P77-F Blink reflex, approach to examine the brainstem, focused on patients with amyotrophic lateral sclerosis (ALS)

Abstract

Background ALS is an incurable disease, but with the treatment of the symptoms, better quality of life could be achieved. So early diagnosis is important, especially in the case of bulbar sympto Blink reflex examination is a reliable measure of the microstructural brainstem integrity. Our aim was to examine the correlation of the presence of bulbar symptoms in ALS and the findings of blink reflex, to have a new supportive testing which indicates loss of the motor neurons and at the same time find parameters in estimating prognosis. Material and methods Blink reflex findings were analysed between the 1st of June 2018 and 31st of December 2018. R1, ipsi- and contralateral R2 was evaluated. Seven patients fulfilled the International ALS Guideline’s criteria. As a control group healthy adults were recruited. Results Average age was 69 years. The parameters of blink reflex were as follows: the latency of R1 was increased in 42% of the patients ( > 12 ± 0.8 ms) and normal in 58%, the ipsilateral R2 wave’s latency was increased in 71% and in 29% absent, the contralateral R2 wave was absent in 86% and 14% had increased latencies ( > 35.5 ± 3.4 ms). All patients had pathological values of blink reflex showing the damage of brainstem interneurons, although with imaging techniques no abnormality was seen and on physical examination 37.5% of the patients had no bulbar sympto. Conclusion Blink reflex could be a useful tool to support suspected ALS diagnosis, or bulbar involvement and to estimate the prognosis.