title: Eyeball pressure testing in the evaluation of serious bradyarrhythmias in Guillain-Barré syndrome.
abstract: OBJECTIVE
  To investigate the usefulness of eyeball pressure testing (EP) as an indicator for impending serious bradyarrhythmias in patients with Guillain-Barré syndrome (GBS) and its relationship to motor disability.
  
  
  BACKGROUND
  Autonomic dysfunction is a common complication in GBS and accounts for a significant number of deaths. Serious bradyarrhythmias are thought to occur only in severe cases but are difficult to predict.
  
  
  METHODS
  In 13 consecutive patients with GBS aged 29 to 70 years, 156 EP (6 to 19 per patient) were done serially for up to 1 year. Bilateral moderate pressure was manually applied and sustained for 25 seconds or until abnormal bradycardia developed, defined as heart rate below 40 beats per minute. Disability was graded by a score from 0 to 5 (DS).
  
  
  RESULTS
  Four of 13 patients (DS 2/2/3-4/5) showed abnormal sensitivity to EP at least once. In two of them, vagal overreactivity could be demonstrated repeatedly, which gradually resolved within 4 and 10 days. In one patient with a rapid progressive course requiring early cardiopulmonary resuscitation, a highly abnormal EP could be recorded until 1 day after heart arrest. Another patient (DS 3-4) with abnormal EP required cardiac pacing twice because of significant bradycardia. The only other event necessitating pacing occurred in a severely disabled patient (DS 5-4) who never showed abnormal EP.
  
  
  CONCLUSIONS
  Vagal overreactivity could be demonstrated in approximately 30% of our patients. It was not restricted to severe motor impairment and was also present in mild-to-moderately disabled patients. In this regard, EP may be a simple and useful bedside test to indicate an increased risk of developing serious bradyarrhythmias in patients with GBS.
authors.affiliation: Department of Neurology, Julius-Maximilians-Universität Würzburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Flachenecker
authors.forename: W
authors.initials: W
authors.lastname: Müllges
authors.forename: P
authors.initials: P
authors.lastname: Wermuth
authors.forename: H P
authors.initials: HP
authors.lastname: Hartung
authors.forename: K
authors.initials: K
authors.lastname: Reiners
mesh_terms: D000328:Adult; D000368:Aged; D001919:Bradycardia / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D011129:Polyradiculoneuropathy / Q000503:physiopathology*