J Cardiovasc Thorac Res, 2013, 5(4), 179 doi: 10.5681/jcvtr.2013.039 http://jcvtr.tbzmed.ac.ir
Pediatric Guillain-Barré Syndrome and Autonomic Dysfunction Ertugrul Kurtoglu1*, Sevket Balta2, Yasin Karakus1, Erdogan Yasar1 Department of Cardiology, Malatya State Hospital, Malatya, Turkey Department of Cardiology, Gulhane Medical School, Ankara, Turkey
1 2
Commentary
Received: 20 November 2013, Accepted: 1 December 2013
G
uillain-Barré sydrome (GBS), the most common cause of acute childhood paralysis worldwide, is an acute inflammatory demyelinating polyradiculoneuropathy with the ability to affect all myelinated peripheral nerves.1 Heart rate variability (HRV), which is recognized as a quantitative marker of the autonomic nervous system, may be used for the early detection of autonomic dysfunction (AD) in childhood GBS.2 However, other factors such as diabetes mellitus, thyroid disorders, higher body mass index and blood pressure may have a confounding effect on HRV.3,4 In addition, patients who are planned to undergo HRV analysis should also undergo echocardiographic evaluation to exclude valvular (mitral valve prolapsus), myocardial (dilated cardiomyopathy) and congenital (atrial septal defects) abnormalities, all of which may also potentially effect HRV.5,6 Lastly, although frequency domain indices of HRV is usually presented in absolute value of power, the representation of low frequency and high frequency in normalized unit may represent the controlled and balanced behaviour of the sympathetic and parasympathetic branches of the autonomic nervous system.7 These mentioned factors seem to have been overlooked by Samadi et al. in the ‘‘Assessment of Autonomic Dysfunction in Childhood Guillain-Barré reporting AD in half of children with mild GBS with no significant association with disease activity.8
Ethical issues: Not applicable Conflict of interests: The authors declare no conflicts of interest.
References 1. 2. 3. 4. 5.
6. 7.
8.
*Corresponding author: Ertugrul Kurtoglu, E-mail: [email protected] Copyright © 2013 by Tabriz University of Medical Sciences
Sladky JT. Guillain-Barre´ syndrome in children. J Child Neurol 2004;19:191-200. Dimario FJ Jr, Edwards C. Autonomic dysfunction in childhood Guillain-Barré syndrome. J Child Neurol 2012;27:581-6. Kardelen F, Akçurin G, Ertuğ H, Akcurin S, Bircan I. Heart rate variability and circadian variations in type 1 diabetes mellitus. Pediatr Diabetes 2006;7:45-50. Babaoglu K, Altun G, Binnetoğlu K. P-wave dispersion and heart rate variability in children with mitral valve prolapse. Pediatr Cardiol 2011;32:449-54. Karakurt C, Aytemir K, Karademir S, Sungur M, Oğuz D, Ocal B, et al. Prognostic value of heart rate turbulence and heart rate variability in children with dilated cardiomyopathy. Acta Cardiol 2007;62:31-7. Koca B, Bakari S, Oztunç F. Correlation among the heart rate variability indices in healthy children and those with atrial septal defect. Turk Kardiyol Dern Ars 2013;41:193-8. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiologic interpretation and clinical use. Circulation 1996:93:1043–65. Samadi M, Kazemi B, Golzari Oskoui S, Barzegar M. Assessment of Autonomic Dysfunction in Childhood GuillainBarré Syndrome. J Cardiovasc Thorac Res 2013;5:81-5.
Pediatric Guillain-Barré Syndrome and Autonomic Dysfunction Ertugrul Kurtoglu1*, Sevket Balta2, Yasin Karakus1, Erdogan Yasar1 Department of Cardiology, Malatya State Hospital, Malatya, Turkey Department of Cardiology, Gulhane Medical School, Ankara, Turkey
1 2
Commentary
Received: 20 November 2013, Accepted: 1 December 2013
G
uillain-Barré sydrome (GBS), the most common cause of acute childhood paralysis worldwide, is an acute inflammatory demyelinating polyradiculoneuropathy with the ability to affect all myelinated peripheral nerves.1 Heart rate variability (HRV), which is recognized as a quantitative marker of the autonomic nervous system, may be used for the early detection of autonomic dysfunction (AD) in childhood GBS.2 However, other factors such as diabetes mellitus, thyroid disorders, higher body mass index and blood pressure may have a confounding effect on HRV.3,4 In addition, patients who are planned to undergo HRV analysis should also undergo echocardiographic evaluation to exclude valvular (mitral valve prolapsus), myocardial (dilated cardiomyopathy) and congenital (atrial septal defects) abnormalities, all of which may also potentially effect HRV.5,6 Lastly, although frequency domain indices of HRV is usually presented in absolute value of power, the representation of low frequency and high frequency in normalized unit may represent the controlled and balanced behaviour of the sympathetic and parasympathetic branches of the autonomic nervous system.7 These mentioned factors seem to have been overlooked by Samadi et al. in the ‘‘Assessment of Autonomic Dysfunction in Childhood Guillain-Barré reporting AD in half of children with mild GBS with no significant association with disease activity.8
Ethical issues: Not applicable Conflict of interests: The authors declare no conflicts of interest.
References 1. 2. 3. 4. 5.
6. 7.
8.
*Corresponding author: Ertugrul Kurtoglu, E-mail: [email protected] Copyright © 2013 by Tabriz University of Medical Sciences
Sladky JT. Guillain-Barre´ syndrome in children. J Child Neurol 2004;19:191-200. Dimario FJ Jr, Edwards C. Autonomic dysfunction in childhood Guillain-Barré syndrome. J Child Neurol 2012;27:581-6. Kardelen F, Akçurin G, Ertuğ H, Akcurin S, Bircan I. Heart rate variability and circadian variations in type 1 diabetes mellitus. Pediatr Diabetes 2006;7:45-50. Babaoglu K, Altun G, Binnetoğlu K. P-wave dispersion and heart rate variability in children with mitral valve prolapse. Pediatr Cardiol 2011;32:449-54. Karakurt C, Aytemir K, Karademir S, Sungur M, Oğuz D, Ocal B, et al. Prognostic value of heart rate turbulence and heart rate variability in children with dilated cardiomyopathy. Acta Cardiol 2007;62:31-7. Koca B, Bakari S, Oztunç F. Correlation among the heart rate variability indices in healthy children and those with atrial septal defect. Turk Kardiyol Dern Ars 2013;41:193-8. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiologic interpretation and clinical use. Circulation 1996:93:1043–65. Samadi M, Kazemi B, Golzari Oskoui S, Barzegar M. Assessment of Autonomic Dysfunction in Childhood GuillainBarré Syndrome. J Cardiovasc Thorac Res 2013;5:81-5.
