Electromedicine 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 theirstress 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
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
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
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 asClinical Director of The Center for Pain andStress-Related Disorders at Columbia-Presby-terian Medical Center, New York City, and ofThe 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, InternationaleÄrztegesellschaft für Energiemedizin, Austria2000 (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 BrookeArmy 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 Archives of General Psychiatry. 1974. 30(4):463-66.
sion. Integrative Physiological and Behavioral Science.
1. Empson JAC. Does electrosleep induce natural
23. Feighner JP, Brown SL, and Olivier JE. Elec-
sleep? Electroencephalography and Clinical Neuro-
trosleep therapy: A controlled double-blind study.
42. Heffernan M. The effect of variable microcurrents
Journal of Nervous and Mental Disease. 1973.
on EEG spectrum and pain control. Canadian Journal
2. Forster S, Post BS, and Benton JG. Preliminary ob-
of Clinical Medicine. 1997. 4(10):4-11.
servations on electrosleep. Archives of Physical Medi-
24. Koegler RR, Hick SM, and Barger JH. Medical
43. McKenzie RE, Rosenthal SH, and Driessner JS. cine and Rehabilitation. 1963. 44:481-489.
and psychiatric use of electrosleep (transcerebral
Some psycho-physiological effects of electrical tran-
3. Frankel BL, Buchbinder R, and Snyder F. Ineffec-
electrotherapy). Diseases of the Nervous System. scranial stimulation (electrosleep). American Psychi-
tiveness of electrosleep in chronic primary insomnia.
atric Association, Scientific Proceedings Summary. Archives of General Psychiatry. 1973. 29:563-568.
25. Kirsch DL and Smith RB. The use of cranial elec-
4. Itil T, Gannon P, Akpinar S, and Hsy W. Quantitative
trotherapy stimulation in the management of chronic
44. Magora F, Beller A, Assael MI, and Askenazi A.
EEG analysis of electrosleep using frequency analyz-
pain: A review. NeuroRehabilitation. 2000. 14:85-94.
some aspects of electrical sleep and its therapeutic
er and digital computer methods. Electroencephalog-
26. Kirsch DL and Gilula MF. CES in the treatment of
value. In Wageneder, F.M. and St. Schuy (Eds). Elec-
raphy and Clinical Neurophysiology. 1971. 31:294.
pain-related disorders. Practical Pain Management.
trotherapeutic Sleep and electgroanesthesia. Excerp-
5. Maagora F, Beller A, Aladjemoff L, Magora A, and
ta Medica Foundation, International Congress Series
Tannenbaum J. Observations on electrically induced
27. Wharton GW, McCoy CE, and Cofer J. Effect of
sleep in man. British Journal of Anesthesiology. 1965. CES therapy on spinal cord injured patients. Present-
45. Brotman P. Low-intensity transcranial electrostim-
ed at the American Spinal Injury Association. New
ulation improves the efficacy of thermal biofeedback
6. Long RC. Electrosleep therapy. Some results with
and quieting reflex training in the treatment of classi-cal migraine headache. American Journal of Elec-
the use of electrically induced sleep in the treatment
28. Logan MP. Improved mechanical efficiency in
tromedicine. 1989. 6(5):120-123.
of psychiatric patients. Journal of the Kansas Medical
cerebral palsy patients treated with cranial elec-
trotherapy stimulation (CES). 1988. In Kirsch, DL, The
46. Overcash SJ and Siebenthall A. The effects ofcranial electrotherapy stimulation and multisensory
7. Rosenthal SH and Calverty LG. electrosleep: Per-
Science Behind Cranial Electrotherapy Stimulation.
cognitive therapy on the personality and anxiety lev-
sonal subjective experiences. Biological Psychiatry. 2nd Ed. Medical Scope Publishing. Edmonton, Alber-
els of substance abuse patients. American Journal ofElectromedicine. 1989. 6(2):105-111.
8. Rosenthal SH and Wulfson NL. Electrosleep: A
29. Malden JW and Charash LI. Transcranial stimula-
47. Kelley J, Whitney K, Irene H, and Kaiman C. Cere-
clinical trial. American Journal of Psychiatry. 1970.
tion for the inhibition of primitive reflexes in children
bral electric stimulation with thermal biomedical feed-
with cerebral palsy. Neurology Report. 1985. 9(2):33-38.
back. Nebraska Medical Journal. 1977. 62(9):322-26.
9. Singh JM, King HA, and Super WC. Effects of tran-
48. Barabasz AF. Hypnosis and cerebral electrothera-
scerebral electrotherapy (TCT) in stress related ill-
30. Okoye R and Malden JW. Use of neurotransmitter
py in the treatment of sleep disturbances in mildly de-
ness. Pharmacologist. 1974. 16(2):264.
modulation to facilitate sensory integration. NeurologyReport. 1986. 10(4):67-72.
pressed patients. Hypnosis Quarterly. 1976.
10. Rosenthal SH and Wulfsohn NL. Electrosleep: A
preliminary communication. Journal of Nervous and
31. Smith RB and Day E. The effects of cerebral elec-
49. Stanley TH, Cazalaa JA, Atinault A, Coeytaux R,
Mental Disease. 1970. 151(2):146-151.
trotherapy on short-term memory impairment in alco-holic patients. International Journal of the Addictions.
Limoge A, and Louville Y. Transcutaneous cranial
11. Rosenthal SH and Wulfsohn NL. Studies of elec-
electrical stimulation decreases narcotic requirements
trosleep with active and simulated treatment. Current
during neurolept anesthesia and operation in man. Therapeutic Research. 1970. 12(3):126-130.
32. Smith RB. Confirming evidence of an effective
Anesthesia and Analgesia. 1982. 61(10):863-866.
treatment for brain dysfunction in alcoholic patients.
12. Rosenthal SH. Electrosleep: A double-blind clini-
Journal of nervous and Mental Disease. 1982.
50. Stanley TH, Cazalaa JA, Limoge A, and Louville Y.
cal study. Biological Psychiatry. 1972. 4(2):179-185.
Transcutaneous cranial electrical stimulation increas-
13. Moore JA, Mellor CS, Standage KF, and Strong H.
es the potency of nitrous oxide in humans. Anesthesi-
33. Schmitt R, Capo T, Frazier H, and Boren D. Cra-
A double-blind study of electrosleep for anxiety and
nial electrotherapy stimulation treatment of cognitive
insomnia. Biological Psychiatry. 1975. 10(1):59-63.
brain dysfunction in chemical dependence. Journal of
51. Childs A and Crismon ML. The use of cranial
14. Bianco Jr F. The efficacy of cranial electrotherapyClinical Psychiatry. 1984. 45(2):60-63.
electrotherapy stimulation in post-traumatic amnesia:
stimulation (CES) for the relief of anxiety and depres-
a report of two cases. Brain Injury. 1988. 2(3):243-47.
34. Childs A. Droperidol and CES in Organic Agita-sion among polysubstance abusers in chemical de-tion. Clinical Newsletter, Austin Rehabilitation Hospi-
52. Alpher EJ and Kirsch DL. Traumatic brain injury
pendency treatment. Ph.D. Dissertation. The Universi-
and full body reflex sympathetic dystrophy patient
treated with cranial electrotherapy stimulation. Ameri-
35. Childs A and Price L. Cranial electrotherapy stim-
15. Gold MS, Pottash ALC, Sternbach H, Barbaban J,
can Journal of Pain Management. 1998. 8(4):124-128.
ulation reduces aggression in violent neuropsychiatric
and Annitto W. Anti-withdrawal effects of alpha methyl
Presented at the Ninth Annual Clinical Meeting of the
patients. Primary Psychiatry. 2007. 14(3):50-56. Pre-
dopa and cranial electrotherapy. Society for Neuro-
American Academy of Pain Management. Atlanta,
sented at the American Psychiatric Association 160th
science, 12th Annual Meeting Abstracts. October,
Annual Meeting: Addressing Patient Needs. San
53. Bennett RM, Cook DM, Clark SR, Burckhardt CS,
and Campbell SM. Hypothalamic-pituitary-insulin-like
36. Smith RB, Tiberi A, and Marshall J. The use of
methadone withdrawal with cerebral electrotherapy
growth factor-1 axis dysfunction in patients with Fi-
cranial electrotherapy stimulation in the treatment of
(electrosleep). British Journal of Psychiatry. 1978.
bromyalgia. Journal of Rheumatology. 1997. 24:384-
closed-head-injured patients. Brain Injury. 1994.
17. Schmitt R, Capo T, and Boyd E. Cranial elec-
54. Cork RC, Wood P, Ming N, Clifton S, James E,
37. Jarzembski WB, Larson S J, and Sances Jr A.
trotherapy stimulation as a treatment for anxiety in
and Price L. The effect of cranial electrotherapy stim-
Evaulation of specific cerebral impedance and cere-
chemically dependent persons. Alcoholism: Clinical
ulation (CES) on pain associated with fibromyalgia.
bral current density. Annals of the New York Academyand Experimental Research. 1986. 10(2):158-160. The Internet Journal of Anesthesiology. 2004. 8(2).
18. Smith RB and O’Neill L. Electrosleep in the man-
55. Lichtbroun AS, Raicer MM, and Smith RB. The
38. Pozos RS, Strack LE, White RK, and Richardson
agement of alcoholism. Biological Psychiatry. 1975.
treatment of fibromyalgia with cranial electrotherapy
AW. Electrosleep versus electroconvulsive therapy. In
stimulation. Journal of Clinical Rheumatology. 2001.
Reynolds, David V. & Sjoberg, Anita E. (Eds). Neuro-
19. Patterson MA, Firth J, and Gardiner R. Treatment
electric Research. Charles Thomas. Springfield. 1971.
of drug, alcohol and nicotine addiction by neuroelec-
56. Capel ID, Dorell HM, Spencer EP, and Davis
tric therapy: Analysis of results over 7 years. Journal
MWL. The amelioration of the suffering associated
39. Kennerly R. QEEG analysis of cranial electrother-
of Bioelectricity. 1984. 3(1&2):193-221.
with spinal cord injury with subperception transcranial
apy: a pilot study. Journal of Neurotherapy. 2004.
electrical stimulation. Spinal Cord. 2003. 41:109-117.
20. Matteson MT and Ivancevich JM. An exploratory
(8)2:112-113. Presented at the International Society
investigation of CES as an employee stress manage-
for Neuronal Regulation Annual Conference. Hous-
57. Tan G, Rintala DH, Thornby J, Yang J, Wade W,
ment technique. Journal of Health and Human Re-
and Vasilev C. Using cranial electrotherapy stimula-
source Administration. 1986. 9:93-109.
tion to treat pain associated with spinal cord injury.
40. Cox A and Heath RG. Neurotone therapy: A pre-
Journal of Rehabilitation Research and Development.
21. Jemelka R. Cerebral electrotherapy and anxiety re-
liminary report of its effect on electrical activity of
2006. 43(4):461-474. Presented at the South Central
duction. Master’s Thesis, Stephen F. Austin State Uni-
forebrain structures. Diseases of the Nervous System.
VA Health Care Network’s Pain Management Initiative
2nd Annual Pain Management Symposium: Cam-
22. Herst ED, Cloninger CR, Crews EL, and Cadoret
41. Heffernan M. Comparative effects of microcurrent
paign Against Pain. Jackson, Mississippi. April 7,
RJ. Electrosleep therapy: A double-blind trial.
stimulation on EEG spectrum and correlation dimen-
Practical PAIN MANAGEMENT, July/August 2008
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BRYGGEKLINIKKEN AS D o c S i d e - august 2009H1N1 (New Influenza)- also known as ”swine flu”The name “swine flu” is both stigmatising and misleading. As a result the Norwegian healthauthorities (and WHO) has now designated the condition as “new flu”. This is supported byus here at Bryggeklinikken, and we furthermore support the guidelines published by theNorwegian health authoriti