AUTONOMIC NERVOUS SYSTEM
Screen, Prevent, and Manage
Autonomic Nervous System (ANS) testing provides a complex assessment of the autonomic nervous system, and identifies the development of cardiometabolic disease, as well is its common comorbidities including, peripheral neuropathy, cardio autonomic neuropathy, and the onset of endothelial dysfunction leading to peripheral arterial disease. It also provides risk stratification for overall cardiometabolic health and cardiovascular disease, as well as providing markers for specific risk factors associated with cardiovascular events such as MI or coronary artery disease. ANS testing is an integral part of preventative medicine as well as the management of diabetics. It also plays a role in the assessment of other disorders that effect the nervous system, and can play a crucial role if diagnosis of patients with multiple symptoms.
The Science of Assessment
The ANS-1 System is an FDA 510K cleared device, which utilizes galvanic skin response, photoplesmography, heart rate variance and BP pulse wave analysis to give you:
- Detection of peripheral neuropathy
- Detection of cardio autonomic neuropathy
- Detection of endothelial dysfunction (onset of PAD/PVD)
- Adjunct in the treatment and management of cardiometabolic health disorders (insulin resistance, diabetes, and cardiovascular disease)
This battery of tests is the testing protocol recommended by the American Academy of Neurology and the American Diabetic Association for the assessment of cardiovascular and diabetic neuropathy in diabetic patients. The ANS-1 System presents the data in an easy to interpret format that can help you risk stratify patients years before they would manifest noticeable physical symptoms. Routine testing, thereafter, can establish the effectiveness of treatment, monitor patients for further disease progression, or provide much needed data prior to planned surgical procedures.
American Academy of Neurology
Examples of the many situations where autonomic testing is of clinical utility include:
- Patients with syncope: Autonomic testing is necessary to differentiate neurally mediated syncope from neurogenic orthostatic hypotension and other causes of syncope.
- Patients with diabetes mellitus: All patients with diabetes are recommended to have autonomic testing (sudomotor, cardiovagal and adrenergic) at diagnosis (type 2 diabetes) or five years after diagnosis (type 1 diabetes).
There is a high prevalence of cardiovascular autonomic neuropathy in the diabetic population. The relationship between autonomic dysfunction and cardiovascular risk has been well documented and is important to monitor for patients planning major surgical procedures or considering moderate to high intensity physical exercise. This is the reason that the ADA recommends autonomic testing for all patients with type 2 diabetes at the time of diagnosis, and all patients with type 1 diabetes five years after diagnosis. The increased perioperative mortality in cardiovascular autonomic neuropathy is linked to greater blood pressure instability and hypothermia.
This information may prompt high-risk patients to forgo an elective procedure or allow the anesthesiologist to prepare for potential hemodynamic changes, thereby reducing the risks of morbidity and mortality.
Christopher H. Gibbons, MD, FAAN
William P. Cheshire Jr., MD, FAAN
Terry D. Fife, MD, FAAN
Approved Model Policy by America Academy of Neurology in July 2014.