Biçimveren Mahmut Sami, Karadaş Ömer, Cüce Ferhat
Department of Neurology, Health Sciences University Gulhane Faculty of Medicine, Ankara, Turkey.
Department of Radiology, Health Sciences University Gulhane Faculty of Medicine, Ankara, Turkey.
Acta Neurol Belg. 2025 Apr;125(2):481-487. doi: 10.1007/s13760-025-02729-8. Epub 2025 Jan 22.
Trigeminal neuralgia is a disease characterized by severe facial pain that significantly reduces patients quality of life. Trigeminal neuralgia is subcategorized as idiopathic, classic or secondary. Magnetic resonance imaging is the basis for classification, but neurophysiological tests are also used. Magnetic resonance imaging provides neuroanatomical information and neurophysiological testing provides physiological information about the trigeminal nerve.
Thirty volunteer patients who were diagnosed with trigeminal neuralgia according to the ICHD-3 diagnostic criteria and met the exclusion and inclusion criteria were included. Blink reflex testing was performed after posterior fossa magnetic resonance imaging. Magnetic resonance imaging was evaluated blindly to avoid bias by one radiologist experienced in neuroradiology.
The blink reflex was determined to be abnormal in 26.7% (n = 8) and normal in 73.3% (n = 22) of the patients included in the study. Magnetic resonance imaging revealed no contact with the trigeminal nerve in 53.3% (n = 16) of the patients, whereas 46.7% (n = 14) of the patients had contact with nerves in the cisternal segment. The blink reflex has sensitivity 42.9% and specificity 87.5%, accuracy value of 66.7%, positive predictive value of 75% and negative predictive value of 63.6% with respect to symptomatic mechanic contact.
The blink reflex is a neurophysiologic test that is well tolerated by patients, cost-effective and highly specific in the context of nerve contact in patients with trigeminal neuralgia. The blink reflex is particularly important in the follow-up and evaluation of trigeminal neuralgia patients for whom magnetic resonance imaging is contraindicated.
三叉神经痛是一种以严重面部疼痛为特征的疾病，会显著降低患者的生活质量。三叉神经痛可分为特发性、典型性或继发性。磁共振成像（MRI）是分类的基础，但也会使用神经生理学测试。MRI提供神经解剖学信息，而神经生理学测试提供有关三叉神经的生理信息。
纳入30例根据国际头痛疾病分类第3版（ICHD-3）诊断标准被诊断为三叉神经痛且符合排除和纳入标准的志愿者患者。在后颅窝磁共振成像后进行眨眼反射测试。由一位有神经放射学经验的放射科医生对磁共振成像进行盲法评估以避免偏差。
在纳入研究的患者中，26.7%（n = 8）的患者眨眼反射被判定为异常，73.3%（n = 22）的患者眨眼反射正常。磁共振成像显示，53.3%（n = 16）的患者三叉神经无接触，而46.7%（n = 14）的患者脑池段神经有接触。对于有症状的机械性接触，眨眼反射的敏感性为42.9%，特异性为87.5%，准确性值为66.7%，阳性预测值为75%，阴性预测值为63.6%。
眨眼反射是一种患者耐受性良好、成本效益高且在三叉神经痛患者神经接触方面具有高度特异性的神经生理学测试。眨眼反射在对磁共振成像有禁忌证的三叉神经痛患者的随访和评估中尤为重要。
