A Longitudinal Cardiovascular Autonomic Function Study in Mild Guillain-Barré Syndrome

Abstract

To identify subclinical autonomic dysfunction in mild Guillain-Barré syndrome (GBS), a set of autonomic function tests was serially performed for up to 6 months in 5 GBS patients with mild disability at the nadir. Parasympathetic autonomic function tests consisted of Valsalva ratio and R-R interval variation during rest and deep breathing. Sympathetic autonomic function was evaluated by blood pressure responses to sustained handgrip, hand immersion in ice water, and active standing. The results showed that abnormal parasympathetic and sympathetic function was frequently encountered in all 5 patients during the acute stage of the illness. Autonomic dysfunction occurred both in axonal and demyelinating types of GBS. There was a trend of improvement in most autonomic function tests after 3 months, comparable to the recovery of motor function. In conclusion, subclinical autonomic dysfunction was present in mild GBS. It was temporary and would resolve spontaneously.

Autonomic dysfunction in Guillain-Barré syndrome and multiple sclerosis

“…Both features may be present even in the same patient. Longitudinal studies of cardiovascular reflex tests have shown that up to 90 % of patients are affected by autonomic failure and that the recovery of autonomic dysfunction parallels the improvement of motor function [16,29]. Power spectrum analysis of heart rate variability indicated that the sympathovagal balance was shifted towards sympathetic function during the acute stages of the disease [8].…”

Quantitative cardiovascular autonomic function study in Fisher syndrome

“…[4][5][6] Autonomic function abnormalities of our patients with FS were highest during the acute stage of neuropathy and improved gradually after 1-3 months. Therefore, autonomic dysfunction in FS is transient and resolves gradually over time, as is seen in GBS.…”

“…6 The autonomic function tests were the Valsalva ratio, RRIV during rest and deep breathing, and BP responses to sustained handgrip (SH) and active standing. During the Valsalva ratio test, the patient was asked to blow into a mouthpiece and maintain a pressure of about 40 mm Hg for 15 seconds.…”

“…3 Longitudinal autonomic function studies have shown that autonomic dysfunction in GBS is temporary and may improve gradually. [4][5][6] Autonomic dysfunction occurs only rarely in FS 7 8 and quantitative data concerning cardiovascular autonomic dysfunction in FS are not available. The purpose of this study was to examine cardiovascular function quantitatively and serially in patients with FS and to assess the clinical significance of the function tests.…”

Teaching cardiac autonomic function dynamics employing the Valsalva (Valsalva-Weber) maneuver

“…This approach has helped characterize particularly the parasympathetic nervous function in healthy subjects and patients with different clinical conditions, such as diabetes mellitus (3,4,9,16,20), systemic arterial hypertension (47), coronary disease (48), heart failure (1, 36), chronic Chagas' disease (2,17,21,22,30,31,34), neurological diseases (7,28,49), and renal failure (15,39), among many others. This approach has helped characterize particularly the parasympathetic nervous function in healthy subjects and patients with different clinical conditions, such as diabetes mellitus (3,4,9,16,20), systemic arterial hypertension (47), coronary disease (48), heart failure (1, 36), chronic Chagas' disease (2,17,21,22,30,31,34), neurological diseases (7,28,49), and renal failure (15,39), among many others.…”