ANSIscope: Early detection of ANS breakdown can save diabetics

G Srinivas Roopi - Chennai

As the technology in healthcare is increasingly becoming important, newer and newer instruments are coming into market. The use of machines is playing a major role from diagnosis to cure.

“Right diagnosis is half cure. And if it is done early, even serious illnesses like heart attack can be avoided,” says, Srini Nageshwar, a first batch Madras IITian who spent over four decades in computer industry and finally came up with an instrument that can measure the so-far immeasurable - the parasympathetics. He claims that ANSIscope can detect any minute changes in Autonomic Nervous System (ANS) and can facilitate early action to avert its breakdown particularly in diabetes patients.

“Your autonomic nervous system is the part of your nervous system that functions to sustain your life by controlling your heart, lungs, digestive system, blood pressure, immune system, certain of your reflexes, fluid balance, pupil diameter, sweating, and sexual function,” explains Nageshwar.

Nageshwar’s US-based company – Dyansys – has developed ANSIscope, combining mathematics with medical science. He has a long career in the computer industry, including a 25-year stint with HP in the US and Europe and an eight-year stint as the European CEO with Iomega.

According to Nageshwar, “The parasympathetic nervous system can change faster than the sympathetic nervous system. As the sympathetics start to mediate a stress response the parasympathetics immediately begin to counter it. If the parasympathetics were not faster than the sympathetics, then any stress response could send the heart into tachycardia and onto ventricular fibrillation before the parasympathetics could act to prevent it.”

The parasympathetics, through the Vagus, are the main controlling influence on respiratory activity. Increases in respiratory analysis are caused by increases in parasympathetic tone. Parasympathetic input to the heart is through fibers that synapse deep in the myocardium. Sympathetic influence on the heart is through surface synapses.

Due to this arrangement the parasympathetics are more sensitive to heart damage (i.e., infarct, ischemia, or cardiomyopathies). Since the parasympathetics are faster to respond, it is usually the branch that is first to indicate changes in health status anywhere in the body.

Autonomic dysfunction or dysautonomia is defined as a disorder of the autonomic nervous system, which is due to abnormalities of one or both of its sub-systems. The ANS influences every cell in the body through its two branches: the sympathetic nervous system (sympathetics) and the parasympathetic nervous system (parasympathetics). The sympathetic and parasympathetic branches of the ANS work together to maintain homeostasis. The ANS controls the heart rate and many other vital functions. A disorder of such a system may be silent and can cause sudden death if not detected early. In the case of diabetes, dysautonomia is due to damage of the nerve fibers of the autonomic system caused by glucose.

In general, the sympathetics are responsible for mediating energy expenditure, while the parasympathetics are responsible for energy conservation and restoration. The sympathetics mediate the “fight or flight” response and the body’s response to stress, pain, and cold. Thus, the sympathetics cause higher heart rates and respiratory rates, shunting blood from the extremities to core organs and muscles, etc.

The parasympathetics mediate resting states after meals and at night, digestion and nutrient storage, and recovery states by helping to co-ordinate immune responses and healing. Thus, the parasympathetics cause slower heart rates and respiratory rates, sleep, increased gastrointestinal track motility, increased peripheral vascular flow, blood flow to all cells, liver and kidneys, and venous return to the heart.

How does the ANSiscope reflect this? Since the ANSiscope measures the activities of the parasympathetic and sympathetic systems with every new heart beat, it further becomes possible to integrate the way these two systems function together, how well they interact. Based on the measurement of these activities, the ANSiscope offers a specific measurement of autonomic dysfunction.

How is the measurement made? The patient is required to lie down without any external stimulation. The ECG electrodes are connected to the body and readings for 500 heartbeats are taken, spanning around five to 10 minutes. At the end of it the ANSiscope displays two pieces of information. First, a percentage of autonomic dysfunction and the second, a classification of the patient according to the percentage of dysfunction. Because the ANSiscope is able to make this measurement, it is an excellent tool for the prevention of the complications of diabetes. Many endocrinologists have said that it is possible to treat this condition if it is detected early enough.

What are the areas of application of ANSiscope? First and the foremost is diabetes. A recent WHO report released in Geneva projected that over 330 million people will be affected by Diabetes by the year 2030. Currently, an estimated 17 million people suffer from diabetes in the US alone. In India, because of marriages between close blood relatives and some other reasons like obesity, the number of diabetic patients has reached over 40 million. It is estimated that between 40 - 60 per cent of these patients suffer from Diabetic Autonomic Neuropathy - the most serious and silent consequence of diabetes. In such cases, cardiac consequences are the cause for a 50 per cent mortality rate over the following five years.

Currently, there is no testing done to detect autonomic neuropathy, especially outside the US. The American Diabetes Association has recommended HRV testing on annual basis as early as 1988, however, because the tests were time-consuming, not easily done and inaccurate, testing is not widespread. The ANSiscope is a quick and painless way of diagnosing Diabetic Autonomic Neuropathy (DAN) early and can become a standard test in such cases. The machine gives a reading of neuropathy and the patient can be monitored over time to determine if the neuropathy is stabilising or advancing.

The ANSiscope display on the monitor shows the measurement. The healthy person has a balance that tends towards the parasympathetic pole, reflecting the fact the healthy people have a parasympathetic predominance. The patient with DAN shows a huge sympathetic predominance, as with any misbalanced ANS condition, and a balance that flares out a lot.

Furthermore, by comparing the indices between the two cases, it shows very clearly that there is high sympathetic activity in the DAN patients. The healthy person has both components working nicely in tandem, whereas in the case of the DAN patient, we can measure an early absence of coupling.

For diabetic patients with DAN, the ANSiscope can give very early detection of the autonomic dysfunction and diagnosis of DAN. It can allow patients to start treatments a lot earlier than usual, thus providing doctors an opportunity to retard/control this complication of diabetes. With its exact and real-time measurement, it can also be used by drug companies to develop drugs to combat DAN.

The ANSiscope offers invaluable help for patients in the areas of anesthesiology wherein dosage needs to be patient-specific and find safer procedures to dose drugs while anaesthetising a patient. The instrument also can be of great use in cardiology to risk stratifying patients.

“We have developed the instrument using commonly available computer parts and are planning to make it available even in rural areas by keeping its price as low as Rs 25, 000,” said Nageshwar adding that negotiations are going on with Philips, GE and Siemens for the commercial production of the instrument.