What is CES (Cranial Electrotherapy Stimulation) treatment?
CES (Cranial Electrotherapy Stimulation) treatment is one of the latest treatment methods developed within the scope of electro medicine.
CES Stimulation therapy aims to apply specially produced microcurrent applied with electrodes placed in the ear to target brain regions.
CES is one of the most recently used micro-stimulation treatments.
How was CES Stimulation Therapy discovered?
It is a program developed by Dr. Daniel Kirsh, director of "Columbia- Presbyterian Medical Center" in New York (USA). Dr. Kirsh, whose work is carried out at the Center for Pain and Stress Related Diseases, has been interested in this subject since 1972.
A brief history of Electrical Medicine shows that the FDA (US Food, Drug and Therapeutic Approval Agency) adopted the CES definition in 1978. So far, safety and efficacy studies have been conducted in 160 human and animal studies (Safety and Effectiveness)
In the 1970s, TENS (Transcutaneal Electrical Neural Stimulation) was used as a physical therapy technique for soft tissue pain. This technique could not be widely used due to its counter-irritant properties and the pain would return in a short time. Later, microcurrent devices were produced. These devices changed the pain messages in the tissues.
Dr. D. Kirsch completed his work in Chronic Pain and Stress. He submitted CES (CET STIMULATION) treatment for Anxiety, Depression and Insomnia, MET (MET STIMULATION) (Microcurrent Electrical Therapy) treatment for Chronic Pain to the FDA and received approval. It can now be used with a doctor's prescription.
The current used in both systems is a special current. It is a combined waveform (Combining Waveforms) that activates the bio electric current produced naturally by the body.
What is MET Therapy?
It is the form of micro stimulation therapy used for pain. It is known as "Microcurrent Electrobiological Treatment". It is applied with pen-shaped electrodes to the painful areas deemed necessary by the physician.
The characteristic of the current is the same as the waveform in CES treatment. It is approved by the FDA for the treatment of chronic pain.
It is estimated to normalize the body's optimal electromagnetic internal balance (homeostasis) by altering nerve cell conduction.
How does CES work?
During CES treatment, the current travels through the hypothalamus region of the brain. There are findings showing that chemical transmitters such as endorphins, serotonin, noradrenaline and dopamine increase and cortisol hormone decreases in the brain. The effectiveness of CES treatment is recognized when the person feels alert, attentive and relaxed at the same time. This is characteristic of the increase in alpha brain waves. Some users report a decrease in anxiety and some report an increase in cheerfulness during the treatment. Some users report a burning sensation and/or a sense of clarity of mind. If results are not achieved in 5-10 sessions, the treatment is considered not successful.
Features of CES - MET Stimulation devices
- It is a portable device of 15-20 cm in size, powered by a nine-volt battery. It consists of two parts.
- Part 1: Used in CES (Cranial Electrotherapy Stimulation) Stimulation Therapy. Microcurrent is sent to the brain with the help of an apparatus attached to the earlobes. It is used in Anxiety, Depression and Sleep Disorders upon doctor's recommendation. Addiction, Attention Deficit, Difficulty in Mental Functions, Psychologically Induced Pain can also be included in the treatment protocol.
- Part 2: MET (Microcurrent Electrobiological Treatment) apparatus; It is produced as special probes in the shape of a pen. With the help of these probes, current can be applied to the painful areas. It has a cumulative (accumulating) effect. It is used in chronic pain. It is known to increase endorphin release.
Effects of CES - MET treatments on brain and body biochemistry
According to Norman Sheady's research, during stimulation, the neurochemical serotonin increases by -40% in the blood and 50-200% in the cerebrospinal fluid. The pain relieving hormone beta endorphin increases by 98% in blood (plasma) and 219% in cerebrospinal fluid.
EEG changes caused by CES - MET treatments
It is known to increase brain wave amplitude (P 300 amplitude) and sleep spindles and to increase alpha wave production. Delta and Theta waves appear to decrease.
Some research on CES - MET treatments
Jarzembski and his research group from the University of Wisconsin found in animal experiments that the current was channeled through the Limbic system. The limbic system is known to be one of the main psychophysiological brain areas.
Ferdjallah from the Department of Biomedical Engineering at the University of Texas at Austin, Austin, showed that the 1-amp current reached the thalamic region of the brain. These findings are evidence that 1 ampere current is sufficient to affect neurotranmitter (chemical transporter) production and release (1,3).
Microcurrent treatments stimulate the brain regions responsible for pain messages, the HPA (Hypothalamo-Pituitary-Adrenal) axis, which controls the production and control of neurotransmitters and important hormones.
They are FDA approved treatments. Articles have been published in peer-reviewed journals. Their scientific value has been proven in uncontrolled, controlled single-blind, placebo-controlled double-blind, shame-controlled studies and open clinical trials.
There are many studies showing that when microcurrent therapies are used at the same time with drug therapies, drug use is reduced by one third (4-10).At the University of Tennessee Medical Center, dog subjects were examined in 5 different study series. Drugs that disrupt the chemical balance in dogs' brains and cause Parkinson-like symptoms were used. Animals needed 4-7 days to return to normal behavior after the drugs were discontinued. In contrast, dogs treated with CES therapy showed a significant restoration of neurochemical balance within 3-7 hours.
At the end of these studies, the authors concluded that CES treatment "induces the passage of chemical transmitters at the presynaptic membrane into the synaptic gap and increases the production of replacement neurotransmitter substances." In simpler terms, it can be said that it increases nerve cell membrane permeability and increases intracellular chemical stores (1,3)
It is now known that small electrical pulses regenerate and repair brain nerve cells. In areas such as cognitive dysfunction (mental slowing down), Fibromyalgia, Addiction, Attention Deficit, there are more and more encouraging scientific developments and study results.
EMG results have also been in the direction of understanding muscle tension.
Side effects of CES - MET treatments
In 126 human studies involving 6007 people, 9 headaches (0.20%) and 5 skin irritations (0.11%) were reported.(1)
In cases with a history of dizziness, nausea and severe headache, it has been reported that these symptoms may increase in the first days.
Blood pressure lowering effects have also been reported.
The biggest problem to be considered in CES stimulation treatments is mild disorientation. If time and place orientation is disrupted and a feeling of confusion occurs, treatment is discontinued.
Addictive use has not been reported.
Outcomes of CES - MET treatments
In the book "The Science Behind Cranial Electrotherapy Stimulation by Daniel L. Kirsh", it is stated that 47 physicians studied 500 patients with 22 different diagnoses. Studies involving 2500 patients were published in the American Journal of Pain Management 2001. The results were similar.
Relief at the level of improvement was found in 60% of patients, partial relief in 25% of patients and non-response to treatment in 25% of patients. In pain studies, the rate of improvement varies between 50-74%. In tension headache and migraine, there are significant results in three-month treatments.
It is also recommended to be used as a factor that facilitates the patient's focus on treatment before psychotherapy and relaxation before "Biofeedback".
In the 2004 edition of "Bioelectromagnetic Medicine", it was seen that 57% improvement was achieved in 1075 patients in the treatment of depression, 62% improvement in 500 cases of anxiety disorder, 62% improvement in 940 cases of insomnia.
References:
- Kirsh DL, Smith RB; Cranial electrotherapy stimulation for Anxiety, Depression, Insomnia, Cognitive dysfunction, and Pain. Bioeletromagnetic Medicine, Chapter 44, Informa Heltcare USA, 2007,pp.727-740
- Jarzembski WB, LaarsonSJ, Sances A Jr. Evaluation of specific cerebral impedance and cerebral current density. Annals of the New York Academy of Sciences 1970; 170:476-490.
- Ferdjallah M, Bostick FX Jr, Barr RE. Potential and current density distributions of cranial electrotherapy stimulation (CES) in a four-concentric-spheres model. IEEE Transactions on Biomedical Engineering 1996; 43(9):939-943.
- O'Connor ME, Bianco f, Nicholson R. Meta-analysis of cranial electrostimulation in relation to the primary and secondary symptoms of substance withdrawal. 12th Annual Meeting of the Bioelectromagnetics Society, June 14, 1991.
- Schmitt R, Capo T, Frazier H, Boren D. Cranial electrotherapy stimulation treatment of cognitive brain dysfunction in chemical dependence. J Clin Psychiarty 1984; 45:60-63.
- Straus B, Elkind A, Bodian CA. Electrical induction of sleep. Am J Med Sci 1964; 248:514-520.
- Itil T, Gannon P, Akpinar S, Hsu W. Quantitative EEG analysis of electrosleep using frequency analyzer and digital computer methods. Electroencephalogr Clin Neurophysiol 1971; 31:294
- Childs A. Droperidol and CES in Organic Agitation. Clinical Newsletter of the Austin Rehabilitation Hospital, 1995.
- Stanley TH, Cazalaa JA, Limoge A, Louville Y. Transcutaneous cranial electrical stimulation increases the potency of nitrous oxide in humans. Anesthesiology 1982; 57:293-297
- Warner R, Hudson-Howard L, Hojnson C, Skolnick M. Serotonin involvement in analgesia induced by transcranial electrostimulation. Life Sciences 1990; 46:1131-1138
