3 Reasons Your Patients and Practice Can Benefit From Autonomic Nervous System Testing

3 Reasons Your Patients and Practice Can Benefit From Autonomic Nervous System Testing

How can the physician use this information to help his/her patient?

Physicians get simple and immediate information on small autonomic fiber status and use it in various medical settings.3 Reasons

Proactive monitoring: Medicine is trending towards prevention of the onset of a disease or complication.  Since the long, unmyelinated, sympathetic c-fibers slowly degenerate yet quickly regenerate with changes in a patient’s lifestyle or therapy, physicians can use this information to determine whether or not a patient is “at risk” of developing a complication and take proactive measures with treatment options.

Assessing the level of intensive glycemic control for diabetics.  It is important to determine whether or not a patient has an autonomic neuropathy before prescribing intensive forms of glycemic treatment. Using this quick screening a physician can decide whether or not he/she must perform more specific but time-consuming tests to assess precisely autonomic function in these patients.

Patient drug or lifestyle compliance: Autonomic Nervous System Testing allows a physician to quickly determine sudomotor functioning as a biomarker for peripheral nerve integrity.  Patient compliance can quickly be determined based on how good or how bad their results are.  This information is complimentary to traditional blood based testing, but is extremely fast and offers immediate results.  No subjectivity is introduced via patient verbal responses and quantitative results allow a precise follow-up.

 

Can the Autonomic Nervous System Testing correlate with HbA1c?

3 Reasons Your Patients and Practice Can Benefit From Autonomic Nervous System

HbA1C is used to monitor glycemic levels for the past 3 month’s period. Autonomic Nervous System Testing is not a blood-based test but focuses on assessment of the small C nerve fiber damage.  As such, Autonomic Nervous System Testing is a test that can be performed in complement to HbA1c. In addition small fiber neuropathy in type 2 diabetes especially depends not only on hyperglycemia also on other metabolic disturbances such as hyperlipidemia. There is no strict correlation evidenced between HbA1C and Autonomic Nervous System Testing results.  In research studies performed, it was observed cases where there were significant decreases in ESC results while no difference measured by HbA1c testing was evidenced.

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Are you sure it is diabetes being found using the Autonomic Nervous System Testing?

Small fiber neuropathy has been associated with many medical conditions including glucose dysmetabolism (diabetes or prediabetes). Several recent studies have found a high prevalence of impaired glucose tolerance in patients with peripheral neuropathies with a rate up to 42% in cases initially thought to be idiopathic compared with 14% in the general population (see article on small fiber neuropathy). Furthermore, peripheral neuropathies are not always diagnosed. Depending on the population studied and the diagnostic methods, up to 90% of patients with diabetes have confirmed peripheral neuropathies.

Another study showed that patients with metabolic syndrome were twice as likely to present with neuropathy as those without.

However there are other causes for polyneuropathies: metabolic syndrome, alcoholism, and chemotherapy drug induced neurotoxicity. In all these cases neuropathies are symmetrical as opposed to mononeuropathies which are asymmetrical.

3 Reasons Your Patients and Practice Can Benefit From Autonomic Nervous System Testing

If sweat dysfunction is detected by Autonomic Nervous System Testing, the possibility is high that a lesion of the peripheral autonomic nervous system exists. The cause must be investigated with further clinical assessment and the precise diagnosis confirmed by a more specific (but less sensitive) test, typically glucose based measurements (fasting or post glucose load test i.e. oral glucose tolerance test, OGTT) or HbA1C and lipid profile.