title: Cortical control of voluntary blinking: a transcranial magnetic stimulation study.
abstract: OBJECTIVE
  To investigate cortical regions related to voluntary blinking.
  
  
  METHODS
  Transcranial magnetic stimulation (TMS) was applied to the facial motor cortex (M1) and the midline frontal region (Fz) in 10 healthy subjects with eyes opened and closed. Motor-evoked potentials were recorded from the orbicularis oculi (OOC), orbicularis oris (OOR), abductor digiti minimi and tibialis anterior using surface and needle electromyography electrodes. Facial M waves and blink reflex were measured using supramaximal electrical stimulation of the facial and supraorbital nerves.
  
  
  RESULTS
  TMS at Fz elicited 3 waves in OOC with no response in other tested muscles except for the early wave in OOR. Facial M1 stimulation produced only early and late waves. Because of their latencies, shapes, and relationship to coil position and stimulation intensity, early and late waves appeared to be analogous to the facial M wave and R1 component of the blink reflex. The intermediate wave at 6-8 ms latency was elicited in OOC by Fz stimulation with eyes closed.
  
  
  CONCLUSIONS
  Since its latency matches the central conduction time of other cranial muscles and it has characteristic of muscle activation-related facilitation, the intermediate wave is presumably related to cortical stimulation. This result provides evidence that the cortical center for the upper facial movements, including blinking, is not principally located in the facial M1, but rather in the mesial frontal region.
authors.affiliation: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bldg 10/Room 5N226, 10 Center Drive, Bethesda, MD 20892-1428, USA.
authors.forename: Y H
authors.initials: YH
authors.lastname: Sohn
authors.forename: B
authors.initials: B
authors.lastname: Voller
authors.forename: M
authors.initials: M
authors.lastname: Dimyan
authors.forename: A
authors.initials: A
authors.lastname: St Clair Gibson
authors.forename: T
authors.initials: T
authors.lastname: Hanakawa
authors.forename: F E
authors.initials: FE
authors.lastname: Leon-Sarmiento
authors.forename: H Y
authors.initials: HY
authors.lastname: Jung
authors.forename: M
authors.initials: M
authors.lastname: Hallett
mesh_terms: D000328:Adult; D001767:Blinking / Q000502:physiology*; D003391:Cranial Nerves / Q000502:physiology; D004558:Electric Stimulation / Q000379:methods*; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005123:Eye; D005154:Facial Nerve / Q000502:physiology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology; D011930:Reaction Time / Q000502:physiology; D050781:Transcranial Magnetic Stimulation