Cranial electrotherapy stimulation
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| Alternative/fringe therapies |
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| Claims |
| Electrical stimulation of the scalp can relieve various psychological disorders. |
| Related fields |
| Year proposed |
| Original proponents |
| Subsequent proponents |
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Cranial Electrotherapy Stimulation (CES) is an unproven[1] treatment for anxiety, depression, insomnia, stress and drug addiction 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.[2][verification needed]
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".
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History
"Electrotherapy" 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.[citation needed]
Low intensity electrical stimulation is believed to have originated in the studies of galvanic currents in humans and animals as conducted by Giovanni Aldini, Alexandero Volta and others in the 18th century [3]. 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[3].
Modern research into low intensity electrical stimulation of the brain was begun by Leduc and Rouxeau in France (1902).[citation needed] In 1949, the Soviet Union expanded research of CES to include the treatment of anxiety as well as sleeping disorders.[citation needed]
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.[4]
In 1976, CES was used by Dr. Margaret Patterson[5][self-published source?] to treat drug addiction under the name "NeuroElectric Therapy" and NET.
Effectiveness
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.[citation needed] No significant lasting side effects have been reported.[citation needed]
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)."[6]
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[6][7][8][9].
However, most studies cited as evidence for its effectiveness failed to report all data necessary for meta-analysis.[6][1]
Regulation
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.[10][11]
In 2004, The FDA ordered Health Directions, Inc., to stop claiming in its literature that the HealthPax CES device could modify brain wave patterns and is effective against epilepsy, stress-related disorders, and several other conditions. The agency's Warning Letter stated that the device had been approved for treat insomnia, depression, or anxiety but was being marketed for unapproved purposes.[12]
Proposed mechanism of action
The exact mechanism of action of CES remains unclear but it is increasingly being viewed as an adaptogen[clarification needed] in that CES reduces stress that underpins many emotional disorders [2]. 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 [7].
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 scientists[who?] remain unsure why this occurs.[citation needed]
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.[citation needed]
Similar Devices
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.[citation needed]
See also
References
- ^ a b Stephen Barrett, M.D. (January 28, 2008). "Dubious Claims Made for NutriPax and Cranial Electrotherapy Stimulation". QuackWatch. http://www.quackwatch.com/01QuackeryRelatedTopics/ces.html.
- ^ a b Smith RB, Cranial Electrotherapy Stimulation: Its First Fifty Years, Plus Three
- ^ a b 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
- ^ 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. PMID 18348596.
- ^ Dr. Margaret Patterson DrMeg.net
- ^ a b c 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.
- ^ a b 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
- ^ 21CFR882.5800, Part 882 ("Neurological Devices")
- ^ FDA medical device classifications
- ^ Gardine TD. (March 4, 2004). "Warning letter to Harold G. Stecker, Ph.D.". http://www.casewatch.org/fdawarning/prod/2004/healthdirections.shtml.
External links
- a review of the research through 2009
- A review of the technology and analysis of the research through 2006
