Abstract
To study the neuroanatomical correlate of involuntary unilateral blinking in humans, using the example of patients with focal epilepsy. Patients with drug resistant focal epilepsy undergoing presurgical evaluation with stereotactically implanted EEG-electrodes (sEEG) were recruited from the local epilepsy monitoring unit. Only patients showing ictal unilateral blinking or unilateral blinking elicited by direct electrical stimulation were included (n = 16). MRI and CT data were used for visualization of the electrode positions. In two patients, probabilistic tractography with seeding from the respective electrodes was additionally performed. Three main findings were made: (1) involuntary unilateral blinking was associated with activation of the anterior temporal region, (2) tractography showed widespread projections to the ipsilateral frontal, pericentral, occipital, limbic and cerebellar regions and (3) blinking was observed predominantly in female patients with temporal lobe epilepsies. Unilateral blinking was found to be associated with an ipsilateral activation of the anterior temporal region. We suggest that the identified network is not part of the primary blinking control but might have modulating influence on ipsilateral blinking by integrating contextual information.
Highlights
IntroductionBlinking is essential for facial expression (emotional blinking) and ocular protection (reflective blinking), but can occur voluntarily, or as conditioned response
Blinking is essential for facial expression and ocular protection, but can occur voluntarily, or as conditioned response
Ipsilateral eyelid contraction was provoked by stimulation in the anterior temporal lobe, including the temporal pole, uncus, amygdala, hippocampus, parahippocampal and fusiform gyrus using an amplitude of 1 to 14 mA, as well as in one patient by stimulation in the fronto-orbital region using an amplitude of 4 mA
Summary
Blinking is essential for facial expression (emotional blinking) and ocular protection (reflective blinking), but can occur voluntarily, or as conditioned response. Brain Topography (2021) 34:698–707 the visual cortex, the cerebellum, the superior temporal lobe, as well as limbic structures (Morecraft et al 2001; Gong et al 2005a) These wide-spread cortical projections and their cortico-cortical interconnections imply that a complex supranuclear network is involved in the context-related regulation of blinking (Muakkassa and Strick 1979; Morecraft et al 2004). This hypothesis is further supported by phenomena like the volitional or emotional facial paralysis, i.e. an impaired voluntary activation of facial muscles but normal activation with emotion and vice versa. We report on epilepsy patients in whom unilateral blinking was induced by ipsilateral cortical stimulation using stereotactically implanted electroencephalography (EEG) electrodes
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