Somatosensory-evoked blink reflex in peripheral facial palsy



Somatosensory-evoked blink reflex (SBR) is an eye blink response obtained from electrical stimulation of peripheral nerves or the skin area of the body away from the face.


The aim of this study was to investigate the presence of SBR in peripheral facial palsy (PFP) and its relation with clinical and electrophysiological changes occurring in PFP as compared with postfacial syndrome (PFS).

Setting and design

This was a single-center, public hospital-based electromyography laboratory study. It was designed as a cross-sectional examination of consecutive patients with PFP and PFS and apparently healthy volunteers.

Patients and methods

The study included 25 patients with PFP, 25 patients with PFS, and 31 healthy volunteers. Facial nerve motor conduction, trigeminal blink reflex, and SBR were studied.

Statistical analysis

Quantitative data were compared using the Mann–Whitney test and the Kruskal–Wallis test. Qualitative data were analyzed using Pearson’s Chi-square test.


SBR was elicited in 67.7% of controls, in 68% of PFS patients, and in 32% of PFP patients. In the PFP group, SBR was found on the nonparalytic side in 28% of patients with paralyzed side stimulation and in 24% of patients with healthy side stimulation. For the PFS group, SBR was found on the nonparalytic side in 48%. Bilateral SBR elicitability was higher than its unilateral elicitability.


SBR occurs in patients with PFP and PFS and in healthy individuals. It has no relation with the clinical and electrophysiological changes occurring in PFP and PFS. Increased brainstem interneurons excitability is not essential to generate SBR. The hypothetical sensory-motor gating mechanism could be responsible for SBR generation.


  1. 1

    Miwa H, Nohara C, Hotta M, Shimo Y, Amemiya K. Somatosensoryevoked blink response: investigation of the physiological mechanisms. Brain 1998; 121:281–291.

    Article  Google Scholar 

  2. 2

    Esteban A. A neurophysiological approach to brainstem reflexes. Blink reflex. Neurophysiol Clin 1999; 29:7–38.

    CAS  Article  Google Scholar 

  3. 3

    Miwa H, Imamura N, Kogahara K, Ohori T, Mizuno Y. Somatosensory evoked blink response: findings in patients with Miller Fisher syndrome and in normal subjects. J Neurol Neurosurg Psychiatry 1995; 58:95–99.

    CAS  Article  Google Scholar 

  4. 4

    Cha JK, Kim SH, Kim JW. Somatosensory Evoked Blink Reflex in neurologic diseases. J Korean Neurol Assoc 1998; 16:660–665.

    Google Scholar 

  5. 5

    Erdemir-Kiziltan M, Uzun N, Kiziltan G, Karaali-Savrun F. Somatosensory evoked blink response in hemifacial spasm and peripheral facial palsy. Electromyogr Clin Neurophysiol 2005; 45:203–207.

    CAS  PubMed  Google Scholar 

  6. 6

    Erkol G, Kiziltan ME, Uluduz D, Uzun N. Somatosensory eye blink reflex in peripheral facial palsy. Neurosci Lett 2009; 460:201–204.

    CAS  Article  Google Scholar 

  7. 7

    Ozgur A, Semai B, Hidir UU, Mehmet Fatih O, Tayfun K, Zeki O. Which electrophysiological measure is appropriate in predicting prognosis of facial paralysis? Clin Neurol Neurosurg 2010; 112:844–848.

    Article  Google Scholar 

  8. 8

    Valls-Solé J, Valldeoriola F, Tolosa E, Marti MJ. Distinctive abnormalities of facial reflexes in patients with progressive supranuclear palsy. Brain 1997; 120:1877–1883.

    Article  Google Scholar 

  9. 9

    Syed NA, Delgado A, Sandbrink F, Schulman AE, Hallett M, Floeter MK. Blink reflex recovery in facial weakness: an electrophysiologic study of adaptive changes. Neurology 1999; 52:834–838.

    CAS  Article  Google Scholar 

  10. 10

    Lew HL, Tsai S. Pictorial guide to nerve conduction techniques. In: Pease WS, Lew HL, Johnson EW, editors. Practical electromyography. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2007;213–255.

    Google Scholar 

  11. 11

    SPSS. Statistical package of social science, version 17. London: University of Cambridge; 2007.

    Google Scholar 

  12. 12

    Miwa H, Yamaji Y, Abe H, Mizuno Y. Evaluation of the somatosensory evoked blink response in patients with neurological disorders. J Neurol Neurosurg Psychiatry 1996; 60:539–543.

    CAS  Article  Google Scholar 

  13. 13

    Cattaneo L, Chierici E, Pavesi G. Bell’s palsy-induced blepharospasm relieved by passive eyelid closure and responsive to apomorphine. Clin Neurophysiol 2005; 116:2348–2353.

    Article  Google Scholar 

  14. 14

    Chuke JC, Baker RS, Porter JD. Bell’s palsy-associated blepharospasm relieved by aiding eyelid closure. Ann Neurol 1996; 39:263–268.

    CAS  Article  Google Scholar 

  15. 15

    Valls-Solé J, Cammarota A, Alvarez R, Hallett M. Orbicularis oculi responses to stimulation of nerve afferents from upper and lower limbs in normal humans. Brain Res 1994; 650:313–316.

    Article  Google Scholar 

  16. 16

    Oge AE, Yayla V, Demir GA, Eraksoy M. Excitability of facial nucleus and related brain-stem reflexes in hemifacial spasm, post-facial palsy synkinesis and facial myokymia. Clin Neurophysiol 2005; 116:1542– 1554.

    Article  Google Scholar 

  17. 17

    Evinger C, Bao JB, Powers AS, Kassem IS, Schicatano EJ, Henriquez VM, Peshori KR. Dry eye, blinking, and blepharospasm. Mov Disord 2002; 17(Suppl 2):75–78.

    Article  Google Scholar 

  18. 18

    Manca D, Muñoz E, Pastor P, Valldeoriola F, Valls-Solé J. Enhanced gain of blink reflex responses to ipsilateral supraorbital nerve afferent inputs in patients with facial nerve palsy. Clin Neurophysiol 2001; 112:153–156.

    CAS  Article  Google Scholar 

  19. 19

    Schicatano EJ, Mantzouranis J, Peshori KR, Partin J, Evinger C. Lid restraint evokes two types of motor adaptation. J Neurosci 2002; 22:569– 576.

    CAS  Article  Google Scholar 

  20. 20

    Kimura J. Disorder of interneurons in Parkinsonism. The orbicularis oculi reflex to paired stimuli. Brain 1973; 96:87–96.

    CAS  Article  Google Scholar 

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Corresponding author

Correspondence to Emmanuel K. A. Saba MD.

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El-Tawab, S.S., Saba, E.K.A. Somatosensory-evoked blink reflex in peripheral facial palsy. Egypt Rheumatol Rehabil 42, 94–99 (2015).

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  • blink reflex
  • facial nerve
  • peripheral facial palsy
  • postfacial syndrome
  • somatosensory-evoked blink reflex