Reliability of the nociceptive blink reflex evoked by electrical stimulation of the trigeminal nerve

Trigeminal and somatic nociceptive systems were studied in controls ( n = 15), episodic migraine ( n = 16), analgesics ( n = 14) and triptan-induced medication overuse headache (MOH) ( n = 15) before and after withdrawal. Patients with MOH and comorbid depressive symptoms and depression without headache were studied to investigate the influence of depression. Trigeminal nociception was studied by simultaneous registration of pain-related cortical potentials (PREP) and nociceptive blink reflex (nBR) following nociceptive-specific electrical stimulation of the forehead. Somatic nociception was evaluated using PREP of upper limbs. We found facilitation of both trigeminal and somatic PREP but not of nBR in MOH, which normalized after withdrawal. No differences were found comparing analgesics vs. triptan MOH. No differences were observed between controls and patients with episodic migraine and depression without headache. A transient facilitation was found of trigeminal and somatic nociceptive systems in MOH, which was more pronounced on a supraspinal level.

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Low-Frequency Short-Time Nociceptive Stimulation of the Greater Occipital Nerve does not Modulate the Trigeminal System

Cephalalgia ◽

10.1111/j.1468-2982.2008.01612.x ◽

2008 ◽

Vol 28 (8) ◽

pp. 842-846 ◽

Cited By ~ 6

Author(s):

TP Jürgens ◽

V Busch ◽

O Opatz ◽

WJ Schulte-Mattler ◽

A May

Keyword(s):

Low Frequency ◽

Blink Reflex ◽

Trigeminal System ◽

Nociceptive Stimulation ◽

Drug Induced ◽

Occipital Nerve ◽

Nociceptive Blink Reflex ◽

Greater Occipital Nerve ◽

Short Time ◽

Stimulation Of

Occipital stimulation in a small group of refractory chronic migraine and cluster headache patients has been suggested as a novel therapeutic approach with promising results. In an earlier study we have shown that a drug-induced block of the greater occipital nerve (GON) inhibits the nociceptive blink reflex (nBR). Now, we sought to examine the effects of low-frequency (3 Hz) short-time nociceptive stimulation of the GON on the trigeminal system. We recorded the nBR responses before and after stimulation in 34 healthy subjects. Selectivity of GON stimulation was confirmed by eliciting somatosensory evoked potentials of the GON upon stimulation. In contrast to an anaesthetic block of the occipital nerve, no significant changes of the R2-latencies and R2-response areas of the nBR can be elicited following GON stimulation. Various modes of electrical stimulation exist with differences in frequency, stimulus intensity, duration of stimulation and pulse width. One explanation for a missing modulatory effect in our study is the relatively short duration of the stimulation.

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Determining the Pathway of the Blink Reflex through Transcutaneous Electrical Stimulation of the Facial Nerve over the Stylomastoid Foramen

ORL ◽

10.1159/000027698 ◽

1999 ◽

Vol 61 (6) ◽

pp. 350-354 ◽

Cited By ~ 1

Author(s):

Katsuhiko Nakamura ◽

Koichiro Sakamaki ◽

Haruhiko Sizuku ◽

Yasuo Koike

Keyword(s):

Electrical Stimulation ◽

Facial Nerve ◽

Blink Reflex ◽

Transcutaneous Electrical Stimulation ◽

Stylomastoid Foramen ◽

Stimulation Of

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Defensive peripersonal space: the blink reflex evoked by hand stimulation is increased when the hand is near the face

Journal of Neurophysiology ◽

10.1152/jn.00731.2011 ◽

2012 ◽

Vol 107 (3) ◽

pp. 880-889 ◽

Cited By ~ 70

Author(s):

C. F. Sambo ◽

M. Liang ◽

G. Cruccu ◽

G. D. Iannetti

Keyword(s):

Electrical Stimulation ◽

Brain Stem ◽

Median Nerve ◽

Safety Margin ◽

Peripersonal Space ◽

Blink Reflex ◽

Hand Position ◽

Electromyographic Activity ◽

The Face ◽

Stimulation Of

Electrical stimulation of the median nerve at the wrist may elicit a blink reflex [hand blink reflex (HBR)] mediated by a neural circuit at brain stem level. As, in a Sherringtonian sense, the blink reflex is a defensive response, in a series of experiments we tested, in healthy volunteers, whether and how the HBR is modulated by the proximity of the stimulated hand to the face. Electromyographic activity was recorded from the orbicularis oculi, bilaterally. We observed that the HBR is enhanced when the stimulated hand is inside the peripersonal space of the face, compared with when it is outside, irrespective of whether the proximity of the hand to the face is manipulated by changing the position of the arm ( experiment 1) or by rotating the head while keeping the arm position constant ( experiment 3). Experiment 2 showed that such HBR enhancement has similar magnitude when the participants have their eyes closed. Experiments 4 and 5 showed, respectively, that the blink reflex elicited by the electrical stimulation of the supraorbital nerve, as well as the N20 wave of the somatosensory evoked potentials elicited by the median nerve stimulation, are entirely unaffected by hand position. Taken together, our results provide compelling evidence that the brain stem circuits mediating the HBR in humans undergo tonic and selective top-down modulation from higher order cortical areas responsible for encoding the location of somatosensory stimuli in external space coordinates. These findings support the existence of a “defensive” peripersonal space, representing a safety margin advantageous for survival.

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Electrical stimulation of the trigeminal nerve root for the treatment of chronic facial pain

Journal of Neurosurgery ◽

10.3171/jns.1995.83.1.0072 ◽

1995 ◽

Vol 83 (1) ◽

pp. 72-78 ◽

Cited By ~ 27

Author(s):

Ronald F. Young

Keyword(s):

Electrical Stimulation ◽

Pain Intensity ◽

Trigeminal Nerve ◽

Nerve Root ◽

Facial Pain ◽

Content Type ◽

Number Of Patients ◽

Trigeminal Nerve Root ◽

Fine Print ◽

Stimulation Of

✓ Between March 1990 and December 1992, 23 patients with chronic intractable facial pain due to various forms of injury to the trigeminal nerve or nerve root underwent implantation of an electrical stimulating system to treat their pain. All patients had failed previous extensive pain treatment efforts. A monopolar platinum-iridium electrode was implanted on the trigeminal nerve root via percutaneous puncture of the foramen ovale. All patients experienced at least 50% reduction in pain intensity during a period of trial stimulation and underwent internalization of the electrode and connection to a completely implanted pulse generator. Independent assessment of the effect of stimulation was obtained by a specially trained nurse practitioner. Over a mean follow-up period of 24 months, six patients reported nearly complete relief of pain and six others reported at least a 50% reduction in pain intensity using a visual analog scale. Thus, 12 (52%) of the 23 patients achieved 50% or greater reduction in pain intensity. Although changes in the patterns of analgesic medication usage were few, six patients (26%) now experience a normal life style. Only one complication was seen, namely a dislocated electrode, which was easily replaced. Chronic electrical stimulation of the trigeminal nerve root appears to be an easy and safe technique for providing relief of chronic facial pain related to injury to the trigeminal nerve in a significant number of patients.

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