Voluntary, spontaneous, and reflex blinking in Parkinson's disease

Rocco Agostino, Matteo Bologna, Loredana Dinapoli, Bruno Gregori, Giovanni Fabbrini, Neri Accornero, Alfredo Berardelli

Research output: Contribution to journalArticlepeer-review


Blinking, a motor act consisting of a closing and an opening eyelid movement, can be performed voluntarily, spontaneously, and reflexly. In this study we investigated the kinematic features of voluntary, spontaneous, and reflex blinking in patients with Parkinson's disease (PD), OFF and ON dopaminergic treatment. Patients were asked to blink voluntarily as fast as possible. Spontaneous blinking was recorded for a minute during which the subjects just relaxed. Reflex blinking was evoked by electrical stimulation on the supraorbital nerve. Eyelid movements were recorded with the SMART analyzer motion system. Patients OFF therapy paused longer than controls during voluntary blinking but not during spontaneous and reflex blinking. The blink rate tended to be lower in patients OFF therapy than in controls and the spontaneous blinking had abnormally low amplitude and peak velocity. Finally, in patients OFF therapy the excitability of the neural circuit mediating the closing phase of the reflex blinking was enhanced. Dopaminergic treatment shortened the pause during voluntary blinking and increased the blink rate. In PD patients the longer pauses between the closing and opening phase in comparison to normal subjects, suggest bradykinesia of voluntary blinking. PD patients also display kinematic abnormalities of spontaneous blinking and changes in the excitability of the closing phase of reflex blinking.

Original languageEnglish
Pages (from-to)669-675
Number of pages7
JournalMovement Disorders
Issue number5
Publication statusPublished - Apr 15 2008


  • Blink
  • Movement control
  • Parkinson's disease

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Medicine(all)


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