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Cranial electrical stimulation
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Cranial electrical stimulation
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Cranial Electrical Stimulation (CES) is a treatment for anxiety, depression, Cognitive disabilities, diabetic neuropathy, drug addiction, fibromyalgia, insomnia, pain, and stress which utilizes small pulses of electric current (mA) across a patient's head. CES is widely regarded as safe and effective alternative treatment modality to pharmacotherapy.
Because of an early focus upon sleeping disorders, CES was originally known as electrosleep therapy. CES is sometimes written Cranial-Electro Stimulation, NeuroElectric Therapy, and Transcranial Electrotherapy and Neurotransmitter Modulator .
- 1 History
- 2 Effectiveness
- 3 Regulation
- 4 Proposed mechanism of action
- 5 Similar Devices
- 6 Podcast Discussion on CES uses
- 7 See also
- 8 References
- 9 External links
"Electrotherapy" has been in use for more than 2000 years, as shown by engravings on the walls of Egyptian tombs showing the use of the Nile catfish  (Malopteurus electricus) for treatment of various conditions. The clinical literature of the early Roman era physician, when Aristotle and Plato reference Scribonius Largus's, writings 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, who in 1801 treated a farmer for "Melancholy" and was reputed to have cured him  ; 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, Giljarowski, V.A.,  in St. Petersburg, USSR 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. In 1976, Dr. Margaret Patterson described using CES to treat drug addiction, and marketed a device under the name "NeuroElectric Therapy" and NET.
About the same time, Saul Liss,BSEE,PhD, working in Paterson, NJ developed the Liss Pain Suppressor, using a 15khz carrier wave, a 15hz, "active wave" and a third harmonic 500hz "modifier wave" signal with low voltage, which he theorized used the skull as a dialectric to provide a "triggering energy" to facilitate the firing of a synapse, sending a signal through the hypothalamus. He obtained an FDA approval for treatment of depression. It was soon clear that there was an increase in serotonin with concomitant decrease in tryptophan caused by his device. He ultimately obtained approval for treatment of pain as well. After dissolving a partnership with "Pain Suppression Labs" , he recommenced marketing the instrument alone under the name "Medi-Consultants" . After his passing in 2006, his estate sold the rights to his instrument to Fisher-Wallace Laboratories in NY .
At present, there are over 125 research studies on CES in humans and 29 experimental animal studies. The overwhelming majority of the scientific research is extremely positive. No significant lasting side effects have been reported.
1977- Looking at a pool of 220 patients at the University of Miami, School of Medicine, Dept of Neurology, Markovich, reported that "ten minutes with the (Liss) Pain Supressor (CES device), was enough to produce considerable improvement that, in the majority of cases, not only reduces the pain, but produces a marked and persistent relaxing effect in the muscles.
1993 - Ten patient were studied, who suffered from chronic neck, shoulder arm pain, and were treated with the Liss bipolar body stimulator (a model variant of the Liss Cranial stimulator), and 8 of 10 showed a "substantial reduction of pain", as evidenced by scores on the VAS. The benefit was maintained throughout the month of therapy and their "reliance on medication was reduced". 
1994 - At the VIth Int'l Congress on Stress in Montreux, Switzerland, Morrison and Liss presented a retrospective of the studies performed with the Liss (CCES) Stimulator, reporting benefits for patients with chronic pain, headaches, fibromyalgia, etc. 
C. Norman Shealy, et al, showed improvement in diabetic neuropathy in 17 of 21 patients over a 12 week treatment regimen, using the GigaTENS unit to treat specific acupuncture points, and progesterone cream. 
1984 - Solomon, et al, in a study at Montefiore Medical Center, of 62 (minus 4 eliminated for various reason) patients with migraine, muscle contraction headache, or both, using the Liss Stimulator, found that 55% noticed improvement with perceived stim, 28% with subliminal stim., and only 18% with placebo. 
Romano evaluated 100 patients with Fibromyalgia syndrome headaches, and found that after therapy, the vast majority of his patients reported significant benefit from the CES. 
For Depression, Anxiety and Insomnia
1989 - Shealy, et al, using the Liss device, measured baseline, 8AM levels of beta-endorphin(BE), Serotonin (ST), Norepinephrine (NE), and Cholinesterase (CHE), in 14 normal individuals. They then measured these levels in 11 severely depressed patients, and 23 chronic pain patients. Incidental to the study was their finding that the chemical profiles they developed showed the relationship of chronic pain to depression. The overall findings showed significant benefits from CES (Liss Stimulator) to both the depressed patients and those with chronic pain. 
1995 - Harvard University School of Public Health, Department of Health Policy and Management found: "The meta-analysis of anxiety showed CES to be significantly more effective than sham (P<.05)."
2000 - In a larger study involving 351 patients with specific depression, Shealy, et al found that photostimulation, education, and vibratory music, was effective therapy in 58% of patients, but when combined with the Liss stimulator, the effectiveness increased to 85%, and 70% of those remained improved after 3 months with no further intervention.
2005 - A meta-analysis has been performed investigating the effectiveness of CES in the treatment of anxiety, depression, insomnia and the retention rates of newly abstinent substance abuse individuals in community-based residential treatment.
In a study of 60 patients with fibromyalgia, it was found that "Treated patients showed a 28% improvement in tender point scores, and a 27% improvement in self-rated scores of general pain level. The number of subjects rating their quality of sleep as poor dropped from 60% at the beginning of the study to 5%." 
For Cognitive disabilities
1999 - A Study preformed by Susan Southworth,  demonstrated a significant improvement in attention and concentration, as measured by a Conner's Continuous Performance Test (CPT).
For Cerebral palsy
The following studies (inter alia) are presented for the Liss stimulator:
1980's - Groundbreaking research in therapy for Cerebral palsy children and others with related disabilities was done by Malden and later by Renee Okoye. Using the Liss CES device.Together and individually several papers were published demonstrating significant benefits in terms of concentration and "Sensory integration" in this population. 
1988 - Michael Logan, received the prestigious Richmond Prize  from the American Academy for Cerebral Palsy and Developmental Neurology, for his work using the Liss stimulator to treat CP children. His research,  which was double blinded and placebo controlled, showed "impressive gains in work performance, 19.9% increase in mechanical efficiency and 43% in workload output, while the placebo group declined".
1993 - Childs published a case report of Liss-CES use in a 25 yr old female, with post anoxic spasticity, in which he reported with sub-occipital placement of the electrodes, that this patient's tonicity was significantly improved along with other benefits, e.g., reduction in her "screaming", and somnolence during treatments when she was normally highly agitated. 
1998 - Alon, et al, of the Univ of Maryland School of Medicine, saw 7 CP children and, in a double blind, placebo controlled study using the Liss (Medi-Consultants) stimulator, demonstrated significant improvement in mean popliteal angle, and motor performance.
Immune system and Anti-Aging Medicine
1995 - Shealy, et al, reported significant increases in DHEA levels from baseline, in 8 patients, after 12 weeks of application of the Liss Stimulator for 5 minutes to 12 traditional acupuncture points, "including those for adrenal, thyroid, and 'Tchong Mo' sites" 
1984- Published clinical results showed that by coupling NeuroElectric Therapy with approximately two weeks of a residential rehabilitation program, participants being treated with such a protocol exhibited a dropout rate of less than 2% and experienced long-term drug abstinence rates of approximately 80%, based upon a follow-up study that determined the sampled participants’ abstinence status anywhere from 1 - 8 years after their initial treatment (n=186). This is compared with about a 3% long-term average abstinence rate for people who are treated using traditional methods. 
A specific form of CES, can be used to ameliorate the effects of acute and chronic withdrawal from addictive substances. CES has been in clinical use in the USA since 1963 and in Europe since 1953, and is recognized by the FDA for the treatment of depression, anxiety and insomnia. 
In the United States, CES equipment must be prescribed by a licensed independent medical provider, 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.
The effectiveness and safety of CES was never fully evaluated by the FDA, as is done with new medical devices, as the technology was "grandfathered" in with the existing treatment label. Thus new CES devices can receive FDA approval without submitting any clinical data by following a 510k approval mechanism.
Proposed mechanism of action
The exact mechanism of action of CES remains unclear but it is increasingly being viewed as an adaptogenTemplate:Clarify in that CES reduces 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 is focused upon the hypothalamic region; during this process, CES electrodes are placed on the ear at the mastoid, near to the face. CES treatment promotes an increase in endorphin, though scientistsTemplate:Who remain unsure why this occurs.. 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. When CES is effective, users are in an "alert, yet relaxed" state, characterized by alpha brain waves.
Electrical devices are not as commonly used in psychiatry as medication, in part due to the stigma of electrical devices for use on the brain (which many relate to electroconvulsive therapy). Other electrical devices that claim to treat psychological disorders are emerging, including devices for vagus nerve stimulation.
Podcast Discussion on CES uses
- Smith, R.B. (2007). Cranial Electrotherapy Stimulation: Its First Fifty Years, Plus Three: A Monograph. Tate Publishing & Enterprises LLC. pp. 19.
- Okoye, MSHS, OTR, Renee; Malden, Joan RPT (Fall, 1986). "Use of Neurotransmitter Modulation to Facilitate Sensory Integration". Neurology Report (Neurology Sect., of the APTA) 10 (4): 67-72.
- Southworth, Susan (1999). "A study of the effects of Cranial Electrical Stimulation on Attention and Concentration". Integrative Physiological and Behavioral Sciences 34 (1): 43–53.
- Parent, André (November 2004). "Giovanni Aldini: From Animal Electricity to Human Brain Stimulation". THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES 31 (4): 576-584. http://www.bium.univ-paris5.fr/chn/textes/parent_aldini.pdf.
- Zaghi S, Acar M, Hultgren B, Boggio PS, Fregni F. (2009). Noninvasive brain stimulation with low-intensity electrical currents: putative mechanisms of action for direct and alternating current stimulation. The Neuroscientist
- Appel, C. P. (1972). "Effect of electrosleep: Review of research". Goteborg Psychology Report 2: 1-24.
- Giljarowski, et al, Vladimir A. (1958). "Electrosleep" (Clinical and Physiological Research) 2nd ed.. St. Petersburg, USSR: Medgiz (State Medical Publishing House)- (sold by) BS Valis. pp. 172. http://www.alib.ru/bs.php4?uid=1332b0231f42a510b626ca86a1baaccab986.
- Bystritsky, A, Kerwin, L and Feusner, J (2008). "A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder". Journal of Clinical Psychiatry 69 (3): 412–417. doi:10.4088/JCP.v69n0311. PMID 18348596.
- Patterson, M.A.; Patterson, L.; Patterson, SL (1996 (Winter)). "Electrostimulation: addiction treatment for the coming millennium". J Altern Complement Med 2 (4): 485-91. http://www.ncbi.nlm.nih.gov/pubmed/9395678. Retrieved 12/2010.
- Liss, Saul, PhD; Liss, Bernard (April-June 1996). "Physiological and Therapeutic Effects of High Frequency Electrical Impulses". Integrative Physiological and Behavioral Science 31 (2): 88-94.
- Morrison, BS, Howard; Liss,PhD, Saul (Feb. 22, 1884). "Cranial Electrical Stimulation for Treatment of Stress Related Pain". Proc. of the VIth Int'l Congress on Stress (Montreux, Switzerland).
- Cassuto, J.; Liss, Saul; Bennett, A. (1993). "The Use of Modulated Energy Carried on a High Frequency Wave for the Relief of Intractable Pain". Int Jour of Clin Pharm Res. (Bioscience Ediprint, Inc.) XIII (4): 239-242.
- "Company History". http://fisherwallace.com/index.php/companyhistory?___store=default. Retrieved 1/01/11.
- Markovich, MD, Simon (Nov 30 - Dec 4, 1977). "Biomedical and Engineering Analysis of Head and Central Nervous System Injuries". Proc. of the Neuroelectric Society, IXth Annual Meeting (Marco Beach Hotel, Marco Beach, FL).
- Shealy, MD, PhD, C. Norman; Myss, MA, Caroline (1995), "Electrical Stimulation Raises DHEA and Improves Diabetic Neuropathy", Stress Medicine 11: 215-217
- Solomon, MD, Seymour; Gugliemo, BS, Karen (January), "Treatment of Headache by Transcutaneous Electrical Stimulation", Headache: 12-15
- Romano, MD, PhD, Thomas (Jan, 1991). "The Usefullness of Cranial Electrotherapy in the Treatment of Headache in Fibromyalgia Patients". Amer Jour of Pain Management 3 (1): 15-19.
- Shealy, MD, C. Norman; Cady, MD, Roger C. (December), "Depression, A Diagnostic Neurochemical Profile & Therapy with Cranial Electrical Stimulation", Journal of neurological and Orthopedic Medicine and Surgery 10 (4): 319-321, ISSN 0890-6599/88-0904
- Sidney Klawansky (July 1995). "Meta-Analysis of Randomized Controlled Trials of Cranial Electrostimulation: Efficacy in Treating Selected Psychological and Physiological Conditions". Journal of Nervous & Mental Disease 183 (7): 478–484. http://www.jonmd.com/pt/re/jnmd/abstract.00005053-199507000-00010.htm.
- Thomlinson, Paul; Shealy, MD (February 9-13), "Successful Holistic Treatment of Chronic Depression", Proc, 22nd Annual Conf. on the Unity of the Sciences
- Gilula MF, Kirsch DL. (2005). Cranial electrotherapy stimulation review: a safer alternative to psychopharmaceuticals in the treatment of depression. Journal of Neurotherapy, 9(2), 63-77.
- Brovar A. (1984). Cocaine detoxification with cranial electrotherapy stimulation (CES): A preliminary appraisal. International Electromedicine Institute Newsletter, 1(4)
- Overcash SJ, Siebenthall A. (1989) The effects of cranial electrotherapy stimulation and multisensory cognitive therapy on the personality and anxiety levels of substance abuse patients. American Journal of Electromedicine, 6(2), 105-111
- Lichtbroun, AS; Raicer MM, Smith RB (Apr 2001). "The treatment of fibromyalgia with cranial electrotherapy stimulation". Journal of Clinical Rheumatology 7 (2): 72-78.
- Poirot, Carolyn (Oct. 25), "Cerebral palsy work praised", Fort Worth Star Telegram: 16
- Logan, PhD, Michael P. (October 1988), "Improved Mechanical Efficiency in Cerebral Palsy Patients Treated With a Cranial Electrotherapy Stimulator", Journal of the Amer. Acad. for CP and Developmental Neurology
- Childs, MD, Allen (March-April), "Case Study: Fifteen-Cycle cranial electrotherapy stimulation for spasticity", Brain Injury 7 (2): 179-181, ISSN 0269-9052
- Alon, PhD, PT, Gad; Syron, PT, Suzan (1998), "Is Transcranial Electrical Stimulation (TCES) a Safe Intervention for Children with Cerebral Palsy?", Jour. Neurological Rehabilitation 12 (2): 65-72
- Patterson, MA; Firth, J (1984), "Treatment of drug, alcohol and nicotine addiction by NeuroElectric Therapy: analysis of results over 7 years", J Bioelectricity 3: 193-221
- 21CFR882.5800, Part 882 ("Neurological Devices")
- FDA medical device classifications
- a review of the research through 2009
- A review of the technology and analysis of the research through 2006
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