Talk:Cranial electrotherapy stimulation

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Contents 1 I 2 Mind machines vs Cranial electrotherapy stimulation 3 Electrical and Electronic Information Regarding Safety 4 Neutrality 5 POV -- entire is misleading advertising 6 Grandfathered FDA approval, no actual FDA effectiveness testing 7 Grandfathered FDA approval is only Class 3 even as to safety 8 Few gold-standards trials found 9 The quackwatch write-up is one of the few non-enthusiast sources of information

[edit] I

I want one. :)

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hackcanada.com has plans to make a CES. Primitive but it really works. I have it on right now.

I have removed some obvious commercial spam from this page, if the author wishes to edit the article they should refrain from spamming.

The naysayers and the pro-psychiatry movement favor persons with anxiety or depression to be on medication, further supporting the pharmaceutical industry.

The CES has been approved in for the treatment of anxiety and depression as well as sleep disorders. There is no information submitted to the contrary. All is shown (below) is that the CES is a Class 3 type device.

[edit] Mind machines vs Cranial electrotherapy stimulation

Both stimulate brain waves to a certain level......so aren't the two basically the same thing? If that is the case why do CES machines require a prescription in the US while Mind Machines do not? Zachorious 02:55, 3 November 2007 (UTC)

I would hazard a guess that it's because CES machines pump electricity into the body (brain) itself, causing both electrical and chemical reactions. Mind machines only indirectly stimulate the brain (though the eyes and ears), and do not pump electricity into the body; thus, they cannot directly cause chemical reactions (though one could argue that they are *almost* directly causing electrical reactions.) As an aside, I've seen CES machines on sale for eBay, no prescription required, so perhaps enforcement isn't taken too seriously. --Lode Runner 22:55, 6 November 2007 (UTC)

You've seen CES machines on ebay? Where? My search found none but a CES guide. What were your keywords when you searched? Also, don't the different brainwave states correspond to different chemical reactions? Or is it the other way around? I would assume that certain alpha wave patterns produce chemical reactions, or at least the opposite. Meaning the different brainwaves produced by mind machines should trigger chemical reactions as well since brainwave states should correspond to chemical reactions. Zachorious 11:45, 11 November 2007 (UTC)

Try searching the full name (not just "CES") and check the 'search title and description' box. This reveals one called "AlphaStim" and another cheaper one called "Zed-time". I've come across at least one other, $800+ one that claimed to be able to induce alpha, beta, theta and gamma waves (I remain dubious.) Wouldn't mind knowing what frequencies, power outputs and cranial contact points were specifically used in the studies.

It would also be very helpful to know which units the FDA has "cleared to be marketed for the treatment of anxiety, depression, and insomnia". Wikipedia has entire articles for most medicines, so I think it's definitely worth mentioning which CES machines have received FDA approval.

As far as the mind machine-induced brainwaves inducing chemical reactions, you are indeed correct. However, the effect is secondary, vs. the primary, direct electrochemical CES reactions. Many common sensory inputs--listening to certain kinds music, being in a room painted a certain color, whatever--affect brain chemistry as well, so it's probably hard to draw a line and say, well THIS type of brainwave-changing sensory input is drastic enough to require a prescription, but listening to Mozart is ok. There's too much gray area. I wouldn't be surprised if many daily sensory activities affected brain chemistry more than your average mind machine. I also wouldn't be surprised if some music styles (e.g. techno or some techno derivatives?) duplicate binaural beats without any medical intentions.

Even if mind machines affect brain chemistry as much or moreso than CES, the distinctions between medicine and simply perceiving the world around you are a lot blurrier. It's a lot easier to tell someone they need a prescription to clip a strange device to their ears and run an electric current through their head than it is to tell someone they need a prescription to look at a special strobe light or listen to some trance techno. --Lode Runner (talk) 15:21, 17 November 2007 (UTC)

[edit] Electrical and Electronic Information Regarding Safety

It's presumed safe, if one has a prescription, to purchase a device used and engineered specifically for electrical stimulation of the brain. However, this is partly a technique of concealment, which is similar to commercial spam, where open information regarding current & voltage of the device, and resistance and receptivity or permittivity of tissues is not explained *at all*. It's also well known that what was considered medically safe in past years, decades, and centuries, has evolved and at times citizens have found that prior practiced medical techniques were not only not safe, but decidedly dangerous.

I think it's reasonable for anyone who is learning about this topic to know what kinds of electrical currents are considered safe for use in cranial stimulation. Presumably, there are some levels of current and voltage, perhaps relating dynamically to frequency, above which danger of extreme numbers of brain cell deaths becomes a valid concern and is generally recognized as *unsafe*, and below which is generally considered safe and would not result in a single brain cell death, with perhaps some values in between. Where are these electrical borders defined in simple to understand units such as voltage, current, and frequency?

Additional areas for improvement of the topic would include the different waveforms used, and how a square wave would have higher harmonic(s) frequencies in addition to the fundamental frequency, versus a perfect sine wave that lacks other harmonics and would be stimulating at only the fundamental frequency. How waveform, frequency, and other generalized electrical 'specifications' such as those in the two paragraphs of mine above may affect CES, would certainly improve the usefulness of the topic.

71.128.192.243 (talk) 20:28, 4 February 2008 (UTC)

[edit] Neutrality

The CES is an FDA approved device for the treatment of several disorders including anxiety and depression. http://www.quackwatch.com/01QuackeryRelatedTopics/ces.html —Preceding unsigned comment added by 24.84.162.80 (talk) 00:10, 23 April 2008 (UTC) "Research conducted in the 20th century has demonstrated that the brain makes use of electrical activity; thus, one can affect mental functions by affecting the organ's electrical activity."

"With the strong arm of the prescription medicine industry backing medication, and the stigma of electrical devices for use on the brain (which many relate to electroconvulsive therapy ) companies that developed such devices had a difficult time receiving financial support for needed research."

"The FDA has cleared several CES units to be marketed for the treatment of anxiety, depression, and insomnia."

Each of these statements is biased and/or unfounded. The first statement is not logically sound. The second statement makes use of unfounded editorialization. The third statement is misleading. The FDA only classifies CES units as Class 3 devices (which may cause harm to users) because it they were grandfathered in due to their use before 1976. (See http://www.fda.gov/cdrh/devadvice/3132.html ) Brw12 (talk) 18:03, 19 February 2008 (UTC)

The first statement is perfectly logical, if worded incorrectly. A car runs on gas, therefore by changing the gas you change the way the car works. That statement says the same thing: The brain works with electricity, so if you change the electricity, you change the way the brain works. -Adam H 02/27/08

Yeah, but there's an important difference. When you're stimulating the brain electrically, you have to work from outside the head; it's possible parts of the brain are shielded against external signals, or that an electrode couldn't limit the signal to a small enough area to achieve a particular effect. NeonMerlin 02:09, 28 February 2008 (UTC)

[edit] POV -- entire is misleading advertising

Overpriced, undermade, unproven, dinky little boxes the size of a cigarette pack with a 9-V battery, marketed for staggering prices.

[edit] Grandfathered FDA approval, no actual FDA effectiveness testing

With respect to FDA approval, I this type of device is approved only because a substantially equivalent device was already in use prior to the enactment of medical device regulations in 1976. As such, the vendors of these devices only need to show that their product is not a novel type of device, and they circumvent proper oversight via a grandfather clause loophole.

[edit] Grandfathered FDA approval is only Class 3 even as to safety

These devices are Class 3, which have the greatest likelihood of adverse effects or injury to the patient. That said, it's hard to tell just what these devices do, let alone how they could hurt.

Here's what the FDA has to say about Class 3 devices: http://www.fda.gov/cdrh/devadvice/3132.html

[edit] Few gold-standards trials found

A few anecdotal reports, unblinded trials, and single-blinded single-center trials conducted by enthusiastic vendors of the "services" were found, and (unsurprisingly) showed favorable effects.

Here's one trial specifying that an effective placebo -- sham treatment -- was used. It concludes that "There is Level 1 evidence from one RCT to suggest that cranial electrotherapy stimulation did not help to improve memory and recall following brain injury"

From http://www.abiebr.com/modules/module6.pdf

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6.2.4 Cranial Electrotherapy Stimulation and Memory

Cranial electrotherapy stimulation (CES) is the application of less than 1 mA of electric current to the cranium. This application has been used to treat a variety of disorders, including treatment of withdrawal of patients with substance abuse (Michals et al. 1993). The effect of CES for the improvement of memory following brain injury was investigated.

Individual Studies Table 6.11 The Effect of Cranial Electrotherapy Simulation on Memory Author/ Year/ Country/ Study design/ Score Methodology Outcome Michals et al. (1993) USA RCT D&B = 22 PEDro = 7 A double blind, sham controlled trial was performed on 24 brain-injured patients to evaluate the effectiveness of cranial electrotherapy stimulation (CES) on post-traumatic memory impairment. After a four-week study period, memory performance was measured using subtests from the Wechsler Memory Scale-Revised, California Verbal Learning Test, and Recurring Figures Test.

Results revealed that CES stimulation in brain-injured patients did not improve memory or immediate and delayed recall compared with controls.

Repeated trial effects showed no significant differences between groups.

PEDro = Physiotherapy Evidence Database rating scale score (Moseley et al. 2002). D&B = Downs and Black (1998) quality assessment score. Discussion Michals et al. (1993) studied cranial electrotherapy stimulation and its effect on post-traumatic memory impairment in clinical care patients with closed head injury. Patients received CES or sham CES treatments for 40 minutes daily over a period of four weeks. The group receiving CES treatment did not improve in their memory performance, nor did their immediate or delayed recall improve.

Further, with retesting, both the CES and the sham CES group showed a similarly significant trend with no group performing any better than the other.

These results suggest that CES stimulation in brain-injured patients does not improve memory functioning.

Conclusions There is Level 1 evidence from one RCT to suggest that cranial electrotherapy stimulation did not help to improve memory and recall following brain injury

[edit] The quackwatch write-up is one of the few non-enthusiast sources of information

http://www.quackwatch.com/01QuackeryRelatedTopics/ces.html

Unfortunately, it is limited in scope, rather than covering the area generally, but contains points worthy of including in the article. —Preceding unsigned comment added by 68.166.205.226 (talk) 22:14, 1 May 2008 (UTC)

Try taking a look at the linked external review. It's about the only extensive and balanced look at the subject that I've seen. Considers all sides in an objective, scientific light, with a review of the history, research, and notable reviews (including the quackwatch article) with footnoted references. I'm almost tempted to replace the whole article with that one link. 69.248.94.24 (talk) 05:27, 24 May 2008 (UTC)