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Cranial Electrotherapy Stimulation (CES)

CES is an electromedical modality indicated for the treatment of anxiety, stress and insomnia.

Completed and ongoing research studies further suggest that CES can also be beneficial as an adjunct therapy in the management of chronic neuropathic pain disorders, including fibromyalgia syndrome, migraine headaches, spinal cord injury pain, and reflex sympathetic dystrophy.  See Kirsch and Smith8 for a succinct overview of CES applications for chronic pain.

"Electrosleep treatment" - an older name for CES - came into the USA from Japan in the late 1960s. This therapy had been originally pioneered in Russia and other East Block countries. Since the current was directed across head, the FDA renamed it "Cranial Electrotherapy Stimulation (CES)" in 1978, and now allows its marketing in the USA for the treatment of anxiety, stress and insomnia. A major use of CES has been in the treatment of symptoms of the drug abstinence syndrome, including severe anxiety, stress and insomnia. The medical use of CES is now becoming more widely indicated in the USA.

During a CES treatment, a mild electrical stimulus is applied transcranially with electrodes attached to the head. CES is a broad category and historically a variety of electrical devices have been used to perform this therapy. In most cases, however, the output has been limited to 1-2 mA of electrical stimulation. Modern CES devices use less than 1mA of low-frequency (0.5Hz) bi-phasic currents applied with the use of electrodes that attach to the patient's ear lobes. An average length of treatment is generally 20-60 minutes. Daily treatments are recommended during the first 1-3 weeks of CES therapy.

 

Comparison with other electromedical modalities

In contrast to other electromedical treatments of psychological and psychiatric disorders, CES utilizes very mild, low-frequency currents often below sensory thresholds in most patients. Unlike Deep Brain Stimulation (DBS) or Vagus Nerve Stimulation (VNS), CES does not require surgical implantation of electrodes and is therefore substantially less expensive and safer. A very low incidence of side effects (usually mild and self-limiting) and a high clinical efficacy make CES an attractive modality that should be considered a first-line medical treatment for anxiety, stress or insomnia in many patients.

Modality

Primary indications

Mechanism (parameters)

U.S. regulatory status

CES
(Cranial Electrotherapy Stimulation)

Anxiety, stress, insomnia

Induction of an alpha state and modulation of electrocortical activity with mild electrical currents to relieve symptoms (9V, < 1mA, 0.5 or 100Hz).

Clinical use

TMS
(Transcranial Magnetic Stimulation)

Severe stress, mania, PTSD, OCD, chronic pain

Modulation of electrocortical activity with electrical currents in the brain generated with a strong external magnetic field.

Investigational

VNS
(Vagus Nerve Stimulation)

Epilepsy, refractory stress

Stimulation with a surgically implanted electrical device to relieve symptoms.

Clinical use

DBS
(Deep Brain Stimulation)

Parkinson's disease, essential tremor, dystonia

Stimulation with a surgically implanted electrical device to relieve symptoms.

Clinical use

ECT
(Electroconvulsive therapy)

Severe stress, mania, schizophrenia

Induction of a bilateral tonic-clonic seizure under anesthesia to relieve symptoms (120-225V, 500-800mA, 30-70Hz).

Clinical use

Postulated mechanism of Alpha-Stim CES10

The exact mechanism by which Alpha-Stim produces effects is not fully known. However, based on previous and ongoing studies, it appears that the Alpha-Stim microcurrent waveform activates particular groups of nerve cells located at the brainstem, a site at the base of the brain that sits atop of the spinal cord. These groups of nerve cells produce the chemicals serotonin and acetylcholine, which can affect the chemical activity of nerve cells that are both nearby and at more distant sites in the nervous system. In fact, these cells are situated to control the activity of nerve pathways that run up into the brain and that course down into the spinal cord.

By changing the electrical and chemical activity of certain nerve cells in the brainstem, Alpha-Stim appears to amplify activity in some neurological systems, and diminish activity in others. This neurological "fine tuning" is called modulation, and occurs either as a result of, or together with the production of a certain type of electrical activity pattern in the brain known as an alpha state which can be measured on brain wave recordings (EEG). Such alpha rhythms are accompanied by feelings of calmness, relaxation and increased mental focus. The neurological mechanisms that are occurring during the alpha state appear to decrease stress-effects, reduce agitation and stabilize mood, and control both sensations and perceptions of particular types of pain.

These effects can be produced after a single treatment, and repeated treatments have been shown to increase the relative strength and duration of these effects. In some cases, effects have been stable and permanent, suggesting that the electrical and chemical changes evoked by Alpha-Stim have led to a durable re-tuning back to normal function.

 

Alpha-Stim CES engages the serotonergic (5-HT) raphe nuclei of the brainstem. 5-HT inhibits brainstem cholinergic (ACh) and noradrenergic (NE) systems that project supratentorially. This suppresses thalamo-cortical activity, arousal, agitation, alters sensory processing and induces EEG alpha rhythm. As well, 5-HT can act directly to modulate pain sensation in the dorsal horn of the spinal cord, and alter pain perception, cognition and emotionality within the limbic forebrain.


Legend: Blue arrows: inhibitory interactions
                Purple arrows: excitatory interactions
                X : suppressed pathways/interactions


Abbreviations: ACh: actetylcholine; LDT: laterodorsal tegmental nucleus of the brainstem; PPN: pediculo-ponitne nucleus of the brainstem; NE: norepinephrine; LC: locus ceruleus, 5-HT: serotonin

Note: Diagram not to scale

For further information on CES we recommend you read CES A Safer Alternative and other relevant References  on the Research page.

 

Use always as directed, always read the label. If symptoms persist contact a health care professional

ARTG No. 137247

 

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