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Neural mapping of prepulse-induced startle reflex modulation as indices of sensory information processing in healthy and clinical populations: A systematic review

Research output: Contribution to journalReview articlepeer-review

Original languageEnglish
JournalHuman Brain Mapping
E-pub ahead of print20 Aug 2021

Bibliographical note

Funding Information: Laura F. Naysmith is funded by Lido CTP Unilever, Biotechnology and Biological Sciences Research Council (BBSRC). Steven C. R. Williams would also like to thank the Wellcome Trust and the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London for their ongoing support of our neuroimaging research. Publisher Copyright: © 2021 The Authors. Human Brain Mapping published by Wiley Periodicals LLC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Startle reflex is modulated when a weaker sensory stimulus ("prepulse") precedes a startling stimulus ("pulse"). Prepulse Inhibition (PPI) is the attenuation of the startle reflex (prepulse precedes pulse by 30-500 ms), whereas Prepulse Facilitation (PPF) is the enhancement of the startle reflex (prepulse precedes pulse by 500-6000 ms). Here, we critically appraise human studies using functional neuroimaging to establish brain regions associated with PPI and PPF. Of 10 studies, nine studies revealed thalamic, striatal and frontal lobe activation during PPI in healthy groups, and activation deficits in the cortico-striato-pallido-thalamic circuitry in schizophrenia (three studies) and Tourette Syndrome (two studies). One study revealed a shared network for PPI and PPF in frontal regions and cerebellum, with PPF networks recruiting superior medial gyrus and cingulate cortex. The main gaps in the literature are (i) limited PPF research and whether PPI and PPF operate on separate/shared networks, (ii) no data on sex differences in neural underpinnings of PPI and PPF, and (iii) no data on neural underpinnings of PPI and PPF in other clinical disorders.

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