Time Parameters of the Blink Reflex in Normal Subjects
Our study was aimed at estimating normal time values for the EMG waves recorded in the blink reflex test. The group examined included 400 healthy subjects (226 women and 174 men, with mean age about 50 years). There was no significant difference between the ages of the male and female subjects. T...
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Інститут фізіології ім. О.О. Богомольця НАН України
2014
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| Цитувати: | Time Parameters of the Blink Reflex in Normal Subjects / J.B.B. Brooks, M.R. Jardim, R.M. Papais-Alvarenga, Y.D. Fragoso // Нейрофизиология. — 2014. — Т. 46, № 3. — С. 245-248. — Бібліогр.: 14 назв. — англ. |
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irk-123456789-1482922021-07-25T13:54:24Z Time Parameters of the Blink Reflex in Normal Subjects Brooks, J.B.B. Jardim, M.R. Papais-Alvarenga, R.M. Fragoso, Y.D. Our study was aimed at estimating normal time values for the EMG waves recorded in the blink reflex test. The group examined included 400 healthy subjects (226 women and 174 men, with mean age about 50 years). There was no significant difference between the ages of the male and female subjects. The mean latency of the R1 wave in the response was 10.3 msec, while R2 was obtained after 32.5 msec, on average. The contralateral response component R2c was observed after 34.4 msec, on average. Gender did not influence the results, while age had a significant effect on R1 (P = 0.029) and R2c (P = 0.0003). The older the subject, the longer the latencies of the above waves. The data obtained on a rather large sampling of the tested subjects can be useful as normography for medical and neurophysiological purposes. У своєму дослідженні ми оцінювали нормальні часові параметри хвиль ЕМГ, що реєструвалися при тестуванні рефлексу кліпання. До обстеженої групи ввійшли 400 здорових осіб (226 жінок та 174 чоловіки, середній вік близько 50 років) без істотної різниці віку в групах чоловіків і жінок. Середній латентний період (ЛП) хвилі R1 у складі досліджуваної рефлекторної відповіді складав 10.30, а хвилі R2 – 32.51 мс. Контралатеральний компонент відповіді R2c виникав із середнім ЛП 34.43 мс. Стать обстежених не впливала істотно на ці значення; в той же час останні демонстрували значну залежність від віку (R1, P = 0.029; R2c, P = 0.0003; чим старші були обстежені, тим довші були вказані ЛП). Результати, отримані на досить великій дослідженій групі здорових осіб, можуть бути корисними як нормографічні дані для медичних та нейрофизіологічних цілей. 2014 Article Time Parameters of the Blink Reflex in Normal Subjects / J.B.B. Brooks, M.R. Jardim, R.M. Papais-Alvarenga, Y.D. Fragoso // Нейрофизиология. — 2014. — Т. 46, № 3. — С. 245-248. — Бібліогр.: 14 назв. — англ. 0028-2561 http://dspace.nbuv.gov.ua/handle/123456789/148292 611.84+612.833 en Нейрофизиология Інститут фізіології ім. О.О. Богомольця НАН України |
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Digital Library of Periodicals of National Academy of Sciences of Ukraine |
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English |
| description |
Our study was aimed at estimating normal time values for the EMG waves recorded in
the blink reflex test. The group examined included 400 healthy subjects (226 women and
174 men, with mean age about 50 years). There was no significant difference between the
ages of the male and female subjects. The mean latency of the R1 wave in the response was
10.3 msec, while R2 was obtained after 32.5 msec, on average. The contralateral response
component R2c was observed after 34.4 msec, on average. Gender did not influence the results,
while age had a significant effect on R1 (P = 0.029) and R2c (P = 0.0003). The older the subject,
the longer the latencies of the above waves. The data obtained on a rather large sampling of
the tested subjects can be useful as normography for medical and neurophysiological purposes. |
| format |
Article |
| author |
Brooks, J.B.B. Jardim, M.R. Papais-Alvarenga, R.M. Fragoso, Y.D. |
| spellingShingle |
Brooks, J.B.B. Jardim, M.R. Papais-Alvarenga, R.M. Fragoso, Y.D. Time Parameters of the Blink Reflex in Normal Subjects Нейрофизиология |
| author_facet |
Brooks, J.B.B. Jardim, M.R. Papais-Alvarenga, R.M. Fragoso, Y.D. |
| author_sort |
Brooks, J.B.B. |
| title |
Time Parameters of the Blink Reflex in Normal Subjects |
| title_short |
Time Parameters of the Blink Reflex in Normal Subjects |
| title_full |
Time Parameters of the Blink Reflex in Normal Subjects |
| title_fullStr |
Time Parameters of the Blink Reflex in Normal Subjects |
| title_full_unstemmed |
Time Parameters of the Blink Reflex in Normal Subjects |
| title_sort |
time parameters of the blink reflex in normal subjects |
| publisher |
Інститут фізіології ім. О.О. Богомольця НАН України |
| publishDate |
2014 |
| url |
http://dspace.nbuv.gov.ua/handle/123456789/148292 |
| citation_txt |
Time Parameters of the Blink Reflex in Normal Subjects / J.B.B. Brooks, M.R. Jardim, R.M. Papais-Alvarenga, Y.D. Fragoso // Нейрофизиология. — 2014. — Т. 46, № 3. — С. 245-248. — Бібліогр.: 14 назв. — англ. |
| series |
Нейрофизиология |
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| first_indexed |
2025-07-12T19:04:05Z |
| last_indexed |
2025-07-12T19:04:05Z |
| _version_ |
1837469063801995264 |
| fulltext |
NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 3 245
UDC 611.84+612.833
J. B. B. BROOKS,1, 2 M. R. JARDIM,2 R. M. PAPAIS-ALVARENGA,2
and Y. D. FRAGOSO1, 2
TIME PARAMETERS OF THE BLINK REFLEX IN NORMAL SUBJECTS
Received September 8, 2013
Our study was aimed at estimating normal time values for the EMG waves recorded in
the blink reflex test. The group examined included 400 healthy subjects (226 women and
174 men, with mean age about 50 years). There was no significant difference between the
ages of the male and female subjects. The mean latency of the R1 wave in the response was
10.3 msec, while R2 was obtained after 32.5 msec, on average. The contralateral response
component R2c was observed after 34.4 msec, on average. Gender did not influence the results,
while age had a significant effect on R1 (P = 0.029) and R2c (P = 0.0003). The older the subject,
the longer the latencies of the above waves. The data obtained on a rather large sampling of
the tested subjects can be useful as normography for medical and neurophysiological purposes.
Keywords: blink reflex, EMG, brainstem, pons, medulla oblongata.
1 Department of Neurology, Universidade Metropolitana de Santos, São Paulo,
Brazil.
2 Department of Neurology, College of Post-Graduation Studies, Universidade
Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Correspondence should be addressed to Y. D. Fragoso
(e-mail: yara@bsnet.com.br).
INTRODUCTION
Initially described by W. Overend in 1896 [1],
peculiarities of the blink reflex (orbicularis oculi
reflex) may be indicative of lesions or dysfunctions of
the brainstem, particularly of those in the trigeminal-
facial arcs. Kugelberg [2] complemented initial
observations in 1952, and the blink reflex test became
a part of standard studies of “face neurophysiology.”
This reflex is elicited by stimulation of the supraorbital
nerve on one side of the face, leading to initiation of two
ipsilateral EMG response components (R1 and R2) and
one contralateral component (R2c). The R1 represents
the activity of an oligosynaptic pathway involving the
main sensory nucleus of the trigeminal nerve and the
intermediate subnucleus of the facial nerve. The R2 is
a second response that includes a descent to the spinal
trigeminal tract, while R2c is provided by a reflex
pathway that crosses the brainstem in the medulla and
progresses through the reticular formation to elicit the
response at the contralateral facial nucleus.
The blink reflex has been shown to be altered in a
variety of neurological conditions. Multiple sclerosis
[3-5], Parkinson’s disease [6], and dementia with Lewy
bodies [7] are among the diseases that may modify
responses in the blink reflex test. Patients with chronic
headaches have also been shown to demonstrate
altered responses in the above test [8, 9], although not
all authors agree with this [10].
When studies of neurological diseases and the blink
reflex were carried out, the control groups used by the
authors were typically rather limited, and maximally
a few dozen control subjects were usually mentioned
in each report. The aim of our study was to assess
the blink reflex test in a relatively large sampling of
individuals claiming to be in good general health, thus
establishing “normal” values of the respective time
parameters that can be used as controls in further blink
reflex studies.
METHODS
The group examined consisted of 400 subjects who
were attending the EMG laboratory for nonspecific
complaints, as well as volunteers who were enrolled
in the project. All subjects previously diagnosed
with central or peripheral nerve diseases, earlier
cranial nerve lesions, autonomic disturbances, or
diabetes mellitus, as well as those using drugs with
anticholinergic properties, were excluded.
The blink reflex was assessed using two-channel
Nicolet Viking Quest EMG equipment (Nicolet
Biomedical Inc., USA). All tests were performed by the
same medical doctor. The subjects were in the supine
position, lying down in a relaxed state with their eyes
NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 3246
J. B. B. BROOKS, M. R. JARDIM, R. M. PAPAIS-ALVARENGA, and Y. D. FRAGOSO
open. Figure 1 shows positions of the electrodes on the
face of the subject. A ground electrode was placed on
the chin; an active recording electrode was fixed on the
inferior orbital part of the orbicularis oculi, just laterally
to the vertical line that can be drawn with the pupils in
midposition. The reference recording electrode was placed
laterally to the lateral canthus of each eye. Recording
electrodes were placed on both sides. The frequency filter
settings were 10 Hz and 10 kHz. Facial nerve studies
were initially performed on each subject to ensure that
normal motor latency and amplitude could be obtained on
each side and that there was no damage to the peripheral
part of the efferent loop of the reflex. The supraorbital
branches of the trigeminal nerve were stimulated on
each side with 20-45 mA rectangular current pulses
(0.1-0.3 msec long). The stimulus intensity was
increased in 5-mA steps until a reliable and reproducible
response was obtained. Bilateral recordings were made
simultaneously.
In order to measure the R1, R2, and R2c latencies
and to obtain an unambiguous response, individual
threshold stimulus intensities were used. Ten responses
were superimposed from each side, and the median of
these responses was chosen. Typical registration of the
waves is shown in Fig. 2.
The results of this study are essentially descriptive
in their nature. Means ± s.d. are shown below.
Whenever statistical analyses were required for the
variables, the Fisher’s exact test and Student’s t-test
were used.
RESULTS
The group of 400 healthy subjects included 226 women
(mean age 50.7 ± 18.7 years) and 174 men (50.9 ±
± 17.8 years). There was no statistically significant
difference between the ages of the male and female
subjects. The R1, R2, and R2c time parameters were
established for these groups and correlated with
gender and age. These results are summarized in
Table 1. The average time taken to elicit the R1
response was 10.30 msec, while R2 was obtained after
32.51 msec, on average. The contralateral response
R2c was observed after an average of 34.43 msec
after stimulation. Gender did not influence the above
values, while age had a significant effect on the R1
(P = 0.029) and R2c (P = 0.0003) latencies. The older
the subject, the longer the latency to elicit the above
waves of the reflex. These results are summarized in
Table 1. Minimum and maximum values recorded for
each subgroup of controls are presented in Table 2.
DISCUSSION
Abnormal values for the blink reflex parameters may
indicate brainstem lesions or dysfunction [11-13].
Although the blink reflex has been studied for many
years, data from a large group of controls have never
been available to the researchers. Small control groups
for each study have been described and should continue
to exist, but it seems expedient to form a large historical
database to use as reference values. When small groups of
patients and controls are studied, discrepant results may
EST
G1 G1G2 G2
T
EST
R1
10.30 msec
32.51 msec
34.43 msec
R2
R2C
0,2 mV
10 msec
F i g. 1. Blink reflex test. Allocation of the electrodes for stimulation
and recording of the reflex.
Р и с. 1. Розташування електродів для стимуляції та відведення
ЕМГ при тестуванні рефлексу кліпання.
F i g. 2. Blink reflex-related waves. R1 is the first ipsilateral wave,
R2 is the second ipsilateral wave, and R2c is contralateral to the
stimulus.
Р и с. 2. Компонентний склад ЕМГ, що реєструється при реф-
лексі кліпання.
NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 3 247
TIME PARAMETERS OF THE BLINK REFLEX
sometimes be obtained. This may have been the case with
headache studies that systematically used fewer than 50
control subjects to assess differences between patients and
controls [8-10]. In the case of diseases, the only reference
that exists for the values obtained at a given time point is
sometimes a value from another patient, which may in any
case be outside of the normal range [5].
Another advantage of having a large database of
control subjects for further studies of the human blink
reflex relates to the ethical aspects of the test. The
blink reflex test is neither painful nor invasive, but
ethics committees may not necessarily approve the
test in controls due to possible discomfort caused by
stimulation. With a large historical published database,
the normal values can be used for comparison with
patients presenting different diseases.
Significant differences in the R1 and R2c latencies
relating to subjects’ ages have previously been
described [10]. Although differences in the values
between men and women in the same age group have
been reported by others [10], our study did not confirm
this finding.
In conclusion, the blink reflex test is a simple,
inexpensive, non-invasive, and painless procedure that
could be used often in daily medical or experimental
practice. It has been reported that several neurological
diseases induced abnormalities in the blink reflex
values [3-7, 9, 14], and our database of 400
subjects is of potential interest to certain groups of
professionals. This large group of subjects providing
normal time values for the responses R1, R2, and R2c
may be of help to clinicians caring for patients, to
electrophysiologists assessing facial reflex responses,
and to researchers studying a variety of neurological
diseases.
All procedures were approved by the Ethics Committee of
the Universidade Metropolitana de Santos under the number
020/2011, CAAE 0017.0.161.000-11 and carried out in
accordance with the Helsinki Declaration of 1975, as revised
in 2000.
Written informed consent was obtained from all individuals
participating in this study. Figure 1 shows the photograph of a
neurologist who authorized the inclusion of his photograph in
this paper.
The authors, J. B. B. Brooks, M. R. Jardim, R. M. Papais-
Alvarenga, and Y. D. Fragoso, confirm that they have no
conflict of interest.
Ж. Б. Б. Брукс1,2, М. Р. Джардім2, Р. М. Папіас-Альваренга,2
Я. Д. Фрагозо1,2
ЧАСОВІ ПАРАМЕТРИ РЕФЛЕКСУ КЛІПАННЯ В НОРМІ
1 Університет Метрополітана де Сантос, Сан-Паулу
(Бразилія).
2 Коледж післядипломних досліджень Федерального
Університету штату Ріо-де-Жанейро (Бразилія).
Р е з ю м е
У своєму дослідженні ми оцінювали нормальні часові пара-
метри хвиль ЕМГ, що реєструвалися при тестуванні рефлек-
Table 1. Latencies of the Components of Blink Reflex-Related EMG
Т а б л и ц я 1. Латентні періоди компонентів ЕМГ, що реєструються при рефлексі кліпання
Groups
Latency of the component, msec
Significance of differences, P
R1 R2 R2c
Total group (n = 400)
10.30 ± 0.94
(8.88…11.71)
32.51 ± 3.32
(27.53…37.49)
34.43 ± 3.20
(29.64…39.23)
Men (n=174)
10.32 ± 0.96
(8.88…11.75)
32.51 ± 3.33
(27.51…37.50)
34.44 ± 3.20
(29.65…39.21) P for R1 = 0.790
P for R2 = 0.994
P for R2c = 0.984Women (n=226)
10.29 ± 0.93
(8.89..11.69)
32.51 ± 3.31
(27.54…37.48)
34.43 ± 3.19
(29.65…39.21)
50 years or younger (n=205)
10.19 ± 0.94
(8.78…11.60)
32.45 ± 3.32
(27.47…37.43)
34.36 ± 3.19
(29.58…39.14)
P for R1 = 0.029
P for R2 = 0.766
P for R2c = 0.000351 years or older (n=195)
10.39 ± 0.95*
(8.97…11.82)
32.55 ± 3.33
(27.55…37.54)
35.51 ± 3.20*
(30.71…40.31)
Footnotes: Means ± s.d. are shown; minimum and maximum values in the groups are shown in parantheses. Cases of significant
intergroup differences are shown by asterisks.
NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 3248
J. B. B. BROOKS, M. R. JARDIM, R. M. PAPAIS-ALVARENGA, and Y. D. FRAGOSO
су кліпання. До обстеженої групи ввійшли 400 здорових осіб
(226 жінок та 174 чоловіки, середній вік близько 50 років)
без істотної різниці віку в групах чоловіків і жінок. Серед-
ній латентний період (ЛП) хвилі R1 у складі досліджуваної
рефлекторної відповіді складав 10.30, а хвилі R2 – 32.51 мс.
Контралатеральний компонент відповіді R2c виникав із се-
реднім ЛП 34.43 мс. Стать обстежених не впливала істотно
на ці значення; в той же час останні демонстрували знач-
ну залежність від віку (R1, P = 0.029; R2c, P = 0.0003; чим
старші були обстежені, тим довші були вказані ЛП). Резуль-
тати, отримані на досить великій дослідженій групі здоро-
вих осіб, можуть бути корисними як нормографічні дані для
медичних та нейрофизіологічних цілей.
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