CES (Cranial electrotherapy stimulation) Devices Currently (Ha!) Available

Turns out there are numerous ‘FDA Cleared’ CES (cranial electrotherapy stimulation AC) devices available for sale in the U.S. when recommended and prescribed by your doctor. Typically these devices are recommended for pain but also for depression. They also seem to be recommended for use in drug treatment. Cost of the device is sometimes covered by insurance.

[Video was removed from Youtube] That clip shows both the Fisher Wallace Stimulator and the Alpha-Stim devices.

More from Fisher Wallace. [Video was removed from Youtube]

Also for doctors: How to prescribe the device.

A couple of other available devices: CES Ultra and European manufacturer Onko Cet offers the Transair series of transcranial electrostimulation (TES) devices.

 

tDCS and CES – A Little History

Is a way to think about the effects of tDCS then, that it increases neuronal ‘excitability’?
Interesting too, the possibility that AC stimulation might actually be affecting neurotransmitter production.

From: Noninvasive Brain Stimulation with Low-Intensity Electrical Currents: Putative Mechanisms of Action for Direct and Alternating Current Stimulation [PDF}

As early as 1794, Aldini had assessed the effect of galvanic head current on himself, and by 1804, he had reported the successful treatment of patients suffering from melancholia. Research continued through the early 20th century; yet because DC induced variable results, or sometime none at all, the use of low-intensity DC (i.e., tDCS) was progressively abandoned…

…between 1938 and 1945, subsequently led to an interest in the application of AC at lower intensities with the first study of “cranial electro-therapy stimulation” (also known as “electrosleep”) published by Anan’ev and others in 1957… Since the 1960s, a series of studies with low-intensity AC stimulation have been published, and cranial AC stimulation devices have become commercially available for personal use (e.g., Alpha-Stim, Fisher Wallace Cranial Stimulator, Transair Stimulator, etc.). However, research in this area has been inconsistent and there remains a lack of solid evidence showing the effects of weak transcranial stimulation with AC.

…During tDCS, low-amplitude direct currents penetrate the skull to enter the brain. Although there is substantial shunting of current at the scalp, sufficient current penetrates the brain to modify the transmembrane neuronal potential and, thus, influences the level of excitability and modulates the firing rate of individual neurons. DC currents do not induce action potentials; rather, the current appears to modulate the spontaneous neuronal activity in a polarity-dependent fashion: For example, anodal tDCS applied over the motor cortex increases the excitability of the underlying motor cortex, whereas cathodal tDCS applied over the same area decreases it. Similarly, anodal tDCS applied over the occipital cortex produces short-lasting increases in visual cortex excitability. Hence, tDCS is believed to deliver its effects by polarizing brain tissue, and although anodal stimulation generally increases excitability and cathodal stimulation generally reduces excitability, the direction of polarization depends strictly on the orientation of axons and dendrites in the indu- ced electrical field.

CES is a nonstandardized and often indistinct method of delivering cranial AC stimulation; indeed many studies cite the method of stimulation simply as “cranial electrotherapy stimulation” without identifying the specific site or other parameters of stimulation (e.g., duration, current density, intensity, electrode size) calling into question existing reviews of this method. Even so, CES has been suggested to be effective in the treatment of anxiety, depression, stress, and insomnia, and the following parameters of stimulation have been reported: frequency (0.5 Hz to 167 kHz), intensity (100 μA to 4 mA), and duration of stimulation (5 min to 6 consecutive days).

… Biochemical changes—neurotransmitter and endorphin release. Several studies suggest that AC stimulation may be associated with changes in neurotransmitters and endorphin release. In this context, subthreshold stimulation induced by AC stimulation would indeed cause significant changes in the nervous system electrical activity.

For further reading on CES (AC stimulation) the wikipedia page is quite good!

DIY tDCS Start Here

Featured

New to DIYtDCS? This is the ‘start here’ collection of articles and posts.

  1. DIYtDCS Feed, last 50 articles http://www.diytdcs.com/feed/
  2. My Twitter feed focuses on breaking tDCS research. @DIYtDCS
  3. My Reddit account, where it’s okay to explore the fringes. DIYtDCS
  4. Recommended device? (29V / 2mA model. Promo code ‘diytdcs’ for discount)
  5. Best instruction video for C3/Motorcortex & F3/DLPFC electrode placement.
  6. Is this (tDCS for depression in pregnancy) the first ‘killer app’?
  7. Cognitive Enhancement with Noninvasive Brain Stimulation (video) Roy Hamilton MD
  8. Simple Montage list with electrode placement and research sources.
  9. Marom Bikson & Peter Toshev ‘Your Electric Pharmacy‘ (excellent overview/intro).
  10. Marom Bikson Presentation on State of the Art tDCS 8/13.
  11. My podcast interviews – deep dives into tDCS with key players (iTunes link)
  12. tDCS SubReddit is where the action is. Now with tDCS FAQ!
  13. An ‘Open tDCS’ project.
  14. Dr. Brent Williams’ DIY device and protocol.
  15. Zap your brain into the zone: Fast track to pure focus
  16. Better Living Through Electrochemistry
  17. Clinical tDCS trials seek volunteers. All. Search. (Example: “tDCS AND Los Angeles”)
  18. Neuroscience: Brain buzz Nature Magazine
  19. DLPFC / F3 Locator (you’ll need a tape measure with Centimeters)
  20. Searchable database of tDCS articles from trans-cranial.com
  21. 10–20 international system
  22. Kadosh The Stimulated Brain: Cognitive Enhancement Using NIBS

Tali Sharot: The optimism bias

At around minute 13, Tali Sharot describes how she and collaborator Dr Ryota Kanai were able to influence the outcome of experiments designed to test optimism bias by applying TMS (transcranial magnetic stimulation). Amazing!

Dr. Tali Sharot at Institute of Cognitive Neuroscience at University College of London
Dr Ryota Kanai
Search for ‘transcranial direct current’ at ICN

One way to think about this (very generally) is that, in this case, TMS had both a positive and negative impact. This should also serve as cautionary to anyone self-experimenting with tDCS.

I recently reached out to Dr. Mark Beeman of Northwestern around the subject of testing the efficacy of tDCS especially in the context of DIY. I became aware of Dr. Beeman’s work through the new Jonah Lehrer book, ‘Imagine’. (I haven’t read it actually, but have listened to Lehrer discuss the book at length in numerous podcasts.) Dr. Beeman took the time to respond to my email stating that he was in fact at work on some experiments that use tDCS. About self-experiments, he had this to say…

I’d be hesitant to do too much self-experimentation. Not that I worry about causing direct damage, but brain activity is often a delicate balance, and enhancing some process may have adverse effects on another.

I also heard back from the  Laboratory of Cognition and Neural Stimulation at the University of Pennsylvania. They are who posted the questionnaire. Basically it was just a follow-up email asking more questions. I have yet to correspond with anyone personally and they have so far signed their emails as Research Specialist.

Transcranial Direct Current Stimulation Improves Learning Abilities in Pilots · | SteadyHealth.com

The lead author of this research study, Dr. Bullard, maintains that this procedure allows for altered brain-wave activity and accelerated learning. She examined MRI brains scans and magnetoencephalography (MEG) and found physical changes to confirm this. Apparently, these tests showed that TDCS gave a six-times baseline boost to the amplitude of a single brain wave.

This boost was not seen when a placebo TDCS was used and this mock wave was ineffective in exciting brain tissue. Basically the effect will persist long after the TDCS is stopped, up to almost an hour of time. These results tell us that TDCS increases the cerebral cortex excitability, therefore increasing arousal, improving sensory input response, and speeding up information processing.

Surprisingly, the MRI brain tests revealed actual structural changes in the brain five days after the TDCS was done. The neurons of the cerebral cortex connect with each other to form circuits by way of nerve fiber bundles (axons) that are buried deep below the surface of the brain. These fiber bundles are more robust and highly organized after the TDCS. None of this is noted on the side of the brain that is not stimulated by this procedure.

via Transcranial Direct Current Stimulation Improves Learning Abilities in Pilots · Healthy Living articles | Well Being center | SteadyHealth.com.

Non-Invasive Brain Stimulation Shown to Impact Walking Patterns

The main experiment consisted of a two-minute baseline period of walking with both belts at the same slow speed, followed by a 15-minute period with the belts at two separate speeds. While people were on the treadmill, researchers stimulated one side of the cerebellum to assess the impact on the rate of re-adjustment to a symmetric walking pattern.

Dr. Bastian’s team found not only that cerebellar tDCS can change the rate of cerebellum-dependent locomotor learning, but specifically that the anode speeds up learning and the cathode slows it down. It was also surprising that the side of the cerebellum that was stimulated mattered; only stimulation of the side that controls the leg walking on the faster treadmill belt changed adaptation rate.

“It is important to demonstrate that we can make learning faster or slower, as it suggests that we are not merely interfering with brain function,” says Dr. Bastian. “Our findings also suggest that tDCS can be selectively used to assess and understand motor learning.”

via Non-Invasive Brain Stimulation Shown to Impact Walking Patterns.
Abstract here.

Efficacy of Transcranial Direct Current Stimulation and Repetitive Transcranial Magnetic Stimulation for Treating Fibromyalgia Syndrome: A Systematic Review – Marlow – 2012 – Pain Practice – Wiley Online Library

Conclusion:  Studies involving excitatory rTMS/tDCS at M1 showed analogous pain reductions as well as considerably fewer side effects compared to FDA approved FMS pharmaceuticals. The most commonly reported side effects were mild, including transient headaches and scalp discomforts at the stimulation site. Yearly use of rTMS/tDCS regimens appears costly $11,740 to 14,507/year; however, analyses to appropriately weigh these costs against clinical and quality of life benefits for patients with FMS are lacking. Consequently, rTMS/tDCS should be considered when treating patients with FMS, particularly those who are unable to find adequate symptom relief with other therapies. Further work into optimal stimulation parameters and standardized outcome measures is needed to clarify associated efficacy and effectiveness.

via Efficacy of Transcranial Direct Current Stimulation and Repetitive Transcranial Magnetic Stimulation for Treating Fibromyalgia Syndrome: A Systematic Review – Marlow – 2012 – Pain Practice – Wiley Online Library.