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Baseline blink reflex R2 changes correlate with affective and interoceptive domains in functional movement disorders.

Claudia Vinciguerra1, Marialuisa Gandolfi2, Angela Sandri3

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Summary

Functional motor disorders (FMD) show reduced blink reflex (BR) R2-area, indicating altered brainstem excitability. This physiological signature aids in diagnosing FMD, especially when combined with other measures.

Keywords:
Blink ReflexBrainstem excitabilityFunctional-motor-disordersTrait marker

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Area of Science:

  • Neuroscience
  • Neurology
  • Clinical Neurophysiology

Background:

  • Functional motor disorders (FMD) are common neurological conditions with disrupted sensory processing.
  • Abnormal prepulse inhibition of the blink reflex (BR) is noted in FMD, but baseline R2-area remains uncharacterized.
  • The R2-area reflects brainstem excitability and cortical modulation, crucial for understanding FMD pathophysiology.

Purpose of the Study:

  • To investigate baseline BR R2-area in FMD patients versus healthy controls (HC).
  • To explore associations between R2-area and affective/interoceptive factors.
  • To assess the diagnostic potential of R2-area, alone and with laser-evoked potentials (LEPs).

Main Methods:

  • Recorded BR R2-component from 75 FMD patients and 75 matched HC.
  • Quantified R2-area using supraorbital stimulation across ipsilateral, contralateral, and average responses.
  • Utilized logistic regression with LEPs to evaluate diagnostic utility.

Main Results:

  • FMD patients consistently showed a reduced baseline R2-area compared to HC.
  • Worse depressive symptoms correlated with larger R2-areas; reduced body awareness correlated with smaller R2-areas.
  • Baseline R2-metrics, particularly ipsilateral area, achieved 71.1% accuracy in discriminating FMD from HC.

Conclusions:

  • Reduced baseline BR R2-area in FMD suggests altered brainstem excitability and potentially enhanced descending inhibition.
  • Affective and interoceptive factors influence brainstem excitability in FMD.
  • Baseline BR R2-area serves as a key physiological signature for multimodal FMD diagnostic frameworks.