What is EZSCAN?

  • EZSCAN is a medical device for the early detection of peripheral autonomic neuropathies it can be used to identify people at increased risk of diabetes (pre-diabetes included).

  • This is an alternative method of screening to optimize prevention
    and management of diabetes risk.

Small fiber neuropathy and diabetes

The degeneration of small nerve fibers reduces sweat gland innervation and impairs sudomotor function.

The sweat gland function tests by applying a small direct current to both hand and foot sensor plates.
At a low voltage, the stratum corneum acts as a capacitor, leaving the sweat ducts as the only channel for the transmission of Cl- ions.

EZSCAN provide a score of metabolic risk.

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EZSCAN Result Screen

The degeneration of small nerve fibers reduces sweat gland innervation and impairs sudomotor function.

The sweat gland function tests by applying a small direct current to both hand and foot sensor plates.
At a low voltage, the stratum corneum acts as a capacitor, leaving the sweat ducts as the only channel for the transmission of Cl- ions.

EZSCAN provide a score of metabolic risk.

Visuel-ezscan-screen-results

EZSCAN is used around the world as a screening tool

Large screening population in Netherlands

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More than 10,000 people already tested with EZSCAN

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Large screening population in China

EZ in China7

FAQ

EZSCAN evaluates sudomotor function on the palm of the hands and sole of the feet where the density of sweat glands is maximal. The method is based on an electrochemical reaction between the sweat chloride and the electrodes. A low DC voltage ≤ 4 volts is applied generating a current relative to chloride (ion) flow supplied by the sweat glands and ducts. An Electro Skin Conductance (ESC) is calculated for the hands and feet on this basis of the current and the voltage that is generated. Similarly to the cardiologic stress test for which the exercise is used as a stimulus to capture specific information that is not assessable in resting state, EZSCAN too relies on an electrical stimulus of sweat chloride to capture information about the sweat dysfunction that cannot be diagnosed in usual conditions. For a better understanding see animation on the web site. Because the skin’s stratum corneum acts like an electrical capacitor allowing only the conduction of chloride to pass to the surface hands and feet electrodes via the sweat duct when a low voltage stimulation is applied, we can be certain that we’re targeting the underlying sweat gland and its sympathetic innervations. This underlying theory has been confirmed in a comparative study performed on patients with Cystic Fibrosis (who have high sweat chloride concentration) and controls (see publication by Hubert et al).Your Content Goes Here

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). Further, peripheral neuropathies are not always diagnosed. Depending on certain population and 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: alcoholism, chemotherapy drug induced neurotoxicity. In all these cases neuropathies are symmetrical as opposed to mononeuropathies which are asymmetrical. If sweat dysfunction is detected by EZSCAN, the possibility is high that a lesion of 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 typical with glucose based measurements (fasting or post charge test i.e. oral glucose tolerance test, OGTT) or HbA1C and lipid metabolism.

Reproducibility is critical for any screening test to be useful. EZSCAN has been tested for reproducibility in several clinical studies on large groups of patients with 5% coefficient of variation for feet ESC and 10% for hands ESC, which is excellent in an en-vivo environment. The reproducibility between measurements performed before and after an exercise is also excellent (see below). Analyzing dynamic chloride-ionic flow of the sweat glands when stimulated by current that are high comparatively to physiologic current (between 1 and 4 V vs mV) provides better information as compared to methods based on sweat volume since chloride concentrations do not change with sweat rate (see article by Quinton et al on web site) Also noteworthy is that the reproducibility of EZSCAN is significantly better than HbA1c (especially finger methods) or the oral glucose tolerance test (both HbA1c and OGTT have an effective reproducibility rate of about 20%). For more information about the reproducibility and robustness of these tests, refer to the article of P Schwarz and et al (accepted for publication in British Journal of Diabetes and Vascular Diseases).

The effect of treatments is a key point and is under investigation. A preliminary study comparing a small group of patients comparable for age and BMI with or without pioglitazone has shown that patients receiving pioglitazone had higher feet ESC although a longer diabetes duration. This preliminary study will be extended on a larger group of patients with measures performed before pioglitazone administration and after 3 or 6 months with pioglitazone. The effect of other diabetes treatments will be tested. Small C fibers innervating sweat glands are sympathetic fibers, and rely on acetylcholine to support neurotransmitter function. The effect of treatment that could act on sympathetic nervous system (i.e. beta-blockers that are not specific for the heart) has not been yet tested. In the same way the effect of atropinic agents has not yet be tested. These agents are known to decrease sweat rate and have been shown to negatively influence other sudomotor function tests such as QSART (Quantitative Sudomotor Axon Reflex Testing) that are based on sweat rate, as opposed to EZSCAN which do not depend on sweat rate.

The effect of treatments is a key point and is under investigation. A preliminary study comparing a small group of patients comparable for age and BMI with or without pioglitazone has shown that patients receiving pioglitazone had higher feet ESC although a longer diabetes duration. This preliminary study will be extended on a larger group of patients with measures performed before pioglitazone administration and after 3 or 6 months with pioglitazone. The effect of other diabetes treatments will be tested. Small C fibers innervating sweat glands are sympathetic fibers, and rely on acetylcholine to support neurotransmitter function. The effect of treatment that could act on sympathetic nervous system (i.e. beta-blockers that are not specific for the heart) has not been yet tested. In the same way the effect of atropinic agents has not yet be tested. These agents are known to decrease sweat rate and have been shown to negatively influence other sudomotor function tests such as QSART (Quantitative Sudomotor Axon Reflex Testing) that are based on sweat rate, as opposed to EZSCAN which do not depend on sweat rate.

Given sweat rate changes with exercise it was important to evaluate the effects of exercise on EZSCAN tests. Measurements were performed before and after high level exercise on more than 100 subjects. They evidenced a coefficient of variation of 13 % for the hands and of 4% for the feet between these two measurements. These results confirm that EZSCAN measurements performed by don’t depend on sweat rate.[/su_spoiler] [su_spoiler title=”Does gender play a factor in the results?”] Evaluation of sudomotor function using other tests such as QSART has shown generally lower measures (in sweat output) in women compared with those on men. This can be explained by lower sweat rates in women. Measurements performed by EZSCAN don’t depend on sweat rate. A study performed on more than 500 women and more than 200 men show no significant differences in hands’ and feet’ ESC. This will be confirmed in future pending studies on larger group populations.

Blood pressureinfluences local vascularisation. Chronic high blood pressure levels induce micro vascular lesions potentially affecting the renal function. Sweat glands representing small nephrons and comparable lesions could be observed in both apparatus. In addition high chronic levels of blood pressure are a risk factor and impact sudomotor function as evidenced by several methods (QSART, skin biopsies….) (see article by Low et al). With high chronic levels of blood pressure, a decrease in ESC is expected given the relationship with sweat dysfunction. High acute blood pressure levels should not affect EZSCAN measurements as EZSCAN does not depend on sweat rate.

EZSCAN is an objective measurement unlike the use of questionnaires which depend on a patient’s understanding of the questions and subjectivity. Questionnaires need to be adapted to target the screened population. The EZSCAN risk score (classified into at-risk/moderate risk/no-risk color coded quadrants) can greatly help the patient and physician visualize the results. EZSCAN is quantitative so it can be used for the follow-up of the subject to evaluate their improvement when involved in a prevention program. EZSCAN provide a simple and easy user interface (e.g., using color classification) that can make for a useful tool – for example in displaying an improve change in risk score/health status could be highly motivating for a patient undergoing intervention/treatment. For patients involved in a training program, usual tools or the follow-up, weight, waist the only parameters that will change in a questionnaire need time to go down that can decrease motivation of the subject.

The EZSCAN score, calculated from hands and feet ESC values relies on the following parameters:

  • comparison between hands and feet patterns
  • demographic data (age and BMI)

The algorithm was developed and refined through numerous clinical studies and is continuously improved with new data.[/su_spoiler] [su_spoiler title=”What is the shelf life of the electrodes?”] Electrodes are made of stainless steel with high Nickel grade, so they are more resistant to corrosive influences. Their shelf-life depends on how often they are used and how good their cleaning is done. Cleaning must be performed after each patient using the proper ANIOS cleaner product. This cleaning is necessary

  1. to respect hygiene and safety standards
  2. to stop the corrosion process being initiated by electrochemical reaction

In one French hospital in which the EZSCAN system has experienced moderately heavy use, the electrodes are still functional and performing satisfactorily even after 5 years. A large study is ongoing in Netherlands with more than 15000 people tested with 4 devices (electrodes are still in service).

EZSCAN Publications

If you wish to receive more information about one of our publications below, please click here to send us an email. Don’t forget to specify the full title of the publication you are interested in.

EZSCAN

Zhu L, Zhao X, Zeng P, Zhu J, Yang S, Liu A, Song Y. Study on autonomic dysfunction and metabolic syndrome in Chinese patients. J Diabetes Investig. 2016 Nov; 7(6): 901–907. Full article

Bajaj S, Tiwari A, Chaurasia AK, Shukla RP. Detection of microvascular complications of type 2 diabetes by EZSCAN and its comparison with standard screening methods. J. Evid. Based Med. Healthc. 2016; 3(66), 3579-3583. Full article

Schwarz P. Screening and prevention of diabetes. Der Internist. 2015;56(10):1124-1133. Abstract here

Chen X, Chen L, Ding R, Shi Q, Zhang Y, Hu D. A preliminary investigation of EZSCAN™ screening for impaired glucose tolerance and diabetes in a patient population. Exp Ther Med. 2015 May;9(5):1688-1694. Full article

Sanchez Hernandez OE, Papacostas-Quintanilla H, Vilier A, Calvet JH, Jiménez Osorio A , Sánchez Trampe BI, Musalem Younes C, Rodriguez-Arellano ME. EZSCAN as a Screening Tool for Prediabetes and Diabetes in a Large Mexican Population. J Diabetes Metab 6:505. doi: 10.4172/2155-6156.1000505. Full article

Sun W, Zhang D, Sun J, Xu B, Sun K, Wang T, Ren 2, Li J, Chen Y, Xu M, Bi Y, Xu Q, Wang W, Gu Y, Ning G. Association between non-alcoholic fatty liver disease and autonomic dysfunction in a Chinese population. QJM 2015;108(8):617-24. Abstract here

Zeng Q, Dong SY, Wang ML, Xiang H, Zhao XL. Association of EZSCAN Values with Arterial Stiffness in Individuals without Diabetes or Cardiovascular Disease. Plos one 2014 Mar 3;9(3):e90854. doi: 10.1371/journal.pone.0090854. Full article

Parfentyeva E, Saha S, Hjellset VT, Kopprasch S, Schwarz PE. Assessment of Small C-Fiber Status for Screening of Oxidative Stress in Patients at Risk of Diabetes.Horm Metab Res 2014;46(5):360-4. Abstract here

Sun J, Zhang Y, Xu B, Lv X, Ding L, Chen Y, Sun W, Lu J, Xu M, Bi Y, Ning G. Autonomic dysfunction assessed by EZSCAN and subclinical atherosclerosis. J Diabetes 2014;6(5):409-16. Abstract here

Müller G, Olschewski J, Stange T, Hjellset VT, Bornstein S, Schwarz PE. Non-invasive Screening of Diabetes Risk by Assessing Abnormalities of Sudomotor Function. Exp Clin Endocrinol Diabetes 2013; 121: 1–5. Abstract here

Müller G, Parfentyeva E, Olschewsky J, Bornstein SR, Schwarz PE. Assessment of small fiber neuropathy to predict future risk of type 2 diabetes. Primary Care Diabetes 2013;7(4):269-73. Abstract here

Chen L, Chen X, Ding R, Shi Q Jr, Hu D. Evaluation of EZSCAN as a screening tool for impaired glucose metabolism. Diabetes Research & Clinical Practice 2013;100 (2):210-4. Abstract here

Yang Z, Xu B, Lu J, Tian X, Li M, Sun K, Huang F, Liu Y, Xu M, Bi Y, Wang W.Autonomic test by EZSCAN in the screening for prediabetes and diabetes. Plos one 2013;8(2):e56480. Full article

Sun K, Liu Y, Dai M, Li M, Yang Z, Xu M, Xu Y, Lu J, Chen Y, Liu J, Ning G, Bi Y. Accessing autonomic function can early screen metabolic syndrome. Plos One 2012;7(8). Full article

Sheng CS, Zeng WF, Huang QF, Deslypere JP, Li Y, Wang JG. Accuracy of a novel non-invasive technology based EZSCAN system for the diagnosis of diabetes mellitus in Chinese. Diabetology & Metabolic Syndrome 2011;22;3(1):36. Full article

Ozaki R, Cheung KK, Wu E, Kong A, Yang X, Lau E, Brunswick P, Calvet JH, Deslypere JP, Chan JC. A new tool to detect kidney disease in Chinese type 2 diabetes patients—comparison of EZSCAN with standard screening methods. Diabetes technology & therapeutics 2011;13(9):937-43. Abstract here

Schwarz PE. Brunswick P, Calvet JH. EZSCAN a new tool to detect diabetes risk. British Journal of Diabetes & Vascular diseases 2011;11(4):204-9. Full article

Ramachandran A, Moses A, Shetty S, Thirupurasundari CJ, Seeli AC, Snehalatha C, Singvi S, Deslypere JP. A new non-invasive technology to screen for dysglycemia including diabetes. Diabetes Research & Clinical Practice 2010;88:302-6. Abstract here

Ramachandran A, Moses A, Snehalatha C, Shetty S, Thirupurasundari CJ, Seeli AC. Assessment of sudomotor function to predict future abnormalities of glucose tolerance in at risk population. Journal of Diabetes & Metabolism 2011;2(3):1-4. Full article

NOT REFERENCED ARTICLES

Bouenizabila E, Kakou C, Bauduceau B, Calvet J-H, Carmoi T. Dépistage du diabète de type 2 et de ses complications en Afrique sub-saharienen : la place potentielle de Sudoscan. Médecine des Maladies Métaboliques. 2015 ; 9 : 165-170. Full Article (French)

Bauduceau B, Bordier L. Intérêt pratique de SUDOSCAN, Une technique innovante pour l’exploration de la neuropathie diabétique et le dépistage du diabète. Diabétologie Pratique, Février 2015. Abstract here (French)

Tillier J. N., Le Canuet P, Calvet J.H. Intérêt de Sudoscan pour l’exploration des neuropathies des petites fibres en pratique neurologique courante. Neurologie Libérale. 2015;4 :20-22. (not online)

Calmet A, Ayoub H, Lair V, Griveau S. Diagnostic précoce et non invasif des neuropathies des petites fibres. L’actualité chimique 2014 ;390 :48-49. Abstract here (French)

Mouly C, Hanaire H, Sénard J-M, Gerdelat A, Pavy-Letraon A. SUDOSCAN chez le diabétique, intérêt en pratique clinique. Diabète et obésité 2014 ;9 :186-90. Abstract here (French)

Calvet J-H Sudoscan : une technique innovante pour l’exploration des neuropathies des petites fibres. Neurologie libérale. 02 – avril-mai-juin 2014 :14-16. (No link available)

Bauduceau B, Bordier L. SUDOSCAN et EZSCAN : deux applications pour les diabétiques d’une même technique innovante. Médecine des maladies Métaboliques 2013;7(6). Abstract here (French)

The advantage of
Neuropathy Early Detection

An innovative device for early detection and follow-up
of Autonomic and Small Fiber Neuropathy.

Simple results obtained in 3 minutes.