaesth 2007; 98:737-45. [PMID: 17519261 DOI: 10.1093/bja/aem104] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The relative roles of forebrain and brainstem in producing adequate anaesthesia are unclear. METHODS We simultaneously analysed the effects of sevoflurane (Group S; n = 18) or propofol (Group P; n = 29) on the bispectral index (BIS) and the first component of the blink reflex (R1). The dose of anaesthetic agent was increased until loss of blink reflex. After discontinuation and reappearance of blink reflex activity, the amount was increased again. The area under curve R1 (area-R1) of the electromyogram of the orbicularis oculi muscle after electrical stimulation of the supraorbital nerve was measured. Using a sigmoid E(max) model and a first-order rate constant k(e0), we characterized the dose-response relationships for BIS and area-R1. RESULTS Concentration-dependent depression of BIS and area-R1 was adequately modelled. The concentration that causes an effect midway between minimum and maximum (EC50) for area-R1 was smaller than EC50 for BIS in both groups [0.34 (0.19) vs 1.29 (0.19) vol% and 1.78 (0.65) vs 2.69 (0.67) mug ml(-1); mean (sd)]. At doses of sevoflurane and propofol with equivalent depression of BIS, sevoflurane depressed area-R1 more than propofol. The k(e0) for area-R1 was about half that for BIS in both groups: 0.24 (0.19-0.29) vs 0.48 (0.38-0.60) min(-1) for Group S; 0.28 (0.23-0.34) vs 0.46 (0.40-0.54) min(-1) for Group P, geometric mean (95% CI). CONCLUSIONS The blink reflex (brainstem function) is more sensitive to sevoflurane or propofol than BIS (forebrain function). Sevoflurane suppresses the blink reflex more than propofol. Different k(e0)s for blink reflex vs BIS indicate different effect sites.
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Affiliation(s)
- J Mourisse
- Department of Anaesthesia, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6500 HB Nijmegen, The Netherlands.
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Busch V, Kaube S, Schulte-Mattler W, Kaube H, May A. Sumatriptan and corneal reflexes in headache-free migraine patients: a randomized and placebo-controlled crossover study. Cephalalgia 2007; 27:165-72. [PMID: 17257238 DOI: 10.1111/j.1468-2982.2007.01265.x] [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: 11/29/2022]
Abstract
A temporary sensitization of central trigeminal neurones in migraine patients during acute attacks has been described in previous studies using the electrically evoked nociceptive blink reflex. The cornea is innervated by small myelinated A-delta and unmyelinated C-fibres only. Stimulation with air puffs activates peripheral nociceptors and allows the investigation of peripheral trigeminal nerve structures. Our objective was to investigate whether corneal reflex examinations with air puff stimulation detect abnormalities in migraineurs during their pain-free interval and if the corneal reflex may be modulated by the administration of an oral triptan. After validation of the nociceptive air puff technique by investigating the corneal reflexes before and after a local anaesthesia of the cornea, we recorded corneal reflexes in 25 migraineurs during their pain-free period and 25 healthy controls before and after the oral administration of 100 mg sumatriptan in a randomized, placebo-controlled, crossover study. Baseline response areas under the curve (AUCs) and latencies of the R2 components of the corneal reflexes did not show any significant differences between patients and controls. Patients did not show any significant differences regarding their headache and non-headache side. The use of an oral triptan had no significant influence on latencies or AUCs in both patients and controls. Our data suggest that there is no facilitation of the trigeminal system in the headache-free interval among patients with migraine. The stable corneal reflexes after the oral administration of 100 mg sumatriptan suggest that there was no inhibition of the trigeminal system, both in patients during their headache-free period and in healthy controls.
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Affiliation(s)
- V Busch
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053 Regensburg, Germany
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14
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Sand T, Møll-Nilsen B, Zwart JA. Blink reflex R2 amplitudes in cervicogenic headache, chronic tension-type headache and migraine. Cephalalgia 2006; 26:1186-91. [PMID: 16961784 DOI: 10.1111/j.1468-2982.2006.01189.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Blink reflex R2 amplitude was investigated in seven patients with cervicogenic headache (CEH), 12 patients with chronic tension-type headache, 23 patients with migraine (10 with aura) and 17 headache-free controls. Standard electrical stimulation of the supraorbital nerve was applied and the response was recorded from the ipsilateral and the contralateral orbicularis oculi muscles. Low R2 amplitude was found in CEH patients compared with control subjects. Headache is unilateral in CEH and the ipsilateral and contralateral responses after stimulation on the painful side were most depressed. R2 amplitude was not significantly affected in migraine and tension headache patients. The results suggest that lower brainstem excitability is reduced in CEH. A state of hypoactivity may be present in caudal trigeminal nucleus neurons on the symptomatic side.
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Affiliation(s)
- T Sand
- Department of Neurology and Clinical Neurophysiology (Norwegian National Headache Centre), St Olav's University Hospital and Norwegian University of Technology and Science, Trondheim, Norway.
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Katsarava Z, Ayzenberg I, Sack F, Limmroth V, Diener HC, Kaube H. A Novel Method of Eliciting Pain-Related Potentials by Transcutaneous Electrical Stimulation. Headache 2006; 46:1511-7. [PMID: 17115984 DOI: 10.1111/j.1526-4610.2006.00446.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electrophysiological techniques such as laser and contact heat evoked pain-related potentials are very useful for studying trigeminal and somatic pain transmission in humans. These methods are, however, partly invasive, expensive, and therefore not available for broad clinical use. We recently proposed a novel technique of noninvasive transcutaneous electrical stimulation. OBJECTIVE To elicit pain-related evoked potentials (PREP) by using a concentric planar electrode and demonstrate their nociceptive specificity. METHODS We registered PREP following stimulation of the forehead and hand in 14 healthy volunteers. Latencies, peak-to-peak amplitudes, and conduction velocities of nociceptive fibers have been estimated. Effects of temporal and spatial summation and of cutaneous anesthesia were evaluated. RESULTS Stimulation with the concentric planar electrode produced pinprick-like painful sensation. Cutaneous anesthesia led to abolishment of PREP responses. Estimated mean conduction velocity was 11.61 +/- 5.12 m/s, which corresponded well with conduction via A-delta fibers. Spatial as well as temporal summation resulted in a parallel increase of perceived pain intensity and PREP amplitudes. CONCLUSION The technique is noninvasive, affordable, and easy to perform and allows quantitative assessment of human nociceptive pathways.
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Cruccu G, Iannetti GD, Truini A. Chapter 28 Brainstem reflexes and their relevance to pain. HANDBOOK OF CLINICAL NEUROLOGY 2006; 81:411-IX. [PMID: 18808850 DOI: 10.1016/s0072-9752(06)80032-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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Cruccu G, Iannetti GD, Marx JJ, Thoemke F, Truini A, Fitzek S, Galeotti F, Urban PP, Romaniello A, Stoeter P, Manfredi M, Hopf HC. Brainstem reflex circuits revisited. Brain 2004; 128:386-94. [PMID: 15601661 DOI: 10.1093/brain/awh366] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Our current understanding of brainstem reflex physiology comes chiefly from the classic anatomical-functional correlation studies that traced the central circuits underlying brainstem reflexes and establishing reflex abnormalities as markers for specific areas of lesion. These studies nevertheless had the disadvantage of deriving from post-mortem findings in only a few patients. We developed a voxel-based model of the human brainstem designed to import and normalize MRIs, select groups of patients with or without a given dysfunction, compare their MRIs statistically, and construct three-plane maps showing the statistical probability of lesion. Using this method, we studied 180 patients with focal brainstem infarction. All subjects underwent a dedicated MRI study of the brainstem and the whole series of brainstem tests currently used in clinical neurophysiology: early (R1) and late (R2) blink reflex, early (SP1) and late (SP2) masseter inhibitory reflex, and the jaw jerk to chin tapping. Significance levels were highest for R1, SP1 and R2 afferent abnormalities. Patients with abnormalities in all three reflexes had lesions involving the primary sensory neurons in the ventral pons, before the afferents directed to the respective reflex circuits diverge. Patients with an isolated abnormality of R1 and SP1 responses had lesions that involved the ipsilateral dorsal pons, near the fourth ventricle floor, and lay close to each other. The area with the highest probabilities of lesion for the R2-afferent abnormality was in the ipsilateral dorsal-lateral medulla at the inferior olive level. SP2 abnormalities reached a low level of significance, in the same region as R2. Only few patients had a crossed-type abnormality of SP1, SP2 or R2; that of SP1 reached significance in the median pontine tegmentum rostral to the main trigeminal nucleus. Although abnormal in 38 patients, the jaw jerk appeared to have no cluster location. Because our voxel-based model quantitatively compares lesions in patients with or without a given reflex abnormality, it minimizes the risk that the significant areas depict vascular territories rather than common spots within the territory housing the reflex circuit. By analysing statistical data for a large cohort of patients, it also identifies the most frequent lesion location for each response. The finding of multireflex abnormalities reflects damage of the primary afferent neurons; hence it provides no evidence of an intra-axial lesion. The jaw jerk, perhaps the brainstem reflex most widely used in clinical neurophysiology, had no apparent topodiagnostic value, probably because it depends strongly on peripheral variables, including dental occlusion.
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Affiliation(s)
- G Cruccu
- Department of Neurological Sciences, La Sapienza University, Rome, Italy.
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Mourisse J, Lerou J, Zwarts M, Booij L. Electromyographic assessment of blink reflexes correlates with a clinical scale of depth of sedation/anaesthesia and BIS during propofol administration. Acta Anaesthesiol Scand 2004; 48:1174-9. [PMID: 15352965 DOI: 10.1111/j.1399-6576.2004.00485.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND General anaesthesia is characterized by loss of consciousness, amnesia and obtundation of reflex responses to noxious stimuli. Quantifying the blink reflex may reflect the depression of reflex arches induced by anaesthetics and thus being informative on the anaesthetic state. METHODS The relation between the electrically evoked blink reflexes and the depth of sedation and anaesthesia induced with intravenous propofol was investigated. Twenty patients received propofol by target-controlled infusion to create a stepwise deepening of sedation and anaesthesia. Depth of anaesthesia was assessed using the observer's assessment of anaesthesia and sedation (OAAS) scale, and by bispectral EEG analysis (BIS). Probit analysis was used to estimate the predicted propofol effect site concentrations producing unconsciousness, no response to noxious stimulation, and loss of blink reflex components. RESULTS Latency of the first (R1) and second (R2) blink component increased, whereas duration and area decreased with increasing depth of sedation and anaesthesia. A reasonably strong correlation between OAAS and the areas of R1 and R2 components was found (Spearman's rho = 0.92 and 0.89). The areas of R1 and R2 and the OAAS also correlated with BIS (Spearman's rho = 0.91, 0.88 and 0.90). EC(50) and EC(95) for loss of R1 were 2.8 (95% CI: 2.5-3.2) micro g/ml and 4.6 (95% CI: 4.1-5.5) micro g/ml, respectively. CONCLUSIONS Our results suggest that the differential sensitivity of the components of the blink reflex could be useful in monitoring depth of sedation and light levels of anaesthesia during the administration of propofol. Both OAAS and BIS correlate similarly with the blink reflex components.
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Affiliation(s)
- J Mourisse
- Department of Anaesthesiology, Radboud University Nijmegen, Nijmegen, the Netherlands.
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19
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Khasani S, Becker K, Meinck HM. Hyperekplexia and stiff-man syndrome: abnormal brainstem reflexes suggest a physiological relationship. J Neurol Neurosurg Psychiatry 2004; 75:1265-9. [PMID: 15314112 PMCID: PMC1739206 DOI: 10.1136/jnnp.2003.018135] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Hyperekplexia and the stiff-man syndrome (SMS) are both conditions with exaggerated startle suggesting abnormal brainstem function. Investigation of brainstem reflexes may provide insight into disturbed reflex excitation and inhibition underlying these movement disorders. PATIENTS AND METHODS Using four-channel EMG, we examined four trigeminal brainstem reflexes (monosynaptic masseter, masseter inhibitory, glabella, and orbicularis oculi blink reflexes) and their spread into pericranial muscles in five patients with familial hyperekplexia (FH), two with acquired hyperekplexia (AH), 10 with SMS, and 15 healthy control subjects. RESULTS Both FH/AH and SMS patients had abnormal propagation of brainstem reflexes into pericranial muscles. All patients with hyperekplexia showed an abnormal short-latency (15-20 ms) reflex in the trapezius muscle with a characteristic clinical appearance ("head retraction jerk") evoked by tactile or electrical stimulation of the trigeminal nerve, but normal monosynaptic masseter reflexes. Inhibitory brainstem reflexes were attenuated in some FH/AH patients. Four of 10 patients with SMS had similar short-latency reflexes in the neck muscles and frequently showed widespread enhancement of other excitatory reflexes, reflex spasms, and attenuation of inhibitory brainstem reflexes. CONCLUSION Reflex excitation is exaggerated and inhibition is attenuated in both stiff-man syndrome and familial or acquired hyperekplexia, indicating a physiological relationship. Reflex transmission in the brainstem appears biased towards excitation which may imply dysfunction of inhibitory glycinergic or GABAergic interneurons, or both.
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Affiliation(s)
- S Khasani
- Department of Neurology, University of Heidelberg, Germany
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20
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Cruccu G, Anand P, Attal N, Garcia-Larrea L, Haanpää M, Jørum E, Serra J, Jensen TS. EFNS guidelines on neuropathic pain assessment. Eur J Neurol 2004; 11:153-62. [PMID: 15009162 DOI: 10.1111/j.1468-1331.2004.00791.x] [Citation(s) in RCA: 385] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In September 2001, a Task Force was set up under the auspices of the European Federation of Neurological Societies with the aim of evaluating the existing evidence about the methods of assessing neuropathic pain and its treatments. This review led to the development of guidelines to be used in the management of patients with neuropathic pain. In the clinical setting a neurological examination that includes an accurate sensory examination is often sufficient to reach a diagnosis. Nerve conduction studies and somatosensory-evoked potentials, which do not assess small fibre function, may demonstrate and localize a peripheral or central nervous lesion. A quantitative assessment of the nociceptive pathways is provided by quantitative sensory testing and laser-evoked potentials. To evaluate treatment efficacy in a patient and in controlled trials, the simplest psychometric scales and quality of life measures are probably the best methods. A laboratory measure of pain that by-passes the subjective report, and thus cognitive influences, is a hopeful aim for the future.
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Affiliation(s)
- G Cruccu
- EFNS Panel on Neuropathic Pain Department of Neurological Sciences, La Sapienza University, Rome, Italy.
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21
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Tinazzi M, Valeriani M, Moretto G, Rosso T, Nicolato A, Fiaschi A, Aglioti SM. Plastic interactions between hand and face cortical representations in patients with trigeminal neuralgia: a somatosensory-evoked potentials study. Neuroscience 2004; 127:769-76. [PMID: 15283973 DOI: 10.1016/j.neuroscience.2004.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2004] [Indexed: 10/26/2022]
Abstract
Neurophysiological and neuroimaging studies suggest that pain may play a major role in determining cortical somatosensory rearrangements even in the adult brain. The re-organizational power of pain, however, has been tested in models in which massive deafferentation co-existed with pain (e.g. in phantom pain). Moreover, information on whether spinal and brainstem changes contribute to pain-related plasticity in humans is meagre. We used the non-invasive somatosensory evoked potentials technique in patients with right primary trigeminal neuralgia and no clinical signs of large-diameter fibers of trigeminal deafferentation to assess whether pain may induce plastic changes at multiple levels in the somatosensory system. Subcortical and cortical potentials evoked by stimulation of the right median and posterior tibial nerves ipsilateral to the facial pain were compared with those obtained following stimulation of the left median and tibial nerves and with those obtained in a control group tested in comparable conditions. Amplitudes of parietal N20 and P27 and frontal N30 potentials observed following stimulation of the right median nerve ipsilateral to the facial pain were greater than those of the left median nerve and showed a positive correlation with magnitude of pain. This right-left asymmetry was absent following stimulation of the patients' tibial nerves and in control subjects. No changes were found in spinal N13 and brainstem P14. That facial pain is associated with neuroplastic changes within the somatic cortical representation of the hand suggests a pain-related topographic cortical reorganisation.
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Affiliation(s)
- M Tinazzi
- Unità Operativa Neurologia Ospedale Civile Borgo Trento, Verona, Italy
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22
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Zerari-Mailly F, Dauvergne C, Buisseret P, Buisseret-Delmas C. Localization of trigeminal, spinal, and reticular neurons involved in the rat blink reflex. J Comp Neurol 2003; 467:173-84. [PMID: 14595767 DOI: 10.1002/cne.10917] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Electrical stimulation of the supraorbital nerve (SO) induces eyelid closure by activation of orbicularis oculi muscle motoneurons located in the facial motor nucleus (VII). Neurons involved in brainstem central pathways implicated in rat blink reflex were localized by analyzing c-Fos protein expression after SO stimulation in conjunction with tracing experiments. A retrograde tracer (gold-horseradish peroxidase [HRP]) was injected into the VII. The distribution patterns of activated c-Fos-immunoreactive neurons and of neurons exhibiting both c-Fos immunoreactivity and gold-HRP labeling were determined in the sensory trigeminal complex (STC), the cervical spinal cord (C1), and the pontomedullary reticular formation. Within the STC, c-Fos immunoreactivity labeled neurons in the ipsilateral ventral part of the principal nucleus, the pars oralis and interpolaris, and bilaterally in the pars caudalis. Colocalization of gold-HRP and c-Fos immunoreactivity was observed in neurons of ventral pars caudalis layers I-IV and ventral pars interpolaris. In C1, SO stimulation revealed c-Fos neurons in laminae I-V. After additional injections in VII, the double-labeled c-Fos/gold-HRP neurons were concentrated in laminae IV and V. Although c-Fos neurons were found throughout the pontomedullary reticular formation, most appeared rostrally around the motor trigeminal nucleus and in the ventral parvocellular reticular nucleus medial to the fiber bundles of the seventh nerve. Caudally, c-Fos neurons were in the lateral portion of the dorsal medullary reticular field. In addition, these reticular areas contained double-labeled neurons in electrically stimulated rats that had received gold-HRP injections in the VII. The presence of double-labeled neurons in the STC, C1, and the reticular formation implies that these neurons receive sensory information from eyelids and project to the VII. These double-labeled neurons could then be involved in di- or trisynaptic pathways contributing to the blink reflex.
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Affiliation(s)
- Fawzia Zerari-Mailly
- Laboratoire de Neuroanatomie Fonctionnelle des Systèmes Sensorimoteurs, 75251 Paris Cedex 05, France
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Proietti Cecchini A, Sandrini G, Fokin IV, Moglia A, Nappi G. Trigeminofacial reflexes in primary headaches. Cephalalgia 2003; 23 Suppl 1:33-41. [PMID: 12699457 DOI: 10.1046/j.1468-2982.2003.00572.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nociceptive processing in trigeminal system is likely to undergo to significant changes in chronic pain disorders such as in primary headache. The electrophysiological testing of brainstem reflexes seems to offer a valuable adjunct to the clinical evaluation, providing direct evidence for central dysmodulation of sensory and pain neurotransmission, i.e. dishabituation pattern and reduced pain threshold. We review the contribution of trigeminofacial reflex studies in the light of those recent data supporting the view of a dysfunctional sensory processing in primary headache.
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Affiliation(s)
- A Proietti Cecchini
- University Center for Adaptive Disorders and Headache, IRCCS C. Mondino Foundation, University of Pavia, Italy
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Giffin NJ, Kowacs F, Libri V, Williams P, Goadsby PJ, Kaube H. Effect of the adenosine A1 receptor agonist GR79236 on trigeminal nociception with blink reflex recordings in healthy human subjects. Cephalalgia 2003; 23:287-92. [PMID: 12716347 DOI: 10.1046/j.1468-2982.2003.00511.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
GR79236 is a highly potent and selective adenosine A1 receptor agonist that has analgesic and anti-inflammatory actions in humans and animals. In animal models it inhibits trigeminal nerve firing and calcitonin gene-related peptide release which play a pivotal role in migraine pathophysiology. Thus GR79236 may have therapeutic potential in migraine. Although there are no validated human models of migraine, the trigeminal nociceptive pathways may be studied with a novel electrode to elicit nociception-specific blink reflex responses. Twelve healthy female volunteers were randomized in a double-blind, placebo-controlled, cross-over trial to investigate the effect of GR79236 on trigeminal nociceptive pathways, as measured by the blink reflex. A secondary objective was to compare the use of two types of electrode, the standard (SE) and nociception-specific electrodes (NE), to investigate human trigeminal pharmacology. Blink reflexes were elicited with SE and NE before and 30 min after GR79236 (10 microg/kg i.v.) or placebo. The median area under the curve of repeated sweeps of the R2 component of the blink reflex was analysed using analysis of covariance with baseline as covariate. Using NE, GR79236 produced a non-significant reduction of the ipsilateral R2 compared with placebo (P = 0.097) and a significant reduction contralaterally (P = 0.008). No significant changes were observed using SE. There were no significant adverse events. The results suggest that NE is more sensitive than SE to detect pharmacological effects in the trigeminal nociceptive system. Furthermore, the adenosine A1 receptor agonist GR79236 inhibits trigeminal nociception in humans. These results support a possible therapeutic role for GR79236 in primary headache disorders.
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Affiliation(s)
- N J Giffin
- Headache Group, Institute of Neurology, London, UK
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Mourisse J, Gerrits W, Lerou J, van Egmond J, Zwarts MJ, Booij L. Electromyographic assessment of blink and corneal reflexes during midazolam administration: useful methods for assessing depth of anesthesia? Acta Anaesthesiol Scand 2003; 47:593-600. [PMID: 12699519 DOI: 10.1034/j.1399-6576.2003.00100.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are at least three components of the anesthetic state: loss of consciousness, amnesia and obtundation of reflex responses to noxious stimuli. To investigate the third component, we used a standard electrical stimulus to evoke a blink reflex, which was electromyographically recorded. These data may give information on the anesthetic state. METHODS The relation between the electrically evoked blink and corneal reflexes and the depth of sedation and anesthesia induced with intravenous midazolam was investigated. Ten patients received i.v. increments of midazolam (1 mg, 2 mg, 3 mg, 3 mg, 3 mg, etc., until a 21-mg total dose) to create a step-wise deepening of sedation and anesthesia. Depth of anesthesia was assessed by the Observer's Assessment of Alertness/Sedation (OAAS) scale, ranging from 5 ( = awake and alert) to 0 ( = no motor response to tetanic stimulation). RESULTS Latency of the first (R1) and second (R2) blink components and the corneal (C) reflex component increased, whereas duration and area decreased with increasing depth of sedation and anesthesia. R1 was last seen at an OAAS score [mean (SD)] of 1.8 (0.8), R2 at a score of 3.1 (1.1), C at a score of 3.8 (0.8), and R3 at 4.8 (0.5). These end-points were all statistically different from each other, except R2 vs. C. CONCLUSIONS Our results suggest that the differential sensitivity of the components of the blink reflex could be useful to monitor depth of sedation and light levels of anesthesia during the administration of midazolam.
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Affiliation(s)
- J Mourisse
- Department of Anesthesiology, University Medical Center Nijmegen, HB, Nijmegen, The Netherlands.
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26
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Katsarava Z, Ellrich J, Diener HC, Kaube H. Optimized stimulation and recording parameters of human 'nociception specific' blink reflex recordings. Clin Neurophysiol 2002; 113:1932-6. [PMID: 12464330 DOI: 10.1016/s1388-2457(02)00307-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Few non-invasive methods are available for studying trigeminal nociception in humans. The 'nociception specific' blink reflex (nBR) is elicited by a preferential stimulation of trigeminal nociceptive fibers and is highly sensitive to changes in trigeminal nociception. The aim of this study was to establish its optimal stimulation parameters. METHODS The inter-individual variability of R2 responses (41 healthy subjects), symmetry of R2 responses after right vs. left sided stimulation (25 subjects), optimal stimulation parameters (3 groups, each 16 subjects) and re-test reliability over time (15 subjects) were studied. RESULTS The nBR had a R2 response with a latency of 44.7+/-7.3ms, but no R1 response. The mean difference of R2 latencies (right vs. left sided stimulation) was 0.4+/-2.1(SD)ms, the mean ratio of the R2 response areas (RA) was 1.05+/-0.39 (SD). Thus, lateral differences of onset latencies greater than 4.6ms (0.4+4.2 (2SD)) or >1.83-fold (1.05+0.78 (2SD)) of RA can be assumed as outside of normal range. Long inter-block intervals of 7min minimized the cumulative habituation of R2 RAs to 23%, onset latencies remained constant. Re-test reliability over 4 weeks was high both for latencies (Crohnbach's alpha=0.85) and RAs (alpha=0.94). CONCLUSIONS The nBR with the established stimulation parameters could be used for studying trigeminal nociception.
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Affiliation(s)
- Z Katsarava
- Department of Neurology, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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27
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Inghilleri M, Conte A, Frasca V, Berardelli A, Manfredi M, Cruccu G. Is the cutaneous silent period an opiate-sensitive nociceptive reflex? Muscle Nerve 2002; 25:695-699. [PMID: 11994963 DOI: 10.1002/mus.10101] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In humans, high-intensity electrical stimuli delivered to the fingers induce an inhibitory effect on C7-T1 motoneurons. This inhibitory reflex, called the cutaneous silent period (CSP) is considered a defense response specific for the human upper limbs. It is not clear whether the CSP-like other defense responses such as the corneal reflex and the R III reflex-is an opiate-sensitive nociceptive reflex. Because opiates suppress some, but not all, nociceptive reflexes, we studied the effect of the narcotic-analgesic drug fentanyl on the CSP and the R III reflex. The CSP was recorded from the first dorsal interosseous (FDI) muscle in seven normal subjects during voluntary contraction, before and 10 and 20 min after fentanyl injection. To assess possible fentanyl-induced changes, we also tested the effect of finger stimulation on motor evoked potentials (MEPs) elicited in the FDI muscle by transcranial magnetic stimulation before and after fentanyl injection. Fentanyl-induced changes were also studied on the R III reflex recorded from the biceps femoris muscle. Fentanyl, as expected, suppressed the R III reflex but failed to change the inhibitory effect of finger stimulation on FDI motoneurons. Finger stimulation reduced the size of MEPs in the FDI, and fentanyl injection left this inhibitory effect unchanged. The differential fentanyl-induced modulation of the CSP and R III reflex provides evidence that the CSP circuit is devoid of mu-opiate receptors and is therefore an opiate-insensitive nociceptive reflex, which may be useful in the assessment of central-acting, non-opioid drugs.
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Affiliation(s)
- Maurizio Inghilleri
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
- Institute Neuromed (Pozzilli), University of Rome "La Sapienza," Rome, Italy
| | - Antonella Conte
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
| | - Vittorio Frasca
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
| | - Alfredo Berardelli
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
- Institute Neuromed (Pozzilli), University of Rome "La Sapienza," Rome, Italy
| | - Mario Manfredi
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
- Institute Neuromed (Pozzilli), University of Rome "La Sapienza," Rome, Italy
| | - Giorgio Cruccu
- Department of Neurological Sciences, University of Rome "La Sapienza," Viale dell'Università 30, 00185 Rome, Italy
- Institute Neuromed (Pozzilli), University of Rome "La Sapienza," Rome, Italy
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Romaniello A, Valls-Solé J, Iannetti GD, Truini A, Manfredi M, Cruccu G. Nociceptive quality of the laser-evoked blink reflex in humans. J Neurophysiol 2002; 87:1386-94. [PMID: 11877513 DOI: 10.1152/jn.00041.2001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Laser radiant-heat pulses selectively excite the free nerve endings in the superficial layers of the skin and activate mechano-thermal nociceptive afferents; when directed to the perioral or supraorbital skin, high-intensity laser pulses evoke a blink-like response in the orbicularis oculi muscle (the laser blink reflex, LBR). We investigated the functional properties (startle or nociceptive origin) of the LBR and sought to characterize its central pathways. Using high-intensity CO(2)-laser stimulation of the perioral or supraorbital regions and electromyographic (EMG) recordings from the orbicularis oculi muscles, we did five experiments in 20 healthy volunteers. First, to investigate whether the LBR is a startle response, we studied its habituation to expected rhythmic stimuli and to unexpected arrhythmic stimuli. To assess its possible nociceptive quality, we studied changes in the LBR and the R2 component of the electrical blink reflex after a lidocaine-induced supraorbital nerve block and after intramuscular injection of the opiate fentanyl and the opiate-antagonist naloxone. To characterize the central pathways for the LBR, we investigated the interaction between the LBR and the three components of the blink reflex (R1, R2, and R3) by delivering laser pulses to the perioral or supraorbital regions before or after electrical stimulation of the supraorbital nerve at various interstimulus intervals. Finally, to gain further information on the central LBR pathways, using two identical CO(2)-laser stimulators, we studied the LBR recovery curves with paired laser pulses delivered to adjacent forehead points at interstimulus intervals from 250 ms to 1.5 s. The LBR withstood relatively high-frequency rhythmic stimulations, and unexpected laser pulses failed to evoke larger responses. When lidocaine began to induce hypoalgesia (about 5 min after the injection), the LBR was abolished, whereas R2 was only partly suppressed 10 min after the injection. Fentanyl injection induced strong, naloxone-reversible, LBR suppression (the response decreased to 25.3% of predrug values at 10 min and to 4% at 20 min), whereas R2 remained appreciably unchanged. Whether directed to the perioral or supraorbital regions, preceding laser pulses strongly suppressed R2 and R3 though not R1. Conversely, preceding electrical stimuli to the supraorbital nerve suppressed the LBR. In response to paired stimuli, the LBR recovered significantly faster than R2. These findings indicate that the LBR is a nociceptive reflex, which shares part of the interneuron chain mediating the nonnociceptive R2 blink reflex, probably in the medullary reticular formation. The LBR may prove useful for studying the pathophysiology of orofacial pain syndromes.
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Affiliation(s)
- A Romaniello
- Department of Neurological Sciences, University of Rome La Sapienza, Viale Universitá 30, I-00185 Rome, Italy
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Abstract
BACKGROUND Electrophysiologic findings of the blink reflex in patients with Bell's palsy are usually said to be either prolonged latencies and/or absent early and middle responses of it. METHODS Facial nerve conduction and blink reflex studies were performed on a 42-year-old male patient with right-side Bell's palsy. Studies were done using protocols previously validated and published elsewhere. RESULTS The right compound muscle action potential was not found after stimulation of the right facial nerve as expected. Absence of the short (R1) and middle (R2) responses of the blink reflex were also noted after right and left supraorbital nerve stimulation. Further, the late (R3) response of the blink reflex was displayed on the abnormal side when electrical stimuli were applied to the right supraorbital nerve while the patient attempted to perform voluntary movement of the paralyzed facial muscles including eye closing. CONCLUSIONS The recording of R3-a late response following fibers and using motoneurons other than those employed by R1 and R2-on the paralyzed side after performing some reinforcement maneuvers allows us to suggest that, in some facial nerve palsies, there are some structures remaining alive that may be useful for carrying out a more timely and accurate diagnosis and follow-up.
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Affiliation(s)
- Fidias E León-Sarmiento
- Departamento de Medicina Interna y Ciencias Básicas, Unidad de Neurología, Facultad de Salud, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia.
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de Tommaso M, Libro G, Guido M, Sciruicchio V, Puca F. The blink reflex and the corneal reflex are followed by cortical activity resembling the nociceptive potentials induced by trigeminal laser stimulation in man. Neurosci Lett 2001; 310:37-40. [PMID: 11524152 DOI: 10.1016/s0304-3940(01)02086-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Laser stimulation of the supraorbital regions evokes brain potentials (LEPs) related to trigeminal nociception. The aim of this study was to record the R2 component of the blink reflex and the corneal reflex in 20 normal subjects, comparing the scalp activity following these reflexes with the nociceptive potentials evoked by CO2 laser stimulation of supraorbital regions. Cortical and muscular reflexes evoked by stimulation of the first trigeminal branch were recorded simultaneously. The R2 component of the blink reflex and the corneal reflex were followed by two cortical peaks, which resembled morphologically N-P waves of LEPs. The two peaks demonstrated a difference in latency of approximately 40 ms, which is consistent with activation time of nociception. This finding suggests that these reflexes are induced by activation of small pain-related fibers.
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Affiliation(s)
- M de Tommaso
- Interuniversity Center for the Study of Headache and Neurotransmitter Disorders of the Central Nervous System, Perugia, Roma, Sassari, Bari, Napoli, Firenze, Italy.
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Ellrich J, Katsarava Z, Przywara S, Kaube H. Is the R3 component of the human blink reflex nociceptive in origin? Pain 2001; 91:389-395. [PMID: 11275397 DOI: 10.1016/s0304-3959(00)00465-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The R3 component of the blink reflex can reproducibly be evoked by noxious stimulation but can probably also be elicited by innocuous stimuli. This study was conducted to investigate the contribution of nociceptive A delta and C fibers to the generation of the electrically evoked R3 blink reflex. Electrical thresholds for detection, pain and all blink reflex components were determined and the modulatory effects of local anesthesia were investigated. The electrical R3 threshold of 4.6 +/- 0.5 mA (mean +/- SE) corresponded to 2.9 times the detection threshold and to 0.35 times the pain threshold. The R3 threshold was significantly below the pain threshold. Under local anesthesia of the supraorbital skin with a complete loss of warm and cold sensation, a loss of pinprick sensation, but a normal detection of tactile stimuli, the electrical pain threshold increased, all other thresholds remained unchanged. Under local anesthesia none of the reflex components were significantly reduced. Cutaneous A beta fibers and nociceptive A delta fibers, but not unmyelinated C fibers, contribute to the generation of the electrically evoked R3 component. According to the recruitment order in peripheral sensory nerves the electrical threshold of the R3 is mainly determined by activation of A beta fibers. Thus, it can not be assumed that the electrically evoked R3 is an adequate model to investigate nociceptive processing.
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Affiliation(s)
- Jens Ellrich
- Department of Experimental and Clinical Pharmacology and Toxicology, Emil-Fischer-Center, Friedrich-Alexander-University Erlangen-Nuremberg, Fahrstrasse 17, D-91054 Erlangen, Germany Department of Neurology, University of Essen, D-45122 Essen, Germany Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1 3BG, UK
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32
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de Tommaso M, Guido M, Libro G, Sciruicchio V, Puca F. Zolmitriptan reverses blink reflex changes induced during the migraine attack in humans. Neurosci Lett 2000; 289:57-60. [PMID: 10899408 DOI: 10.1016/s0304-3940(00)01255-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The question about the 5-hydroxytryptamine (5-HT)(1B-1D) receptors agonists, if the clinical efficacy in migraine attacks is linked with the action at the central level or at the peripheral one, is still unresolved. We evaluated the effects of zolmitriptan and sumatriptan on blink reflex in thirty migraine without aura patients during the attacks in order to assess the central action on the trigeminal system. Both drugs were effective in reducing headache severity compared to placebo. In the migraine attack an increased area of the R3 component on the pain side was observed; it was suppressed by zolmitriptan, which confirmed its action on the central trigeminal circuits, though the clinical relevance of this effect could be questioned.
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Affiliation(s)
- M de Tommaso
- Interuniversity Center for the Study of Headache and Neurotransmitter Disorders of the Central Nervous System, Perugia, Roma, Sassari, Bari, Napoli, Firenze, Italy.
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Palmeri A, Restivo DA, Casabona A. Involvement of the noradrenergic system in modulating the blink reflex in humans. Brain Res 2000; 867:210-6. [PMID: 10837815 DOI: 10.1016/s0006-8993(00)02245-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several researches have shown that the spinal reflex transmission in animals, as well as humans, was inhibited by alpha(2)-agonists, due to a disfacilitation of tonic noradrenergic control on motoneuronal output. To understand better the mechanisms regulating certain aspects of motor activity, here we reinvestigated the possible role of noradrenergic systems in modulating reflex activity of the brainstem in humans. To this aim, blink reflex responses (R1 and R2) evoked by electrical stimulation of the supraorbital nerve were electromyographically recorded in healthy volunteers. Both R1 and R2 areas were measured at 10-min intervals before and after i.v. injection of alpha(2)-agonist clonidine (0.5 microg/kg). The substance induced consistent depression of R1, which reached its maximum 40 min after drug administration (-43% of the control values). Ipsilateral R2 area resulted little affected by clonidine (-15% at 50 min), whereas no effects were observed in contralateral R2. Blood pressure values were never altered by drug injections. These results, taken together with previous observations, support the hypothesis that alpha(2)-agonist substances may cause a transient inactivation of noradrenergic neurons, thus releasing neurons involved in the circuitry of the blink reflex from a facilitatory drive. Since clonidine differentially modulated blink reflex responses, it is likely to assume that such a disfacilitation concerns mostly pontine units mediating the R1. However, the complexity of clonidine's effects at multiple pre- and postsynaptic sites does not allow us to exclude that other systems are involved in the alpha(2)-mediated control of facial motoneurons.
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Affiliation(s)
- A Palmeri
- Department of Physiological Sciences, University of Catania, Viale Andrea Doria 6, I-95125, Catania, Italy.
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Kaube H, Katsarava Z, Käufer T, Diener H, Ellrich J. A new method to increase nociception specificity of the human blink reflex. Clin Neurophysiol 2000; 111:413-6. [PMID: 10699400 DOI: 10.1016/s1388-2457(99)00295-3] [Citation(s) in RCA: 205] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The medullary R2 response of the blink reflex can be elicited by innocuous and noxious stimuli. The purpose of this study was to elicit a nociception specific R2 response with a new surface electrode. METHODS In 10 healthy subjects the blink reflex was elicited using a standard (10-15 mA) and a new concentric surface electrode type (0.6-1.6 mA) which produces a pin-prick-like pain. RESULTS After topical local anaesthesia with lignocaine/prilocaine R1 was unchanged, R2 was attenuated by 12% after standard stimulation but was almost abolished (-91%) with the new electrode type. CONCLUSION Stimulation with low stimulus intensities but electrode-dependent high current density allows preferential depolarization of superficial nociceptive A-delta fibres. This new method is less traumatic than others and is useful in the study of trigeminal nociception.
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Affiliation(s)
- H Kaube
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
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35
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Abstract
Brainstem reflexes and hand-muscle reflexes can be elicited and recorded with routine EMG equipment. Not all these reflexes are useful in clinical neurology. But those that are - the subject of this review - exhibit distinct patterns of abnormality that have clinical diagnostic and localizing value in various diseases, including cranial neuropathies, focal lesions within the cervical cord, brainstem, and brain, movement disorders, and pain.
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Affiliation(s)
- G Cruccu
- Dipartimento Scienze Neurologiche, Università di Roma 'La Sapienza', Viale Università 30, 00185, Rome, Italy.
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36
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Reply to Dr. Jens Ellrich. Pain 2000. [DOI: 10.1016/s0304-3959(99)00189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Electrophysiological studies in childhood headache are of interest because of the need to make a clinical diagnosis and also because of the efficacy of physiopathological studies in juvenile age attributable to the recent outcome of the illness, with less clinical modification by environmental factors or drug use. Electrophysiological studies in childhood headache are concerned with migraine and electroencephalographic (EEG) evaluations; evoked potentials, event-related potentials and, less often, electromyographic studies are also reported. Visual analysis of EEG suggests an association between migraine and epilepsy; quantitative EEG, visual and event-related evoked potentials show fluctuating abnormalities, depending on the occurrence of the migraine attacks and permanent anomalous patterns related to the basic mechanisms underlying the disease. Blink reflex studies might suggest a primary dysfunction of the nociceptive control central system in children affected by tension-type headache and migraine. The use of neurophysiological procedures in juvenile migraine is considered limited in clinical practice and of particular interest in neurophysiological studies of headache.
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Affiliation(s)
- F Puca
- Clinica Neurologica I, Università di Bari, Italy
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38
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Abstract
The blink reflex (BR) is a generalised phenomenon in mammals. Its teleological protective eye function is perhaps the reason why the BR can be provoked by a multitude of stimuli. As corneal and glabellar reflexes, BR has an inveterate use in the neurological exploration. Some of its physiopathological aspects were discussed more than 100 years ago, and soon half a century will have passed since the first electrophysiological study was published. This review focuses on the BR elicited by the electrical stimulation of the trigeminal supraorbital nerve, a controlled and reliable model in clinical neurophysiology. The electrically elicited BR is an exteroceptive-nociceptive reflex recorded on the orbicularis oculi muscle and formed by three components: the two principal ones, R1 and R2, of well-known characteristics, and a third, R3, of increasing interest, to which there is wide mention. The trigeminal afferent limb reaches the facial efferent one by means of a long and quite complex central pathway located at the brainstem bulbopontine level. The anatomical substrate and criteria of the rich topographical lesional semiology of the BR are established. The importance of the suprasegmental influences upon the reflex, coming mainly from the cerebral cortex and basal ganglia, as well as the impairment caused by their damage, will be emphasised. Special attention is paid to the relationship between the reflex and the dopaminergic system, and the consequences of its derangement. The methods of habituation and suppression-recovery of the BR are extensively and critically reviewed. These methods measure its excitability and serve in practice for the pathophysiological study of numerous diseases. The relationship of the BR with the spontaneous blinking is considered, and the existence of a primary inhibitory reflex on levator palpebrae muscles, previous to the active reflex response of the orbicularis, is proposed. The electrophysiological characteristics of the glabellar reflex, the corneal reflex, the acoustic, photic and somatosensory provoked BR, the ontogeny, and some of the common factors influencing the reflex, such as sleep, are also discussed. The strategic position of the neural structures of the BR, in an area involved in the gating of the various sensory-motor systems and the relative ease to its evaluation with common methodology used in clinical neurophysiology, makes the BR an essential tool for the diagnosis and pathophysiological insight into an important number of human neurological disorders.
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Affiliation(s)
- A Esteban
- Department of Clinical Neurophysiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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39
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40
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Abstract
To our knowledge, this is the first report on pain-related abnormalities of the eye blink reflex (BR) in a clinical pain patient population. The objective of this study was to evaluate the possible neuropathic mechanisms underlying the burning mouth syndrome (BMS), by means of objective electrophysiological examination of the trigemino-facial system. We studied the BR with stimulation of the supraorbital nerve (SON) with particular emphasis on the occurrence of the pain-related ultralate R3 components, and the habituation response of the R2 components. The subjects consisted of eleven BMS patients and 10 healthy control subjects. All patients underwent thorough clinical oral and neurological examinations. The motor function of the trigeminal nerve was assessed with a jaw reflex recording, and a needle-EMG examination of the facial and masticatory muscles was performed in the patients with abnormalities in the BR recordings. The jaw reflexes, the latencies of the BR components, and the needle-EMG examinations were normal in all patients. As a group, the BMS patients had statistically significantly higher stimulus thresholds for the tactile R 1 components of the BR compared with the control subjects. With non-noxious stimulation, the BMS patients showed more frequently pain-related R3 components (11/22 SONs) compared with the controls (3/20 SONs). In addition, four BMS patients had abnormal habituation of the R2 components. In two of these patients, the findings were segmental (i.e., unilateral), coinciding with the side of the subjective BM symptoms. The abnormalities of the BR tests appeared to be related to longer disease duration. Our results suggest a possible pathologic involvement of the nervous system in chronic BMS.
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Affiliation(s)
- Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Central Hospital, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland Department of Oral and Maxillofacial Surgery, Turku University Central Hospital, Turku, Finland Department of Neurology, Turku University Central Hospital, Turku, Finland
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41
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Bereiter DA. Morphine and somatostatin analogue reduce c-fos expression in trigeminal subnucleus caudalis produced by corneal stimulation in the rat. Neuroscience 1997; 77:863-74. [PMID: 9070758 DOI: 10.1016/s0306-4522(96)00541-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The influence of morphine and somatostatin on nociceptor-evoked activation of central trigeminal neurons and cardiovascular reflex responses was assessed in barbiturate-anaesthetized rats. Morphine or the somatostatin analogue, octreotide, was given intracerebroventricularly 20 min prior to application of mustard oil to the corneal surface. The expression of the immediate early gene, c-fos, was used to estimate neuronal activation within the spinal trigeminal nucleus. Morphine reduced the number of Fos-positive neurons produced at the transition region between trigeminal subnucleus caudalis and the upper cervical spinal cord, whereas c-fos expression at the subnucleus interpolaris/caudalis transition was not affected significantly. Morphine also reduced the arterial pressure and heart rate responses to corneal stimulation in proportion to the dose of morphine and required a threshold dose similar to that which reduced c-fos expression. Naloxone prevented the morphine-induced inhibition of c-fos expression and cardiovascular reflex responses to corneal stimulation. Somatostatin analogue reduced the number of Fos-positive neurons at the subnucleus caudalis/cervical cord transition, but not at the subnucleus interpolaris/caudalis transition, an effect that was not prevented by naloxone. Somatostatin analogue did not blunt the cardiovascular responses evoked by corneal stimulation. A subthreshold dose of morphine plus a threshold dose of somatostatin analogue caused a greater inhibition of Fos-positive neurons at the subnucleus caudalis/cervical cord transition, but not in reflex-evoked autonomic responses, than the same dose of either drug alone. Intracerebroventricular administration of morphine and somatostatin analogue inhibit corneal activation of neurons within the superficial laminae at the subnucleus caudalis/cervical cord transition through opioid and non-opioid-dependent neural pathways, respectively. By contrast, the low sensitivity of corneal-responsive neurons at the subnucleus interpolaris/caudalis transition to analgesics suggests that these neurons are not simply a rostral extension of the medullary dorsal horn. Correlation analyses suggest that morphine-induced inhibition of cardiovascular responses to corneal stimulation depend on the activity of neurons at the subnucleus caudalis/cervical cord transition and not on those at the subnucleus interpolaris/caudalis transition region.
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Affiliation(s)
- D A Bereiter
- Department of Neuroscience, Brown University/Rhode Island Hospital, Providence 02903, U.S.A
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Leon-S FE, Suwazono S, Takenaga S, Arimura K, Osame M. The effects of tobacco smoking on the short, middle, and long latency responses of the blink reflex in humans. J Clin Neurophysiol 1997; 14:144-9. [PMID: 9165409 DOI: 10.1097/00004691-199703000-00007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The three responses (R1, R2, and R3) of the electrically elicited blink reflex (BR) obtained in four normal human subjects were investigated before and after smoking both a filtered and an unfiltered cigarette. The changes observed in the BR were stronger and statistically more significant for the unfiltered than for the filtered cigarette, (p < 0.0001) and were more dramatic in R3 than R1 or R2. The action of nicotine on central pathways located at the interneuronal network of the brainstem, basal ganglia, and C fiber structures involved with this reflex seems to be the most likely mechanism for these findings.
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Affiliation(s)
- F E Leon-S
- Third Department of Internal Medicine, Kagoshima University School of Medicine, Japan
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43
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Cruccu G, Leardi MG, Ferracuti S, Manfredi M. Corneal reflex responses to mechanical and electrical stimuli in coma and narcotic analgesia in humans. Neurosci Lett 1997; 222:33-6. [PMID: 9121716 DOI: 10.1016/s0304-3940(97)13335-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The corneal reflex, a bilateral eye-blink, can be elicited in humans either by mechanical or electrical corneal stimulation. Both in comatose patients and in normal subjects injected with the opiate fentanyl, the electrically-evoked corneal reflex was more suppressed than the mechanically-evoked reflex. We propose that the mechanical input yields a reflex more resistant to depression of the corticoreticular drive and to narcotic analgesia, because it exploits temporal summation at central synapses, whereas the electrical input exploits spatial summation.
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Affiliation(s)
- G Cruccu
- Department of Neurological Sciences, University of Rome, La Sapienza, Italy
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44
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Leon-S FE, Arimura K, Suwazono S, Arimura Y, Osame M. The effects of shounousui on the three responses of the blink reflex in man. Muscle Nerve 1997; 20:110-2. [PMID: 8995593 DOI: 10.1002/(sici)1097-4598(199701)20:1<110::aid-mus17>3.0.co;2-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F E Leon-S
- Third Department of Internal Medicine, Kagoshima University School of Medicine, Japan
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45
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Ellrich J, Hopf HC. The R3 component of the blink reflex: normative data and application in spinal lesions. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1996; 101:349-54. [PMID: 8761045 DOI: 10.1016/0924-980x(96)95684-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The clinical value of the R3 component (R3) of the blink reflex (BR) for differentiating between lesions at the medulla oblongata and cervical spinal cord level is still unclear. In 50 healthy volunteers (25 women, 25 men, aged 20-75 years) reproducible ipsi- and contralateral R3 responses could be evoked showing a mean onset latency of 84 ms, a duration of 32 ms and a side-to-side difference of almost 3 ms. The latency increased with age. Eleven patients with lesions of the cervical spinal cord (segments C1-C6) showed normal R3 latencies. In 4 patients with pathology of the brain-stem, however, R3 was abnormal, showing identical changes as observed with the R2 component. Our results suggest that the reflex arc of R3 does not descend to the cervical spinal cord but within the brain-stem possibly takes the same connections as the R2 component.
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Affiliation(s)
- J Ellrich
- Department of Neurology, University Clinic of Mainz, Germany.
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46
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Pellegrini JJ, Evinger C. The trigeminally evoked blink reflex. II. Mechanisms of paired-stimulus suppression. Exp Brain Res 1995; 107:181-96. [PMID: 8773238 DOI: 10.1007/bf00230040] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The paired-stimulus paradigm, presentation of a pair of identical reflex-eliciting stimuli to the supraorbital nerve (SO) with an interstimulus interval of less than 2 s, evokes a response to the second, test, stimulus which is less than that elicited by the first, conditioning, stimulus. In this study, we investigated the site of this suppression and its pharmacology in the alert guinea pig. Both the early (R1) and the late (R2) component of the SO-evoked blink reflex exhibited suppression in the paired-stimulus paradigm. Initiation of suppression appeared to be specific to the afferent limb of the reflex rather than the result of motor activity generated by the conditioning stimulus. Neither acoustic conditioning stimuli nor air puffs that elicited blinks via another branch of the trigeminal nerve suppressed the test response. Extremely weak SO shocks, however, that did not directly elicit a reflex, caused suppression of the response to subsequent SO stimuli of normal intensity. Paired stimulus suppression of the R1 component appeared to involve activation of GABAB receptors within the spinal trigeminal nucleus. Both systemic injections and microinjections of baclofen into the spinal trigeminal nucleus enhanced R1 suppression, whereas identical injections of CGP35348, a GABAB antagonist, diminished R1 suppression. Furthermore, single-unit recordings in alert animals revealed that spinal trigeminal neurons exhibited suppression in the paired-stimulus paradigm that resembled that of the R1 component of the blink reflex. These findings showed that sensory gating underlies paired-stimulus suppression of the SO-evoked blink reflex and that activation of GABAB receptors plays an important role in this process.
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Affiliation(s)
- J J Pellegrini
- Department of Biology, College of St. Catherine, St. Paul, MN 55105, USA
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47
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Rossi B, Vista M, Farnetani W, Gabrielli L, Vignocchi G, Bianchi F, Berton F, Francesconi W. Modulation of electrically elicited blink reflex components by visual and acoustic prestimuli in man. Int J Psychophysiol 1995; 20:177-87. [PMID: 8788220 DOI: 10.1016/0167-8760(95)00035-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The effects of a prestimulus on the electrically elicited blink reflex components were investigated in 20 healthy subjects. In the first group of 10 subjects (warned group), electric shocks were delivered in isolation or preceded, at an interstimulus interval (ISI) of 0.1 s, 1 s, or 10 s, by a visual or acoustic warning stimulus. In the second group of 10 subjects (unwarned group), the electric shocks were delivered either in isolation or preceded, at the same ISI, by visual or acoustic stimuli having no warning value. The modulation of the three blink reflex components was then analysed. Compared to the baseline condition, the R1 oligosynaptic component was enhanced at 0.1 s and 1 s ISI, in the warned group with the visual prestimulus, but only at 0.1 s after a visual and acoustic prestimulus in the unwarned group. On the contrary, the polysynaptic responses showed a different course: R2 was significantly reduced at the 0.1 s interval in the warned group with both the prestimuli, and only with the visual prestimulus in the unwarned group. The R3 was inhibited at all three intervals with the visual prestimulus, and at the 0.1 s and 1 s with the acoustic one in the warned group, and only at 0.1 s in the unwarned group, both after visual and acoustic prestimuli. The decrement in R2 and R3 observed with the shortest interval was probably related to the prepulse inhibition of startle reflex. Furthermore, only R3 was still inhibited at longer intervals, when the sustained processes of attention may have influenced this component. Perhaps this combination of events represents, in the warned group, the best preparation for voluntary reflex reaction.
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Affiliation(s)
- B Rossi
- Institute of Clinic Neurology, University of Pisa, Italy
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48
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Pellegrini JJ, Horn AK, Evinger C. The trigeminally evoked blink reflex. I. Neuronal circuits. Exp Brain Res 1995; 107:166-80. [PMID: 8773237 DOI: 10.1007/bf00230039] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this study, we characterized the pathways that generate the trigeminal blink reflex in the guinea pig. Blinks were evoked by stimulation of the supraorbital branch of the trigeminal nerve and measured by recording electromyographic activity in the lid-closing orbicularis oculi muscle (OOemg) and, in one case, lid position. Blinks evoked by stimulation of the supraorbital nerve consisted of two bursts of muscle activity ipsilateral to the side of stimulation. The first, R1, had a latency of 6.9 ms and the second, R2, had a latency of 17.25 ms. Increasing stimulus intensity to 3 times threshold for evoking an ipsilateral blink elicited an R1 and R2 response contralaterally, with latencies of 9.2 ms and 19.25 ms, respectively. We investigated the causes for this bipartite response that is seen in the guinea pig, as well as other mammals including humans. The two-component response could arise from different populations of afferents, or from different central circuits, or a combination of these two causes. Multiunit recording in the trigeminal ganglion and simultaneous measurement of the OOemg showed that activation of A beta afferents alone was sufficient to elicit both the R1 and the R2 responses, but that activation of A delta afferents could enhance both responses. Different neural circuits, however, produce the R1 and R2 responses. Transganglionic tracing with wheatgerm agglutin or choleragenoid subunit of cholera toxin bound to HRP revealed that primary afferents from the supraorbital branch of the trigeminal nerve terminated densely in the dorsal horn of spinal cord segment C1 and in the caudalis-interpolaris border region of the spinal trigeminal nucleus. Injections of HRP into the orbicularis oculi motoneuron region of the facial nucleus showed that both of these regions projected to the facial nucleus. Hemisections at the level of C1 eliminated the R2 blink response, but not the R1 response, evoked by stimulation of the supraorbital branch of the trigeminal nerve. Subsequent hemisections at the level of the obex eliminated the R1 response. Microinjections of the GABAB agonist baclofen into the spinal trigeminal nucleus at the level of the obex abolished the R1 but not the R2 response. Thus, the spinal trigeminal nucleus produces the R1 component, whereas the R2 component originates in the C1 region of the spinal cord.
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Affiliation(s)
- J J Pellegrini
- Department of Biology, College of St. Catherine, St. Paul, MN 55105, USA
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49
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Leon-S FE, Arimura K, Arimura Y, Sonoda Y, Osame M. Contralateral early blink reflex in patients with HTLV-I associated myelopathy/tropical spastic paraparesis. J Neurol Sci 1995; 128:51-7. [PMID: 7722534 DOI: 10.1016/0022-510x(94)00205-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Thirty-two Japanese patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) were studied by means of the electrically elicited blink reflex and three responses (R1, R2, R3) were registered. 69% of the patients displayed a uni- or bilateral crossed R1 response (R1k) as compared to 11% in the control group. A positive correlation between R1k and an exaggerated jaw jerk reflex was found in the patients. Central abnormalities of the nervous system with diminished presynaptic inhibition acting in the interneuronal input of the brainstem of HAM/TSP patients was the most likely cause. It could lead to the unmasking of crossed trigemino-facial pathway reflex which is present in the normal population from birth. These results strongly support the supraspinal involvement of the central nervous system (CNS) in HAM/TSP more than usually thought.
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Affiliation(s)
- F E Leon-S
- Third Department of Internal Medicine, Kagoshima University School of Medicine, Japan
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50
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Sand T, Zwart JA. The blink reflex in chronic tension-type headache, migraine, and cervicogenic headache. Cephalalgia 1994; 14:447-50; discussion 394-5. [PMID: 7697706 DOI: 10.1046/j.1468-2982.1994.1406447.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
R1 and R2 blink reflex latencies were investigated blind in 10 patients with cervicogenic headache, 11 patients with chronic tension-type headache, 11 patients with migraine, and 9 headache-free controls. There were no R1 or R2 latency differences between the four groups. The latency of R1 increased significantly with headache duration in tension-type headache patients. Shorter R1 latencies were found on the symptomatic side than on the non-symptomatic side in cervicogenic headache patients. The results suggest that a state of hyperactivity may be present in the ipsilateral trigeminal nucleus in cervicogenic headache. Hypoactivity, however, may develop over time in tension-type headache.
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Affiliation(s)
- T Sand
- Department of Neurology, University Hospital of Trondheim, Norway
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