CES For Mild Traumatic Brain Injury
Based on the consistently robust results of cranial electrotherapy stimulation (CES) seen throughout this preliminary data, the use of this safe and effective electromedical modality as an adjunct to medical and psychological interventions for mild traumatic brain Cranial electrotherapy stimulation Electroconvulsive Therapy,Electroanes- treatment with CES reported general feel-
thesia, and CES
ings of relaxation and a substantial reduc- tion of anxiety.6-10 When treated daily over assumption that if the strong current used a few weeks to a month, even severe cases 1960s as “electrosleep.” It involves the turned down sufficiently, electroanesthe- CES Research In The US: Stress, Reha-
bilitation, Cognitive Improvements
back into homeostatic balance the brain’s electrochemistry which can be thrown into tant seizure activity. Once electroanesthe- clinical use followed. Controlled scientif- disarray by physical or psychological trau- sia devices were available, physicians who sis, the brain can function normally again, sion—of patients withdrawing from illicit er substantial notch to microcurrent lev- nicotine.14-19 Other studies looked at the for 20 minutes to one hour per day, at least stress of graduate students in a business once a week, but as often as daily in severe cases. Most symptoms improve significant- cerated prisoners on a prison psychiatric ward,21 and of psychiatric patients in gen- tient to complete a good nights rest.
often provided a CES unit to have at home to use from time to time in order to pre- This article reviews the promising avail- component of rehabilitation medicine.
able information on cranial electrothera- ters—waveform, frequencies, current lev- els, etc.—were necessary to reliably induce well known to suffer from extreme stress, brain injury (mTBI) in the civilian sector sleep in their patients. These researchers but it is equally applicable to the military were never able to find a set of electrical and their therapists work to get their lives rehabilitation setting since mild traumat- back to a semblance of normality.25,26 It ic brain injury (mTBI) is one of the signa- ture injuries of the current wars in Iraq that the patients who were given even one tients and, in doing so, it was found to sig- Practical PAIN MANAGEMENT, July/August 2008 nificantly reduce their muscle spasticity.2,27 palsy patients in gaining control of prim- dramatic changes in behavior, the patient vision, and p.r.n. injections for explosive were controlled until two years later when pletely unnecessary. Although the patient he suffered a significant concussion play- an improvement in their stress level, they ing high school football. At that time he gressive, which clearly had been his most in cognitive function, with an average gain tonic-clonic seizures a day, uncontrollable of 12 to 18 points on standardized IQ tests administered just previous to and follow- Case 2: Aggressive Behavior
ing three weeks of daily CES treatment. It in a disappearance of the seizures for two was in this manner that researchers found onset of status epilepticus followed by a curity unit of North Texas State Hospital drug and alcoholic addicts was not perma- nent. While the cognitive abilities of most viral encephalitis. On awakening, his be- havior deteriorated into confusion, sexu- hospital where she had carried out 17 as- saults on peers and staff over a two-month changes, 1:1—and even 2:1—staff cover- patients with mild traumatic brain injuries she continued to attack, throw furniture, kick walls and doors, and required fre-quent restraints. She would fall down upto eight times a day, accuse staff of shov-ing her, and make false reports to the De- “.in every case where patients experienced an improvement in their stress level, they also experienced a dramatic improvement in cognitive floridly paranoid, developed grudge lists, function, with an average gain of 12 to 18 points on standardized IQ tests and would follow peers and staff aroundyelling at them to get away from her. At administered just previous to and following three weeks of daily CES other times, she would target peers for as- sault when they were taking staff ’s timeand attention, which she was demanding.
She sometimes expressed remorse over motor vehicle accidents or falls from high and frontal slowing. Brain stem auditory, elevations on construction projects. That tients and little was known of the effects tal, and lorazepam were all ineffective. age 15. Since 1991, she was in Texas State tient stay, he was physically aggressive 247 Case Summaries
times, made 58 verbal threats, engaged in two years for stealing a car with a baby in Case 1: ‘Rancho Level IV’ Patients
the back seat. For the past 13 years, she ic or post-stroke) patients may be classi- fied as ‘Rancho Level IV’ from the Ran- p.r.n., the assaultive episodes decreased in the schizoaffective disorder, in that her “The patient is in a heightened state of activity with severely decreased ability to 30 minutes twice daily, CES was added.
the present and responds primarily to his first three weeks of treatment, and the vi- olent assaults ceased. In addition to extin- attendant’s arm. She was thought to be of borderline intelligence, but had obtained cessful in decreasing the other four behav- threats were down 100% (to zero), task re- Practical PAIN MANAGEMENT, July/August 2008 Profile of
CES treatment
Sham treatment
hol and street drugs at age 12, and by 21 Mood States
pre to post
pre to post
pre to post
she described herself as an alcoholic like Subscale
apine and ziprazidone along with a largedose of oxcarbazepine and escitalopram.
She had 12 episodes of physical assault in trations. In spite of the large doses of med-icine, she was sleepless many nights, ate three times daily, for her frequent agitat- proved after two weeks and she begansleeping and eating better. Oxcarbazine TABLE 1. Profile of Mood States pre- and post-scores from CES, sham CES, and wait in line
controls in a double blind pilot study on traumatic brain injuries. small dose of clozapine (200mg/day) wasadded. Two weeks later, the quitiapine dose was cut in half and she continued the through the entire brain, but canalized es- she had only five aggressive episodes, re- total of 12 one hour sessions. It was found group, but not in the placebo (sham treat- Scientists at the University of Tennessee Medical Center completed a series of five group. Their fatigue scores also improved studies that used various drugs to delib- significantly, as did their cognitive func- bance score on the Profile of Mood States for PRN’s and other interventions. At the chemical homeostasis within 3 to 7 hours.
was returned to the referring hospital.
There was no recurrence of her illness on CES—the dogs required 4 to 7 days to re- discontinuation of the CES treatments.
the study, the 11 patients in the two con- tient who had the seizure during the dou- ble blind phase of the study was receiving study to date revealing significant increas- Double Blind Pilot Study of CES for TBI
of his parents, he also received actual CES es in alpha activity denoting more relax- ation and significant decreases in delta ac- study. Neither he nor any of the other sub- tivity that accounts for the increased alert- ing in a supervised care home. Their time since injury ranged from six months to 32 while receiving actual CES treatment and, seizure experience in the weeks following CES Mechanisms and EEG Studies
ment (N=5), or “wait in line” controls studied. Researchers at the University of statistician all remained blind to treat- gesting an alteration in the mood of tense, Practical PAIN MANAGEMENT, July/August 2008 which he completed fast fourier transfor- so on, yet in every case there was a robust Scale IQ of 71. Six months after the acci- tern.41,42 Itil used a computerized frequen- score was essentially unchanged at 63. He cy analyzer to study the EEG’s of ten male ject population were addicts, patients un- tention of visual and verbal information.
pital, patients in a sleep laboratory, or WMS was 83, but acquisition of new learn- daily for three weeks. He averaged 29 cor- rect responses immediately after CES, and an alert state remained in the alert state.
there was an increase in 5-10 Hz activity of CES, immediate recall was in the 36-37 and a decrease in fast alpha and beta ac- ing patient improvement if given just be- fore or along with biofeedback of various kinds.45-47 It potentiated the hypnothera- with eight psychiatric patients suffering (55% improvement), and delayed recallimproved to an average of 47 (56% in-crease over baseline).
“Childs reported on the effectiveness of CES in two cases of post- traumatic amnesia. The first was a 21-year-old male who sustained a TBI closed head injury in a motor vehicle ac-cident in 1984, with extensive lacerations following a motorcycle accident but recovered much of his tested memory and a broken leg. Initial CT scan revealed recall functions following a series of CES treatments administered three intraventricular hemorrhages within theoccipital horns of both ventricles. An area and one-half years after the accident.” that appeared consistent with an infarc-tion of the left anterior thalamus was alsonoted. An EEG three weeks later showed slowing consistent with diffuse encephalo- tized.48 Similarly, it was found that it po- treatment a day for five days, the patients tentiated the effects of psychoactive med- ications,34 and also general anesthetics in progressive dilation of the ventricles.
alpha with increased amplitude in the oc- From the day of injury, the patient was ex- cipital-parietal leads.43 Magora studied 20 hospitalized patients suffering from long- thetized with less anesthesia as the surgery demonstrated severe memory deficits.
Twelve weeks after the injury he was trans- ferred to a rehabilitation hospital where turbance, and delusions of being dead. He Post-traumatic Amnesia
had difficulty distinguishing between fan- hours a day for a total ranging from 10 to 20 treatments. A majority (75%) of the pa- sia. The first was a 21-year-old male who treatment with a return to a normal sleep sustained a TBI following a motorcycle ac- lel with the return to a normal sleep pat- memory recall functions following a series after which he was unable to find his way tern, all the other psychiatric signs (e.g., anxiety, depression, agitation, delusions, one-half years after the accident. Post-ac- revealed a right lateral basal ganglia hem- cephalic amnesia secondary to trauma.
tricles. He was totally unresponsive for ten ate recall, and 23 for delayed recall. After Practical PAIN MANAGEMENT, July/August 2008 aged 35 and delayed recall averaged 25.
life. Prior to CES he claimed that “life was to be a very effective treatment for pain not worth living to the degree that suicide call averaged 35 and delayed recall aver- was an attractive option.” He found this tients. 54,55 CES has also shown to be effec- tive in two double blind studies of spinal discontinuation of treatment, he was test- provement of 50-74% relief from his pain, on delayed recall (39% improvement).
hypothesized ability of CES to functional- Subjective observations by staff indicat- ly stabilize the traumatized brain and re- taneity, and initiative in both patients, but day, then the pain gradually returned. In his own words, “The Alpha-Stim 100 [the search will likely confirm these findings and definitively prove CES to be an effec- tive treatment for patients with traumatic tions have not been able to accomplish.
brain injury or, at the very least, a signif- icantly beneficial adjunct to other forms Combined TBI and Global RSD
8 hours or so, these near pain-free hours allow my body to recycle itself, granting for this heavily-medicated population.
tracranial TBI coupled with full body re- this therapy, the constant ‘level 10’ debil- Daniel L. Kirsch, PhD, FAIS is an internation- flex sympathetic dystrophy (global RSD).
itating pain levels leave me with no phys- ally renowned authority on electromedicine with In spite of severe disabilities of his brain ical or emotional reserves to carry on daily over three decades experience in the field who life. The CES therapy has no side effects, currently serves as the Electromedical Dept. Ed- itor of Practical Pain Management and a Con- crippling and lasting side effects that have tributing Editor of the Journal of Neurothera- Employment of People with Disabilities.
py. He was board-certified as a Diplomate of the pairments can not be reversed.” On a zero American Academy of Pain Management in vided satisfactory pain relief for WHH to 1990 and was named a Fellow of the Ameri- complete his tasks and enjoy a relatively says CES reduces his pain level from a 10 can Institute of Stress in 1997. He is a Mem- higher quality of life than he was able to to a 3 which he describes as “the differ- ber of the International Society of Neurofeed- ence between standing on a busy street in back and Research and a Member of Inter-Pain (an association of pain management specialists tranquil creek.” He added “CES provides in Germany and Switzerland). He served as Clinical Director of The Center for Pain and Stress-Related Disorders at Columbia-Presby- terian Medical Center, New York City, and of The Sports Medicine Group, Santa Monica, at bedtime, Kolopin 0.5mg 1 tab t.i.d. to where he was able to perform his daily ex- California. Dr. Kirsch is the author of two books ercise routine. He was also able to rest bet- on CES titled, The Science Behind Cranial 60mg t.i.d. and Fentanyl patches for four ter at night, which he credited as creating Electrotherapy Stimulation, 2nd Ed. published years. This regime did little to reduce his a “positive emotional and physical self-en- by Medical Scope Publishing Corporation, Ed- monton, Alberta, Canada in 2002; and and burning. Nor did it relieve his diffi- Schmerzen lindern ohne Chemie CES, die Rev- culty sleeping. Transcutaneous electrical olution in der Schmerztherapie, Internationale Ärztegesellschaft für Energiemedizin, Austria 2000 (in German). Dr. Kirsch is a research con- sultant to the US Army and VA Medical Cen- ters and currently spends much of his time giv- ing lectures at national military conferences and b.i.d., Restoril 7.5mg at bedtime, Kolopin grand rounds at Veterans Affairs Medical Cen- ters and U.S. Army hospitals such as Brooke Army Medical Center, Walter Reed Army Med- Conclusion
ical Center, and William Beaumont Army Med- duced anxiety level and a significantly en- ical Center. Best known for designing the Alpha- Stim line of medical devices, Dr. Kirsch is Chair- tients may be due to brain dysfunction fol- man of Electromedical Products International, lowing whiplash injury or similar traumas Inc. of Mineral Wells, Texas, USA with addi- to the brain.53 That concept is still under tional offices in Europe and Asia. Dr. Kirsch Practical PAIN MANAGEMENT, July/August 2008 References
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