Cranial electrotherapy stimulation
Encyclopedia
Cranial Electrotherapy Stimulation (CES) is an experimental psychiatric treatment that applies a small, pulsed electric current across a patient's head. It has been claimed to have beneficial effects in conditions such as anxiety
, depression
, insomnia
and stress
. However, its effectiveness is still being studied.
" has been in use for at least 2000 years, as shown by the clinical literature of the early Roman physician
, Scribonius Largus
, who wrote in the Compositiones Medicae of 46 AD that his patients should stand on a live black torpedo fish for the relief of a variety of medical conditions, including gout and headaches. Claudius Galen (131 - 201 AD) also recommended using the shocks from the electrical fish for medical therapies.
Low intensity electrical stimulation is believed to have originated in the studies of galvanic currents in humans and animals as conducted by Giovanni Aldini
, Alessandro Volta
and others in the 18th century. Aldini had experimented with galvanic head current as early as 1794 (upon himself) and reported the successful treatment of patients suffering from melancholia using direct low-intensity currents in 1804.
Modern research into low intensity electrical stimulation of the brain was begun by Leduc and Rouxeau in France (1902). In 1949, the Soviet Union expanded research of CES to include the treatment of anxiety
as well as sleeping disorders.
In the 1960s and 1970s, it was common for physicians and researchers to place electrodes on the eyes, thinking that any other electrode site would not be able to penetrate the cranium
. It was later found that placing electrodes on the earlobes was far more convenient, and quite effective.
CES was initially studied for insomnia and called electrosleep therapy; it is also known as Cranial-Electro Stimulation and Transcranial Electrotherapy.
In 1972, a specific form of CES was developed by Dr. Margaret Patterson, providing small pulses of electric current across the head to ameliorate the effects of acute and chronic withdrawal from addictive substances. She named her treatment "NeuroElectric Therapy (NET)".
and the experimenter "knew which patients were receiving CES or sham treatment." Most studies cited as evidence for the effectiveness of CES failed to report all data necessary for meta-analysis.
A bibliography by Kirsch (2002) listed 126 scientific studies of CES involving human subjects and 29 animal studies . An estimated 145 human studies have been completed, encompassing over 8800 people receiving active CES.
A pilot study showed that CES reduced the symptom burden of generalized anxiety disorder, with a decrease in Hamilton Anxiety Rating Scale (HARS) across a 6 week study, but the study had a small sample of participants and no control group.
CES research has been conducted in pain management and the reduction of anxiety in patients undergoing dental procedures..
A 3-week randomized controlled study which looked at insomnia in fibromyalgia
patients found significant improvement in sleeping patterns. In a longitudinal insomnia study, subjects showed improvement of symptoms during a two-year follow-up (p<0.0008).
Studies have found statistically significant results in the treatment of depression with CES.
As a result of the 1976 Medical Device Amendments, CES was placed in Class III by the FDA. Manufacturers who prove both safety and efficacy may enter the market, with FDA clearance, utilizing the 510(k) process instead of the premarket approval process, at this time.
It has been proposed that during CES, an electric current
is focused upon the hypothalamic region
; during this process, CES electrode
s are placed on the ear at the mastoid, near to the face. All modern analysis using computer simulation to predict current flow through the brain, however, suggest that CES has no spatial focality and may result in current passing through most of the brain .
It has been suggested that the current results in an increase of the brain's levels of serotonin
, norepinephrine
, and dopamine
, and a decrease in its level of cortisol
. After a CES treatment, users are in an "alert, yet relaxed" state, characterized by increased alpha and decreased delta
brain waves as seen on EEG.
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
, insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
and stress
Stress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
. However, its effectiveness is still being studied.
History
"ElectrotherapyElectrotherapy
Electrotherapy is the use of electrical energy as a medical treatment In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of...
" has been in use for at least 2000 years, as shown by the clinical literature of the early Roman physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
, Scribonius Largus
Scribonius Largus
Scribonius Largus was the court physician to the Roman emperor Claudius.About 47 AD, at the request of Gaius Julius Callistus, the emperor's freedman, he drew up a list of 271 prescriptions , most of them his own, although he acknowledged his indebtedness to his tutors, to friends and to the...
, who wrote in the Compositiones Medicae of 46 AD that his patients should stand on a live black torpedo fish for the relief of a variety of medical conditions, including gout and headaches. Claudius Galen (131 - 201 AD) also recommended using the shocks from the electrical fish for medical therapies.
Low intensity electrical stimulation is believed to have originated in the studies of galvanic currents in humans and animals as conducted by Giovanni Aldini
Giovanni Aldini
Giovanni Aldini , Italian physicist born at Bologna, was a brother of the statesman Count Antonio Aldini and nephew of Luigi Galvani, whose treaties on muscular electricity he edited with notes in 1791....
, Alessandro Volta
Alessandro Volta
Count Alessandro Giuseppe Antonio Anastasio Gerolamo Umberto Volta was a Lombard physicist known especially for the invention of the battery in 1800.-Early life and works:...
and others in the 18th century. Aldini had experimented with galvanic head current as early as 1794 (upon himself) and reported the successful treatment of patients suffering from melancholia using direct low-intensity currents in 1804.
Modern research into low intensity electrical stimulation of the brain was begun by Leduc and Rouxeau in France (1902). In 1949, the Soviet Union expanded research of CES to include the treatment of anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
as well as sleeping disorders.
In the 1960s and 1970s, it was common for physicians and researchers to place electrodes on the eyes, thinking that any other electrode site would not be able to penetrate the cranium
Human skull
The human skull is a bony structure, skeleton, that is in the human head and which supports the structures of the face and forms a cavity for the brain.In humans, the adult skull is normally made up of 22 bones...
. It was later found that placing electrodes on the earlobes was far more convenient, and quite effective.
CES was initially studied for insomnia and called electrosleep therapy; it is also known as Cranial-Electro Stimulation and Transcranial Electrotherapy.
In 1972, a specific form of CES was developed by Dr. Margaret Patterson, providing small pulses of electric current across the head to ameliorate the effects of acute and chronic withdrawal from addictive substances. She named her treatment "NeuroElectric Therapy (NET)".
Effectiveness
A meta-analysis by Harvard University School of Public Health found significant improvement in one measure (anxiety) after CES, but noted that 90% of the studies included in the review were inadequately blindedDouble-blind
A blind or blinded experiment is a scientific experiment where some of the people involved are prevented from knowing certain information that might lead to conscious or subconscious bias on their part, invalidating the results....
and the experimenter "knew which patients were receiving CES or sham treatment." Most studies cited as evidence for the effectiveness of CES failed to report all data necessary for meta-analysis.
A bibliography by Kirsch (2002) listed 126 scientific studies of CES involving human subjects and 29 animal studies . An estimated 145 human studies have been completed, encompassing over 8800 people receiving active CES.
A pilot study showed that CES reduced the symptom burden of generalized anxiety disorder, with a decrease in Hamilton Anxiety Rating Scale (HARS) across a 6 week study, but the study had a small sample of participants and no control group.
CES research has been conducted in pain management and the reduction of anxiety in patients undergoing dental procedures..
A 3-week randomized controlled study which looked at insomnia in fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
patients found significant improvement in sleeping patterns. In a longitudinal insomnia study, subjects showed improvement of symptoms during a two-year follow-up (p<0.0008).
Studies have found statistically significant results in the treatment of depression with CES.
Regulation
In the United States, CES technology is classified by the Food and Drug Administration as Class III medical devices and must be dispensed by or on the order of a licensed healthcare practitioners, i.e. a physician, psychiatrist or nurse practitioner; psychologists, physician assistants, and occupational therapists who have an appropriate electrotherapy license may prescribe CES, dependent upon state regulations.As a result of the 1976 Medical Device Amendments, CES was placed in Class III by the FDA. Manufacturers who prove both safety and efficacy may enter the market, with FDA clearance, utilizing the 510(k) process instead of the premarket approval process, at this time.
Proposed mechanism of action
The exact mechanism of action of CES remains unclear but it is proposed that CES reduces the stress that underpins many emotional disorders. The proposed mechanism of action for CES is that the pulses of electric current increase the ability of neural cells to produce serotonin, dopamine DHEA endorphins and other neurotransmitters stabilizing the neurohormonal system.It has been proposed that during CES, an electric current
Electric current
Electric current is a flow of electric charge through a medium.This charge is typically carried by moving electrons in a conductor such as wire...
is focused upon the hypothalamic region
Hypothalamus
The Hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions...
; during this process, CES electrode
Electrode
An electrode is an electrical conductor used to make contact with a nonmetallic part of a circuit...
s are placed on the ear at the mastoid, near to the face. All modern analysis using computer simulation to predict current flow through the brain, however, suggest that CES has no spatial focality and may result in current passing through most of the brain .
It has been suggested that the current results in an increase of the brain's levels of serotonin
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
, norepinephrine
Norepinephrine
Norepinephrine is the US name for noradrenaline , a catecholamine with multiple roles including as a hormone and a neurotransmitter...
, and dopamine
Dopamine
Dopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...
, and a decrease in its level of cortisol
Cortisol
Cortisol is a steroid hormone, more specifically a glucocorticoid, produced by the adrenal gland. It is released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat,...
. After a CES treatment, users are in an "alert, yet relaxed" state, characterized by increased alpha and decreased delta
Delta wave
A delta wave is a high amplitude brain wave with a frequency of oscillation between 0–4 hertz. Delta waves, like other brain waves, are recorded with an electroencephalogram and are usually associated with the deepest stages of sleep , also known as slow-wave sleep , and aid in characterizing the...
brain waves as seen on EEG.