Neurophysiologic Effects of NeuroCes™
NeuroCes™ Cranial Electrotherapy Stimulator induces changes in neurohormones and neurotransmitters in various psychiatric diseases particularly in depression, and anxiety disorders. Cranial Electrotherapy Stimulation (CES) increases blood level of Beta-Endorphin and Serotonin immediately and may lead over a 2 week period to homeostasis of Serotonin in depressed patients (Shealy et al., 1989).
Cerebrospinal fluid and plasma levels of five neurochemicals including serotonin, beta-endorphin, melatonin, noradrenalin and cholinesterase measured in five asymptomatic, normal subjects at rest and after 20 minutes of Cranial Electrotherapy Stimulation (CES) have been reported by Shealy et al, 1989. Although cerebrospinal fluid levels of serotonin and beta-endorphin rise to a greater extent with CES, beta-endorphin, serotonin and melatonin appear to change significantly in plasma and provide observations of clinical interest. Plasma levels of noradrenalin appear to change moderately after CES. Hypothalamic modulation may explain the reported antidepressant effect of CES (Shealy et al, 1989). Figure 1 and Figure 2 show increased maximum level of neurochemicals in cerebrospinal and plasma in five asymptomatic, normal subjects.
Cranial Electrotherapy Stimulation of serotonergic neurons in the central nervous system (CNS) could act directly on the hypothalamus, causing release of hypothalamic releasing hormones (Liss S, Liss B, 1996).
Cerebrospinal Fluid and Plasma Neurochemicals
Figure 1. Percentage change of neurochemicals in plasma in asymptomatic, normal subjects after 20 minutes of CES (Shealy et al,1989).
Figure 2. Percentage change of neurochemicals in cerebrospinal fluid in asymptomatic, normal subjects after 20 minutes of CES (Shealy et al,1989).
The difference in the levels of blood plasma serotonin, tryptophan, cortisol and ACTH following Cranial Electrotherapy Stimulation has been evaluated by Closson. Measurements of the serum concentration of each of the agents listed in Figure 3 were made before stimulation and 10 minutes after conclusion of a 20-minute treatment (Closson, Win. J. 1988).
Figure 3. The difference in the levels of blood plasma biochemicals following 20 min. CES Stimulation.
According to the study “Potential and Current Density Distributions of Cranial Electrotherapy Stimulation (CES) in a Four-Concentric-Spheres Model” conducted at the Biomedical Engineering Program of the University of Texas at Austin, based on the radial current density simulation, the maximum injected current density by the CES therapy, using a standard 1 mA stimulus, is about 5 µA/cm2 reaches the thalamic area at a radius of 13.30 mm of the model. This demonstrated that the CES electrical field as a facilitating stimulus could cause the release of neurotransmitters responsible for physiological effects (Ferdjallah et. al., 1996).
Potential and Current Density Distributions
Figure 4. The four concentric spheres model of the human head representing the brain tissue, the cerebrospinal fluid, the skull, and the scalp.
The effects of cranial electrotherapy stimulation (CES) on human EEG and brain current density were evaluated by quantitative electroencephalography (qEEG) and low resolution brain electromagnetic tomography (LORETA) by Kennerly, 2006.
According to Kennerly’s study, changes in quantitative EEG and low resolution tomography following cranial electrotherapy stimulation, the qEEG tests revealed that in 0.5 Hz frequency of CES there was a significant increase in alpha relative power (8 - 12 Hz) with concomitant decreases in delta (0 - 3.5 Hz) and beta relative power (12.5 - 30 Hz). The 0.5 Hz CES decreased a wide frequency range of delta activity. The changes found in qEEG relative power were consistent with the affective and cognitive effects of CES reported in the literature, such as increased relaxation and decreased anxiety.
Visual comparison of the relative power spectral display at baseline and after the stimulus revealed a consistent pattern of an increase in alpha activity with concomitant decreases in delta and beta activity (Figure 5.a and Figure 5.b). In some records a bimodal distribution appeared in the post CES spectral display that was not present in the baseline condition (Kennerly, 2006).
Quantitative EEG and Low Resolution Tomography
Relative Power (%)
Baseline Spectral EEG (0.5 Hz CES)
Figure 5.a. Relative power EEG spectra of a single individual before 0.5 Hz CES.
Relative Power (%)
Spectral EEG after 20 minutes of 0.5 Hz CES
Figure 5.b. Relative power EEG spectra of a single individual after 0.5 Hz CES. There is an increase in alpha power with decreases in delta and beta Power. The bimodal distribution of the spectral EEG after CES is a response variant found in some individuals.
A Relative Power Topographical Map of activity shown in Figure 6 can represent the same information in a graphical manner that more clearly conveys the pattern of change by location (Kennerly, 2006):
Figure 6. Relative power p-value topographical map for 0.5 Hz CES. Statistically significant changes (0.05 or better) after 0.5 Hz CES are indicated by color; white indicates no significant change. The arrows indicate the direction of change. Statistically significant decreases were seen in delta and beta with statistically significant increases in alpha.
The immediate effects of CES stimulation on patterns of brain activity in the resting state, and on functional connectivity within intrinsic connectivity networks using functional neuroimaging simultaneously with cranial stimulation have been determined by Feusner et al, 2012.
CES causes cortical brain deactivation in midline prefrontal and parietal regions. CES thus appears to result in similar cortical deactivation patterns for different frequencies but is associated with stronger alterations in functional connectivity for higher frequency. Cortical deactivation patterns differ from those associated with current intensity, suggesting that cortical deactivation may depend more on frequency than intensity of stimulation (Feusner et al, 2012).
Functional Magnetic Resonance Imaging (fMRI)
Figure 7. Regions of decreased brain activity as a result of cranial electrotherapy stimulation (CES) for 0.5-Hz stimulation (blue), 100-Hz stimulation (yellow), and regions of overlap between the two frequencies (green).
NeuroCes™ stimulation may result in cortical deactivation, as well as altering brain connectivity in the default mode network (DMN) after 20 minutes of treatment.
REFERENCES:
Shealy et al,1989. Depression: A Diagnostic, Neurochemicals Profile & Therapy with Cranial Electrotherapy Stimulation (CES). The Journal of Neurological & Orthopaedic Medicine & Surgery, 1989.
Liss S, Liss B., 1996. Physiological and therapeutic effects of high frequency electrical pulses. Integr Physiol Behav Sci 1996;31:88–96.
Closson, Win. J. 1988. Changes in Blood Biochemical Levels following Treatment with TENS Devices of Differing Frequency Composition, private experiment partially funded by Pain Suppression Labs Inc.
Ferdjallah et. al, 1996. Potential and current density distributions of cranial electrotherapy stimulation (CES) in a four concentric-spheres model. IEEE Trans Biomed Eng 1996;43:939–43.
Kennerly, Richard C, 2006. Changes in quantitative EEG and low resolution tomography following cranial electrotherapy stimulation. August 2006, 425 pp., 81 tables, 233 figures, 171 references.
Feusner JD, et al.,2012. Effects of Cranial Electrotherapy Stimulation on resting state brain activity. Brain Behav 2012;2(3):211–20.