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Blink reflex as a prognostic indicator for patients with prolonged disorders of consciousness: a prospective
Juanjuan Fu1,2, Hui Feng2, Huaping Pan2
1Department of Rehabilitation Meidicine, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China.
BMJ Open
|August 31, 2025
Summary
The R2 component of the blink reflex shows potential as a prognostic indicator for consciousness improvement in patients with prolonged disorders of consciousness (DOC). Higher R2 amplitudes predict better outcomes, aiding in clinical assessment.
Area of Science:
- Neuroscience
- Clinical Neurology
- Rehabilitation Medicine
Background:
- Prolonged disorders of consciousness (DOC) present significant diagnostic and prognostic challenges.
- Accurate prognostication is crucial for guiding clinical management and patient care decisions.
- The blink reflex, a readily assessable neurological response, warrants investigation for its prognostic utility in DOC.
Purpose of the Study:
- To investigate the characteristics of the blink reflex in patients with prolonged DOC.
- To determine the prognostic value of blink reflex components for consciousness improvement.
- To establish the correlation between blink reflex parameters and clinical consciousness scores.
Main Methods:
- A prospective case-control study involving 58 patients with DOC (vegetative state/unresponsive wakefulness syndrome or minimally conscious state) within 3 months of brain injury.
- Electromyography was used to record early (R1) and late (iR2, cR2) blink reflex components at baseline.
- Patients were assessed using the Coma Recovery Scale-Revised (CRS-R) at baseline and followed up for 6 months to determine improvement.
Main Results:
- Patients who improved showed significantly higher R2 mean amplitudes and shorter latencies compared to the non-improved group.
- The ipsilateral (iR2) and contralateral (cR2) late components of the blink reflex were significant predictors of consciousness improvement (AUC 0.78 and 0.76, respectively).
- R2 mean amplitudes demonstrated a significant positive correlation with the baseline Coma Recovery Scale-Revised (CRS-R) total score.
Conclusions:
- The R2 amplitude of the blink reflex is a promising prognostic indicator for consciousness recovery in patients with prolonged DOC.
- Objective electrophysiological measures like R2 amplitude can supplement clinical assessments for prognostication.
- Further research can validate these findings and integrate blink reflex analysis into routine DOC evaluations.
