발병초기 벨마비 환자의 진단에서 순목 반사(blink reflex)의 유용성

석정임,이동국,김창형 대한임상신경생리학회 2012 Annals of Clinical Neurophysiology Vol.14 No.1

Background: Bell’s palsy is the most common disease of cranial nerve. While most electrodiagnostic tests can detect the abnormality of facial nerve several days later in Bell’s palsy, blink reflex usually reveals the abnormality earlier than other tests. Therefore, we investigated the diagnostic usefulness of blink reflex in the early stage of Bell’s palsy. Methods: We performed a prospective investigation in patients with facial palsy. We enrolled patients with Bell’s palsy who were evaluated within 7 days of symptom onset and excluded patients with secondary causes of facial palsy. We analyzed the findings of blink reflex according to age, sex, evaluation time, and severity of facial palsy. Results: Of 320 consecutive patients with facial palsy, a total of 204 patients were enrolled. Blink reflex was normal for 10 patients and abnormal for 194 patients. The time interval between the symptom onset and the evaluation time was not associated with the result of blink reflex,but House-Brackmann grade was significantly related to the result of blink reflex (P<0.001). Patients with mild Bell’s palsy often showed normal blink reflex. Conclusions: Our study shows that blink reflex is useful diagnostic test regardless of evaluation timing in the early stage of Bell’s palsy, although it could be normal in patients with mild Bell’s palsy.

삼킴 및 구음장애 소아 환자에서 Blink Reflex의 유용성 - 증례 보고 -

박정미,임형태,최익선,김정문,이계욱 대한근전도전기진단의학회 2010 대한근전도 전기진단의학회지 Vol.12 No.1

Blink reflex can be used for electrophysiological study of the brainstem function. Blink reflex shows status of polysynaptic pathway through relay of complex route, especially pons and lateral medulla. We diagnosed lesion in pons and medulla using blink reflex study in a 45-month-old girl showing severe dysarthria, dysphagia and ataxia with no evidence of abnormality from brain MRI and BAEP study. We suggest blink reflex study as a good diagnostic method for evaluating patient with dysphagia to differentiate brainstem lesion, from cerebral lesion especially in equivocal brain MRI results. Blink reflex study is more useful with advantage of non-invasive and cost effective, and more accurate than BAEP study or brain MRI in brainstem lesion.

Blink reflex changes and sensory perception in infraorbital nerve-innervated areas following zygomaticomaxillary complex fractures

Park, Young Sook,Choi, Jaehoon,Park, Sang Woo Korean Society of Plastic and Reconstructive Surge 2020 Archives of Plastic Surgery Vol.47 No.6

Background Infraorbital nerve dysfunction is commonly reported after zygomaticomaxillary complex fractures. We evaluated sensory changes in four designated areas (eyelid, nose, zygoma, and lip) innervated by the infraorbital nerve. This evaluation was conducted using the static two-point discrimination test and the vibration threshold test. We assessed the diagnostic significance of the blink reflex in patients with infraorbital nerve dysfunction. Methods This study included 18 patients, all of whom complained of some degree of infraorbital nerve dysfunction preoperatively. A visual analog scale, the infraorbital blink reflex, static two-point discrimination, and the vibration threshold were assessed preoperatively, at 1 month postoperatively (T1), and at a final follow-up that took place at least 4 months postoperatively (T4). The results were analyzed using a multilevel generalized linear mixed model. Results Scores on the visual analog scale significantly improved at T1 and T4. The infraorbital blink reflex significantly improved at T4. Visual analog scale scores improved more rapidly than the infraorbital blink reflex. Two-point discrimination significantly improved in all areas at T4, and the vibration perception threshold significantly improved in the eyelid at T4. Conclusions Recovery of the infraorbital blink reflex reflected the recovery of infraorbital nerve dysfunction. We also determined that the lip tended to recover later than the other areas innervated by the infraorbital nerve.

말초성 안면마비 환자의 예후와 순목반사 검사의 관계: 후향적 연구

구본혁,유희경,석경환,이주현,류수형,이수연,김민정,박연철,서병관,박동석,백용현 대한침구의학회 2014 대한침구의학회지 Vol.31 No.4

Objectives : This study was performed to find the relation between prognosis of peripheral facial palsy and blink reflex. Methods : Data was collected from patients who were admitted and treated by East-West Collaborative Treatment of Facial Palsy Center in Kyung Hee University Hospital at Gangdong from January 2012 to June 2013. Patients were screened by inclusion/exclusion criteria and 163 patients’ medical records were reviewed including blink reflex performed 14 ± 2 days after onset and House-Brackmann grade. Patients were divided into three groups, normal, delayed and absent group by blink reflex test. Trends of each recovery rate to House-Brackmann grade Ⅱ and Ⅰ depending on three group were analyzed at 1 month, 3 months and 6 months after onset using Linear by linear association. Results : At 1 month, 3 months and 6 months after onset, both recovery rate to House- Brackmann grade Ⅱ and Ⅰ had a tendency to be decreased statistically significantly in order of normal, delayed and absent group. Conclusions : We could find feasibility of blink reflex as a prognostic factor of peripheral facial palsy. Further study will be necessary.

미만성 축색 손상 환자에서의 안륜근 반사

조근열,김현동,황윤성 大韓再活醫學會 1997 Annals of Rehabilitation Medicine Vol.21 No.6

하치조신경 손상시 Mento-Blink Reflex의 진단적 의의

이청기,황정혜,이경아 大韓再活醫學會 1999 Annals of Rehabilitation Medicine Vol.23 No.5

Utilization of Averaging Process of Blink Reflex to Improve Diagnosis of Facial Nerve Palsy

Jong-kyun Yoo,Jeong-hee Cho,Dea-sik Kim 대한의생명과학회 2012 Biomedical Science Letters Vol.18 No.4

The conventional blink reflex has limited clinical application since it displays a wide range of change in the responses. Thus, we studied the blink reflex using the averaging process which is engaged in evoked potential studies in order to measure various responses such as latency, amplitude, and duration, which have been difficult to measure due to their wide ranges of changes. Among the Bell"s palsy patient group, 13 patients who had the symptoms of incomplete palsy were examined to assess the results of the blink reflex through the averaging process. The subjects were 54 people in a normal group (108 eyes) and 18 patients (36 eyes) with Bell"s palsy. For the study method, the conventional blink reflex and the blink reflex using the averaging process were measured for the people in the normal group, while in the Bell"s palsy group, only the blink reflex using the averaging process was analyzed. In the case of the normal group, the blink reflex using the averaging process could measure all of the latency, amplitude, and duration. It was also observed that the latency, amplitude, and duration of R1, ipsilateral R2, and contralateral R2 significantly differed on the affected side of the Bell"s palsy patients, compared to the unaffected side. The blink reflex using the averaging process should be more effective than the conventional method since the former can evaluate the latency, amplitude, and duration for Bell"s palsy, while the latter can only assess latency.

Evaluation of Trigeminal Nerve Involvement Using Blink Reflex Test in Bell’s Palsy

손은진,Ki Bong Lee,김지훈,Yoon-Ah Park,박윤길,Won Sang Lee 대한청각학회 2011 Journal of Audiology & Otology Vol.15 No.3

Background and Objectives: Facial nerve dysfunction in Bell's palsy is evaluated using various parameters including physical examination and electrophysiological studies. Associated symptoms of facial numbness or paresthesia are reported by some patients with Bell's palsy. The aim of this study was to investigate trigeminal nerve involvement in Bell's palsy using blink reflex test. Subjects and Methods: Facial nerve and trigeminal nerve functions were assessed using House-Brackmann (HB) grading system, electroneuronography (ENoG) and blink reflex tests in 28 patients diagnosed as Bell's palsy. Results: HB grades correlated with degeneration ratio from ENoG (p=0.002, chi-square test). The ipsilateral R1 reponse of the blink reflex was absent or abnormal in 27/28 patients (96.4%), and ipsilateral R2 response was absent or abnormal in 26/28 patients (92.8%). Contralateral R2 was abnormal in 5/28 patients (17.8%), suggesting involvement of trigeminal nerve in a portion of patients. The results of blink reflex test showed no significant correlation to the outcome of facial nerve function (HB grade) in Bell's palsy patients. Conclusions: Blink reflex test provides information about trigeminal and facial nerve functions in addition to ENoG results. Our study suggests that subclinical involvement of trigeminal nerve may accompany facial nerve dysfunction in Bell's palsy. Introduction Bell's palsy is the most common cause etiology of acute facial nerve palsy occurring in about 10-30 per 100,000 of the general population.1) Since the facial nerve is primarily a motor nerve, dysfunction of the seventh cranial nerve is usually evident by limitation of voluntary movements by facial expression muscles. Taste disturbance from the small sensory component through the chorda tympani may be present. Some patients also complain of facial numbness or paresthesia, not confined to the postauricular area related to the auricular sensory branch, but on the lateral side of the face. Such symptoms may be related to trigeminal nerve involvement. Electrophysiological studies are widely utilized in facial palsy patients in addition to physical examination of voluntary movements. Nerve excitability test (NET) and electroneuronography (ENoG) are widely used to assess the functional status and to predict the outcome.2,3,4) The blink reflex (BR) is a polysynaptic reflex responseof the orbicularis oculi muscle elicited by electricalstimulation of the supraorbital nerve and is mediated by the afferent trigeminal nerve, the brainstem and the efferent facial nerve. The BR test can be used to evaluate the function of the involved nerves.5,6) The BR responses consist of two different temporaryresponses: early ipsilateral R1 and late bilateral R2. The R1 is generated through a reflex arc in the ipsilateral part of the brainstem with a direct connection between trigeminal pathway and the facial motor nucleus, and the R2 is presumed to be mediated through polysynaptic interneurons in the lateral reticular formation in the brainstem.7)The aim of this study was to investigate trigeminal nerve involvement in Bell's palsy patients using blink reflex test. Subjects and Methods The clinical data of patients presenting with acute onset unilateral facial nerve palsy to the Yonsei University College of Medicine Gangnam Severance Hospital from between October 2010 to June 2011 were reviewed. Twenty-eight patients who were diagnosed as Bell's palsy and followed up for more than 1 month were included in the study. Exclusion criteria were previous history of facial palsy, Ramsay-Hunt syndrome, traumatic facial palsy, diabetes mellitus, and facial palsy due to central or peripheral nervous system disorders. Bell's palsy was diagnosed when other recognizable causes were ruled out by careful history review, neurological examinations, serological and radiological studies. The facial nerve function was assessed by House-Brackmann (HB) facial nerve grading system at initial presentation and at each follow up visit. Complete recovery to HB grades I or II were considered satisfactory compared to incomplete recovery to HB grades III to IV. Electrophysiological tests were performed using performed using a Viking IV electromyographysystem (Nicolet, Madison, WI, USA) between 3 to 14 days since the onset of facial palsy. On ENoG, supramaximal stimulation of 0.2-ms duration at a rate of 1 Hz was provided through bipolar surface electrodes. Electrodes were placed with the anode just outside the stylomastoid foramen and the cathode in front of the ear lobe and manipulated to obtain the maximal compound action potential amplitude on the display. For recording, the surface disc electrodes were placed in the nasolabial fold. The ground electrode was placed on the lower jaw. Peak-to-peak amplitudes of ENoG response on the affected side were compared with those on the unaffected side. Percentage of response amplitude on the affected side compared with that on the unaffected side was designated the degeneration ratio (DR) value for the patient. For evaluation of trigeminal nerve function, BR tests were performed. In BR testing, 18-mA stimulation of 0.2-ms duration was applied via the supraorbital margin, and responses of the orbicularis oculi muscles were recorded through surface disc electrodes. The responses of both sides were recorded (i...

신경과 질환의 체성감각 유발 순목반사

차재관,김상호,김재우 대한신경과학회 1998 대한신경과학회지 Vol.16 No.5

안면마비 회복 예측에서 순목 반사의 역할

표소은,박윤길,박진영,이주원 대한근전도전기진단의학회 2018 대한근전도 전기진단의학회지 Vol.20 No.1

Objective To determine whether blink reflex can be used as a prognosis test for Bell’s palsy and whether it can complement the limitations of electroneurography (ENoG) as a prognostic test for Bell’s palsy. Methods This retrospective study included 99 patients diagnosed with Bell’s palsy from August 2011 to January 2017. Findings of clinical examination of facial nerve function were recorded using the House-Brackmann scale at the initial visit and follow up examination was done at the second and third visit. Electrophysiological evaluations were performed using blink reflex and ENoG tests within one month of Bell’s palsy onset. Clinical data were analyzed using Student’s T- and Chi-square tests. Results Acceptable left side R1, R2 and abnormal right side R2 latencies or abnormal left side R1, R2 and acceptable right side R2 latencies of the blink reflex and poor clinical recovery measured by the House-Brackmann grade of patients with Bell’s palsy showed a statistically significant correlation (p = 0.009). Likewise, in patients with an ENoG degeneration ratio less than 90%, Acceptable left side R1, R2 and abnormal right side R2 latencies or abnormal left side R1, R2 and acceptable right side R2 latencies of the blink reflex and poor clinical recovery from Bell’s palsy showed statistical significance (p = 0.015). Conclusions Blink reflex could be a prognostic factor for clinical recovery in patients with Bell’s palsy. Furthermore, blink reflex could complement the limitations of ENoG as a prognostic test.