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 Bioelectromagnetic
Medicine – Chapter 44 Unabridged Version
Cranial Electrotherapy Stimulation for Anxiety, Depression, Insomnia,
Cognitive Dysfunction, and Pain: A Review and Meta-Analyses
Daniel L. Kirsch, Ph.D., D.A.A.P.M., F.A.I.S. and Ray B. Smith, Ph.D.
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I. Introduction and History of CES
While the use of electric currents in medical practice dates back more
than 2,000 years, today’s interest in cranial electrotherapy
stimulation (CES) probably had its beginnings in the research thrusts
that began in France in 1903 by Leduc and Rouxeau. Leduc’s student,
Robinovitch, made the first claim for inducing sleep from electrical
treatment in 1914. (1)
Subsequent research interest revolved around electronarcosis and then
electroconvulsive shock treatments through the late 1930s. Interest in
the smaller amounts of electric current involved in CES did not begin
in earnest until work by Anan’ev and his group, in 1957, and in 1958
when Gilyarovski published a book entitled: Electrosleep. (2) That
work initiated the interest in CES that has lead linearly to the
present research and clinical use of CES in America and elsewhere.
The term “cranial electrotherapy stimulation” is used in the U.S.A.
for what in much of the rest of the world is still called “electrosleep.”
The treatment arrived in America as “electrosleep,” but American
researchers soon found that it did not necessarily induce sleep during
treatment, and that its clinical effects were obtained whether or not
sleep occurred. (3,4) Today, any small electrical current that is
passed across the head for therapeutic purposes is called cranial
electrotherapy stimulation, officially, though many related terms such
as “transcranial electrical stimulation,” “cerebral electrostimulation,”
“alpha induction therapy,” “neuromodulation,” “neuroelectric therapy,”
can be found in the titles of many research articles, making it
difficult to find and index CES studies in the literature. (5,6) A
recently revised annotated bibliography of CES research summarized 126
human studies, 29 animal studies, and 31 review articles. (7)
Another cause of confusion was the great number of stimulus parameters
that fell under the CES rubric. An earlier report found that
frequencies used in CES treatment ranged from 1 to 15,000 Hz, the
pulse width varied from 0.1 to 20 millisecond, and the maximum peak
pulse amplitude varied from 0 to 20 milliampere (mA), while the output
potential ranged up to 50 volts, and the supply voltage ranged from a
3.6 volt battery source to line voltage of 120 volts AC. (8)
The United States is the only country in the world that requires a
prescription from a licensed health care practitioner to dispense a
CES device, and the Food and Drug Administration’s (FDA) officially
accepted marketing claims for its use are for the treatment of
anxiety, depression and insomnia. Other clinical disorders have been
found to be positively affected by CES, however, including several
types of cognitive dysfunction, the substance abstinence syndrome, and
more recently such widely disparate areas as reflex sympathetic
dystrophy, multiple sclerosis and fibromyalgia. Each of these will be
discussed in turn.
One of the major problems CES has had in entering mainstream medicine
– and staying there – is that since the dawn of electromedicine,
everything imaginable has been claimed to be successfully treated by
medicinal applications of electricity at one time or another. Possibly
underlying the large variety of claims for CES effectiveness were the
early findings of Jarzembski and his research group at the University
of Wisconsin. When CES was applied to the head of primates in whose
brains sensors had been implanted, they found that 42% of the current
applied externally actually penetrated through every region of the
brain, though it canalized especially along the limbic system. (9)
More recent research conducted by Ferdjallah at the Biomedical
Engineering Department of the University of Texas at Austin has shown
that from 1 mA of current, about 5 µA/cm2 of CES reaches the thalamic
area at a radius of 13.30 mm which is sufficient to affect the
manufacture and release of neurotransmitters. (10)
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Bioelectromagnetic Medicine• 2004 |
Used with permission of Electromedical Products
International, Inc.
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