EYEBALL PRESSURE TESTING IN THE EVALUATION OF SERIOUS BRADYARRHYTHMIAS IN GUILLAIN-BARRE-SYNDROME

Objective: To investigate the usefulness of eyeball pressure testing ( EP as an indicator for impending serious bradyarrhythmias in patients with Guillain-Barre syndrome (GBS) and its relationship to motor disab ility. Background: Autonomic dysfunction is a common complication in G BS and accounts for a significant number of deaths. Serious bradyarrhy thmias are thought to occur only 11 severe cases but are difficult to predict. Methods/Design: In 13 consecutive patients with GBS aged 29 t o 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 he art rate below 40 beats per minute. Disability was graded by a score f rom 0 to 5 (DS). Results: Four of 13 patients (DS 2/2/3-4/5) showed ab normal sensitivity to EP at least once. In two of them, vagal overreac tivity could be demonstrated repeatedly, which gradually resolved with in 4 and 10 days. In one patient with a rapid progressive course requi ring early cardiopulmonary resuscitation, a highly abnormal EP could b e recorded until 1 day after heart arrest. Another patient (DS 3-4) wi th abnormal EP required cardiac pacing twice because of significant br adycardia. The only other event necessitating pacing occurred in a sev erely disabled patient (DS 5-4) who never showed abnormal EP. Conclusi ons: Vagal overreactivity could be demonstrated in approximately 30% o f our patients. It was not restricted to severe motor impairment and w as also present in mild-to-moderately disabled patients. In this regar d, EP may be a simple and useful bedside test to indicate an increased risk of developing serious bradyarrhythmias in patients with GBS.