Electrotherapy Stimulation (CES)
is an electromedical modality indicated for the treatment of anxiety,
depression 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 syndrome1,2,
spinal cord injury pain5,6,
and reflex sympathetic dystrophy7.
See Kirsch and Smith8
for a succinct overview of CES applications for chronic pain.
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, depression and insomnia
(CES regulatory status). A
major use of CES has been in the treatment of symptoms of the
drug abstinence syndrome, including severe anxiety, depression
and insomnia. The medical use of CES is now becoming more widely
indicated in the USA9.
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 therapy9.
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, depression or insomnia
in many patients.
(Cranial Electrotherapy Stimulation)
of an alpha state and modulation of electrocortical activity
with mild electrical currents to relieve symptoms (9V, <
1mA, 0.5 or 100Hz).
(Transcranial Magnetic Stimulation)
depression, mania, PTSD, OCD, chronic pain
of electrocortical activity with electrical currents in the
brain generated with a strong external magnetic field.
(Vagus Nerve Stimulation)
with a surgically implanted electrical device
to relieve symptoms.
(Deep Brain Stimulation)
disease, essential tremor, dystonia
with a surgically implanted electrical device
to relieve symptoms.
depression, mania, schizophrenia
of a bilateral tonic-clonic seizure under anesthesia to relieve
symptoms (120-225V, 500-800mA, 30-70Hz).
mechanism of Alpha-Stim® CES10
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.
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.
click to enlarge
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, and cognition
and emotionality within the limbic forebrain.
(2006)11 has shown beneficial changes in brain
activity after a single 20-minute treatment with Alpha-Stim®
CES. Blue shows a decrease in
delta frequency (slow brain waves) activity while red
shows an increase in alpha (relaxation waves) frequency
Cork et al. (2004). The effect of cranial electrotherapy stimulation
(CES) on pain associated with fibromyalgia. The
Internet Journal of Anesthesiology.
2 Lichtbroun et al. (2001). The treatment of fibromyalgia with cranial
electrotherapy stimulation. Journal
of Clinical Rheumatology,
3 Brotman, P. (1989). Low-intensity transcranial electrostimulation
improves the efficacy of thermal biofeedback and quieting reflex
training in the treatment of classical migraine headache. American
Journal of Electromedicine,
4 Solomon et al. (1989). Safety and effectiveness of cranial electrotherapy
in the treatment of tension headache. Headache.
5 Capel et al. (2003). The amelioration of the suffering associated
with spinal cord injury with subperception transcranial electrical
6 Tan et al. (2006).Using cranial electrotherapy stimulation to
treat pain associated with spinal cord injury. Journal
of Rehabilitation Research and Development,
7 Alpher, E. J., and D. L. Kirsch (1998). Traumatic brain injury
and full body reflex sympathetic dystrophy patient treated with
cranial electrotherapy stimulation.
American Journal of Pain Management, 8(4):124-128.
8 Kirsch, D. L. and R. B. Smith (2000b). The use of cranial electrotherapy
stimulation in the management of chronic pain: a review. NeuroRehabilitation,
9 Kirsch, Daniel L. (2002). The Science
Behind Cranial Electrotherapy Stimulation, 2nd Edition, Medical
Scope Publishing Corporation, Edmonton, Alberta, Canada, 224 pp.
10 James Giordano, Ph.D. (Center for Clinical
Bioethics, Georgetown University Medical Center, Washington, DC).
Kennerly (2006). Changes in
quantitative EEG and low resolution tomography following cranial
electrotherapy stimulation. Ph.D. Dissertation, University of
North Texas. 425 pp.