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Blink reflex recovery cycle distinguishes patients with idiopathic normal pressure hydrocephalus from elderly subjects

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Abstract

Background

The R2 component of blink reflex recovery cycle (R2BRrc) is a simple neurophysiological tool to detect the brainstem hyperexcitability commonly occurring in several neurological diseases such as Parkinson’s disease and atypical parkinsonisms. In our study, we investigated for the first time the usefulness of R2BRrc to assess brainstem excitability in patients with idiopathic Normal Pressure Hydrocephalus (iNPH) in comparison with healthy subjects.

Methods

Eighteen iNPH patients and 25 age-matched control subjects were enrolled. R2BRrc was bilaterally evaluated at interstimulus intervals (ISIs) of 100, 150, 200, 300, 400, 500 and 750 ms in all participants. We investigated the diagnostic performance of R2BRrc in differentiating iNPH patients from control subjects using ROC analysis. Midbrain area and Magnetic Resonance Hydrocephalic Index (MRHI), an MRI biomarker for the diagnosis of iNPH, were measured on T1-weighted MR images, and correlations between R2BRrc values and MRI measurements were investigated.

Results

Fourteen (78%) of 18 iNPH patients showed an enhanced R2BRrc at ISIs 100–150–200 ms, while no control subjects had abnormal R2BRrc. The mean amplitude of bilateral R2BRrc at the shortest ISIs (100–150–200 ms) showed high accuracy in differentiating iNPH patients from controls (AUC = 0.89). R2BRrc values significantly correlated with midbrain area and MRHI values.

Conclusions

This study represents the first evidence of brainstem hyperexcitability in iNPH patients. Given its low cost and wide availability, R2BRrc could be a useful tool for selecting elderly subjects with mild gait and urinary dysfunction who should undergo an extensive diagnostic workup for the diagnosis of NPH.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Code availability

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Alessandro Mechelli and Andrea Quattrone contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy

    Alessandro Mechelli & Andrea Quattrone

  2. Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy

    Rita Nisticò & Aldo Quattrone

  3. Neuroscience Research Centre, University Magna Graecia, Catanzaro, Italy

    Marianna Crasà & Aldo Quattrone

  4. Department of Medical Sciences, Institute of Neurosurgery, University Magna Graecia, Catanzaro, Italy

    Domenico La Torre

  5. Biotecnomed S.C.aR.L., Catanzaro, Italy

    Basilio Vescio

  6. Neuroscience Centre and Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Magna Graecia University, 88100, Catanzaro, Italy

    Aldo Quattrone

Authors
  1. Alessandro Mechelli
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  2. Andrea Quattrone
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Contributions

Conceptualization: AM, AQ, and AQ; methodology: AM, AQ, RN, MC, DLT, and BV; formal analysis and investigation: AM, AQ, RN, MC, DLT, and BV; writing—original draft preparation: AM, and AQ; writing—review and editing: AQ; supervision: AQ.

Corresponding author

Correspondence to Aldo Quattrone.

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Conflicts of interest

The authors declare no financial or other conflict of interest.

Ethics approval

All the study procedures and ethical aspects were approved by the institutional review board of Magna Graecia University, Catanzaro, Italy.

Consent to participate

Written informed consent was obtained from each participant included in the study.

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Not applicable.

Supplementary Information

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Supplementary file1 (DOCX 14 KB)

Supplementary Figure 1.

a Correlation graph between midbrain area (mm2) and mean R2BRrc at ISIs 100–200 ms in the 14 iNPH patients with abnormal blink reflex recovery cycle. b Correlation graph between Magnetic Resonance Hydrocephalic Index (MRHI) and mean R2BRrc at ISIs 100–200 ms in the 14 iNPH patients with abnormal blink reflex recovery cycle. r = correlation coefficient, p = statistical significance (TIFF 9873 KB)

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Mechelli, A., Quattrone, A., Nisticò, R. et al. Blink reflex recovery cycle distinguishes patients with idiopathic normal pressure hydrocephalus from elderly subjects. J Neurol 269, 1007–1012 (2022). https://doi.org/10.1007/s00415-021-10687-3

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  • DOI: https://doi.org/10.1007/s00415-021-10687-3

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