二連刺激法による眼輪筋反射の検討

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The response of the orbicularis oculi muscle to unilateral electrical stimulation of the supraorbital nerve, blink reflex test, provides significant information on both peripheral and central nervous system disorders. The response consists of two discrete components, an early ipsilateral reflex (R1) and a late bilateral reflex (R2). As R1 is a synchronous response with constant latency, it is considered to be a useful indicator of facial and trigeminal nerve disorders. Our previous investigation in healthy subjects using a single pulse stimulus showed that 1) the threshold of R1 was higher than that of R2, 2) the amplitude of R1 was inconstant, 3) R1 was sometimes difficult to evoke.To facilitate R2 response, we examined the blink reflexes with paired stimuli at various intervals. Paired electrical stimuli of 0.3msec pulse duration were percutaneously delivered to the supraorbital nerve with the interval of 5, 10, 20, 40, 60, 80, 100msec.The examination with the interval of 5-10msec was useful to facilitate R1, but did elicit pain. With 20-40msec, R1 was often difficult to recognize because of the superposition of the R1 with polyphasic R2 of conditioning stimulus. In the majority of cases, stimuli with the interval 60-80msec was tolerable and R1 could effectively be facilitated.We also examined the blink reflex by averaging technique to make R1 more visible. Summation of 10 consecutive responses is sufficient for this purpose. Averaging technique is particularly valuable in detecting small R1.To evaluate clinical implications of examination of paired stimulation, seven patients with facial paralysis were examined. All were clinically in the stage of healing. In most cases, examination of the paired stimuli proved to be effective to visualize small or prolonged R1 in cases of facial palsy.

二連刺激法による眼輪筋反射の検討

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