The blink reflex (BR) is integrated at the brainstem; however, it is modulated by inputs from various structures such as the striatum, globus pallidus, substantia nigra, and nucleus raphe magnus but also from afferent input from the peripheral nervous system. Therefore, it provides information about the pathophysiology of numerous peripheral and central nervous system disorders. The BR is a valuable tool for studying the integrity of the trigemino-facial system, the relevant brainstem nuclei, and circuits. At the same time, some neurophysiological techniques applying the BR may indicate abnormalities involving structures rostral to the brainstem that modulate or control the BR circuits. This is a state-of-the-art review of the clinical application of BR modulation; physiology is reviewed in part 1. In this review, we aim to present the role of the BR and techniques related to its modulation in understanding pathophysiological mechanisms of motor control and pain disorders, in which these techniques are diagnostically helpful. Furthermore, some BR techniques may have a predictive value or serve as a basis for follow-up evaluation. BR testing may benefit in the diagnosis of hemifacial spasm, dystonia, functional movement disorders, migraine, orofacial pain, and psychiatric disorders. Although the abnormalities in the integrity of the BR pathway itself may provide information about trigeminal or facial nerve disorders, alterations in BR excitability are found in several disease conditions. BR excitability studies are suitable for understanding the common pathophysiological mechanisms behind various clinical entities, elucidating alterations in top-down inhibitory systems, and allowing for follow-up and quantitation of many neurological syndromes.

Department of Clinical Neurophysiology Division of Medical Imaging Turku University Hospital and University of Turku Postal Box 52 FIN 20521 Turku Finland

Department of Medico Surgical Sciences and Biotechnologies Sapienza University of Rome Polo Pontino ICOT via Franco Faggiana 1668 04100 Latina Italy

Department of Neurology and Center of Clinical Neuroscience Charles University Prague 1st Faculty of Medicine and General University Hospital Prague Kateřinská 30 12800 Prague 2 Czech Republic

Department of Neurology Hochzirl Hospital A 6170 Zirl Austria

IDIBAPS Institut d'Investigacions Biomèdiques August Pi i Sunyer Villarroel 170 08024 Barcelona Spain

Istanbul University Cerrahpasa Cerrahpasa Faculty of Medicine Department of Neurology Division of Neurophysiology Istanbul Turkey

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