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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.
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.

©2006 by

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Cranial Electrotherapy Stimulation for Anxiety, Depression, Insomnia, Cognitive Dysfunction, and Pain: A Review and Meta-Analyses