Electrophysiological assessment of the cranial reflexes

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Abstract

Electrophysiological assessment methods play a key role in the diagnosis of various neurological disorders. Electrophysiological evaluation of cranial reflexes is particularly valuable for neurologists. This article provides an overview of electrophysiological evaluation methods for cranial reflexes, which are most commonly used in clinical practice. They provide objective assessment of the functional integrity of nervous system structures that make up the cranial reflex arc, identify the level and, in some cases, the nature of disease, as well as pathophysiological mechanisms of central and peripheral nervous system disorders. We describe the instruments and main approaches to analysing the results for the standard blink reflex, blink reflex with prepulse inhibition, blink reflex with paired stimuli and recovery curve evaluation, reflex inhibition of the levator palpebrae superioris, jaw jerk reflex, and reflex inhibition (cutaneous silent period) of the masseter muscle.

About the authors

Yury A. Seliverstov

Research Center of Neurology

Author for correspondence.
Email: doctor.goody@gmail.com
ORCID iD: 0000-0002-6400-6378

Cand. Sci. (Med.), senior researcher, Scientific advisory department

Russian Federation, Moscow

Anna A. Abramova

Research Center of Neurology

Email: doctor.goody@gmail.com
ORCID iD: 0000-0002-7960-1006

neurologist, Scientific advisory department

Russian Federation, Moscow

Konstantin M. Evdokimov

Research Center of Neurology

Email: doctor.goody@gmail.com
ORCID iD: 0000-0001-6217-4151

postgraduate student

Russian Federation, Moscow

Amayak G. Broutian

Research Center of Neurology

Email: doctor.goody@gmail.com
ORCID iD: 0000-0002-6381-2925

Cand. Sci. (Med.), Head, Laboratory of clinical neurophysiology

Russian Federation, Moscow

Marina Yu. Maximova

Research Center of Neurology; A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: doctor.goody@gmail.com
ORCID iD: 0000-0002-7682-6672

D. Sci. (Med.), Prof., Head, 2nd Neurology department, Professor, Department of nervous diseases, Faculty of dentistry

Russian Federation, Moscow; Moscow

Sergey N. Illarioshkin

Research Center of Neurology; A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: doctor.goody@gmail.com
ORCID iD: 0000-0002-2704-6282

D. Sci. (Med.), Prof., Corr. Member of the Russian Academy of Sciences, Deputy director, Head, Department for brain research, Professor, Department of nervous diseases, Faculty of dentistry

Russian Federation, Moscow; Moscow

Mikhail A. Piradov

Research Center of Neurology; A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: doctor.goody@gmail.com
ORCID iD: 0000-0002-6338-0392

D. Sci. (Med.), Prof., Academician of the Russian Academy of Sciences, Director, Head, Department of nervous diseases, Faculty of dentistry

Russian Federation, Moscow; Moscow

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Supplementary files

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2. Fig. 1. Electrode and stimulator placement for blink reflex recording.

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3. Fig. 2. Early (R1) and late (R2) blink reflex responses. The early response is observed only on the ipsilateral side to the stimulation, while the late response occurs bilaterally. Recorded on a Viking EDX machine.

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4. Fig. 3. Levels of brainstem damage identified during blink reflex testing. R1 — early response reflex arc; R2 — late response reflex arc; VI — ab- ducens nerve nucleus; VII — facial nerve nucleus; Vmot — TN motor nucleus; Vpr — TN principal sensory nucleus.

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5. Fig. 4. Correlation between blink reflex areas during inhibition. А — without preliminary inhibition; В — with preliminary inhibition using an electrical stimulus. Recorded on a Viking EDX machine.

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6. Fig. 5. Blink reflex recovery curve.

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7. Fig. 6. Early (SP1) and late (SP2) silent periods of the levator palpebrae superioris muscle (adapted from [3]). А — 3-track overlay of myographic activity of the right levator palpebrae superioris muscle (top) and the right orbicularis oculi muscle (bottom) when the right supraorbital nerve was stimulated (R*). Ipsilateral stimulation caused early (SP1) and late (SP2) silent periods in the levator palpebrae superioris muscle, as well as R1 and R2 in the right orbicularis oculi muscle. B — 3-track overlay of the myographic muscle activity on the right, like in A, when the left supraorbital nerve is stimulated (L*). SP1 may also be registered during contralateral stimulation, unlike R1.

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8. Fig. 7. Electrode placement for recording the jaw jerk reflex.

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9. Fig. 8. Muscle response when evaluating the jaw jerk reflex. The type of response when the jaw jerk reflex is performed is similar to the M-response during the nerve conduction study. Recorded on a Viking EDX machine.

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10. Fig. 9. Electrode and stimulator placement for recording reflex inhibition of the masseter muscle.

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11. Fig. 10. Early (SP1) and late (SP2) silent periods of the masseter muscle. Recorded on a Viking EDX machine.

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Copyright (c) 2021 Seliverstov Y.A., Abramova A.A., Evdokimov K.M., Broutian A.G., Maximova M.Y., Illarioshkin S.N., Piradov M.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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