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. 2018 Apr 19;13(4):e0196155.
doi: 10.1371/journal.pone.0196155. eCollection 2018.

Graphical and statistical analyses of the oculocardiac reflex during a non-invasive intracranial pressure measurement

Yasin Hamarat  1 , Laimonas Bartusis  1 , Mantas Deimantavicius  1 , Lina Siaudvytyte  2 , Ingrida Januleviciene  2 , Arminas Ragauskas  1 , Eric M Bershad  3 , Javier Fandino  4 , Jenny Kienzler  4 , Elke Remonda  4 , Vaidas Matijosaitis  5 , Daiva Rastenyte  5 , Kestutis Petrikonis  5 , Kristina Berskiene  6 , Rolandas Zakelis  1
Affiliations

Graphical and statistical analyses of the oculocardiac reflex during a non-invasive intracranial pressure measurement

Yasin Hamarat et al. PLoS One. .

Abstract

Purpose: This study aimed to examine the incidence of the oculocardiac reflex during a non-invasive intracranial pressure measurement when gradual external pressure was applied to the orbital tissues and eye.

Methods: Patients (n = 101) and healthy volunteers (n = 56) aged 20-75 years who underwent a non-invasive intracranial pressure measurement were included in this retrospective oculocardiac reflex analysis. Prespecified thresholds greater than a 10% or 20% decrease in the heart rate from baseline were used to determine the incidence of the oculocardiac reflex.

Results: None of the subjects had a greater than 20% decrease in heart rate from baseline. Four subjects had a greater than 10% decrease in heart rate from baseline, representing 0.9% of the total pressure steps. Three of these subjects were healthy volunteers, and one was a glaucoma patient.

Conclusion: The incidence of the oculocardiac reflex during a non-invasive intracranial pressure measurement procedure was very low and not associated with any clinically relevant effects.

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Conflict of interest statement

Competing Interests: Professor Arminas Ragauskas is an inventor of patented the non-invasive ICP measurement method and a shareholder of Vittamed Neuroscience (Waltham, MA, USA). Arminas Ragauskas, Laimonas Bartusis, Mantas Deimantavicius and Rolandas Zakelis have received financial support from Vittamed Neuroscience (Waltham, MA, USA). Clinical studies were funded by the: European Commission’s Seventh Framework Programme project ‘BrainSafe’ (grant no. 232545), Lithuanian-Swiss Programe project ‘BrainCare’ (grant no. CH-3SMM01/06), European Social Fund under the Global Grant measure (grant no. VP1-3.1-SMM-07-K-03-080), National Space Biomedical Research Institute via NASA NCC9-58, and Center for Space Medicine, Baylor College of Medicine. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Schematic representation of the non-invasive intracranial pressure (ICP) measurement equipment Vittamed 205.
(A) Relevant orbit and brain anatomy in contact with the ICP measurement device. (B) Block diagram of the system control unit. ICA—internal carotid artery; IOA—intracranial part of the ophthalmic artery; EOA—extracranial part of the ophthalmic artery; TCD—transcranial Doppler; Pe—external pressure applied to the ocular globe.
Fig 2
Fig 2. Example spectrograms of pulse waves of blood flow in the ophthalmic artery collected by a transcranial Doppler using different external pressure steps.
(A) 0 mmHg; (B) 48 mmHg. HR—heart rate.
Fig 3
Fig 3. Typical heart rate variation.
(A) A heart rate variation in a healthy volunteer. (B) A pressure increase of 4 mmHg per pressure Pe(t) step (time period of approximately 30 sec each) was used on the ocular globe from 0 mmHg to 48 mmHg.
Fig 4
Fig 4. Histogram of HRdiff (parameter for the detection of the oculocardiac reflex) for subjects from all groups and 870 external pressure steps applied during all of the non-invasive intracranial pressure measurements.
Fig 5
Fig 5. Heart rate (HR) variation at every external pressure step (Pe) applied on the ocular globe in the case of a 10% decrease in the MHR compared to the BHR.
(A) Healthy subject. (B) Glaucoma patient. (C) Healthy subject. (D) Healthy subject.
See this image and copyright information in PMC

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