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Case Series and Case Reports

Cranial Electrotherapy Stimulation in the Treatment of Posttraumatic Stress Disorder: A Pilot Study of Two Military Veterans

Alfred G. Bracciano, Wen Pin Chang, Stephanie Kokesh, Abe Martinez, Melissa Meier, Kathleen Moore

Department of Occupational Therapy, Creighton University, Omaha, Nebraska, USA, 2007


This case study investigated the effects of cranial electrotherapy stimulation (CES) on the prevalence and intensity of posttraumatic stress disorder (PTSD) symptoms and self- perceived improvement of performance and satisfaction in daily activities in war veterans. Two male Caucasian veterans (ages 54 and 38) diagnosed with PTSD participated in these case studies with a pretest-posttest design. The Canadian Occupational Performance Measure (COPM) and the PTSD Symptom Scale-Interview (PSS-I) were administered before and after the 4-week CES treatment.

Cranial Electrotherapy Stimulation Reduces Aggression in Violent Neuropsychiatric Patients

Allen Childs, MD, FAPA, and Larry Price, PhD

North Texas State Hospital-Vernon Campus, Multiple Disabilities Unit, Vernon, Texas, USA, 2007


The study sought to determine if 3 months of daily cranial electrotherapy stimulation (CES) treatment reduced aggression in violent neuropsychiatric patients in a maximum security hospital. CES was used to treat 48 chronically aggressive neuropsychiatric patients in a maximum security psychiatric hospital. Retrospective chart review compared 3 months pre-treatment with 3 months of active therapy. Early patients had responded positively to CES with a 41% reduction in episodes of violence (P<001), a 40% reduction in episodes requiring restraint (P<.001) and seclusion (P<05), and 42% fewer as-needed emergency medications (P<01). A subgroup of 10 treatment-resistant psychotic patients, who attacked without warning or apparent motivation and were designated as having sudden assault syndrome, were 48% less violent on CES (P<001). CES has significant anti-aggressive effects in violent neuropsychiatric patients, who are often refractory to medication. This safe, easy-to-administer treatment can benefit long-term severely ill patients.

Cranial Electrotherapy Stimulation Reduces Aggression in a Violent Retarded Population: A Preliminary Report

Allen Childs, MD, F.A.P.A.

North Texas State Hospital-Vernon Campus, Multiple Disabilities Unit, Vernon, Texas, USA, 2004


Nine aggressive, retarded patients refractory to conventional care at a maximum security hospital were given a 3-month course of cranial electrotherapy stimulation. Aggressive episodes declined 59% from baseline; seclusions were down 72%; restraints were down 58%; and use of prescribed as needed sedative medications decreased 53%. The most dramatic change was that of a disorganized, schizophrenic patient whose aggressive episodes declined from 62 to 9, seclusions from 53 to 8, restraints from 9 to 1 and PRNs from 25 to 1. No patients discontinued cranial electrotherapy stimulation (CES) because of side effects. This preliminary report indicates that CES appears to be an efficacious, safe, and cost-effective addition to the treatment regimen in this patient population.

Cranial Electrotherapy Stimulation for the Treatment of Chronically Symptomatic Bipolar Patients

Mostafa Amr, MD, Mahmoud El-Wasify, MD, Ahmed Z. Elmaadawi, MD, R. Jeannie Roberts, MD and Rif S. El-Mallakh, MD.

Department of Psychiatry, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Psychiatry, Mayo Clinic, Rochester, MN; and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Louisville, Louisville, KY., 2013.


The aim of this study was to determine if cranial electrotherapy stimulation (CES) is beneficial in chronically symptomatic bipolar (CSBP) subjects. A retrospective chart review of all consecutive CSBP subjects who were prescribed CES collected demographic and clinical information. The Clinical Global Impression improved significantly [mean (SD), 2.7 (0.6) at baseline vs 2.0 (0.0), t = 0, P G 0.001], but mood symptoms change minimally. There were very few adverse effects of CES. Patients with CSBP continue to experience symptoms with CES but also are modestly improved.

The Effect of ROSHI Protocol and Cranial Electrotherapy Stimulation on a Nine-Year-Old Anxious, Dyslexic Male with Attention Deficit Disorder: A Case Study

Stephen J. Overcash, EdD

Psychological Services, 640 Philadelphia Avenue, Chambersburg, PA 17201, USA, 2005


This case study describes diagnosis and treatment of a nine-year-old male with poor reading achievement, attention deficit disorder, and severe generalized anxiety disorder. The goal of the treatment was to significantly increase this young man’s reading achievement, reduce his anxiety to a normal level, and to reduce his ADD symptoms so he could concentrate at a normal level for his age and sex. Psychological testing was administered and QEEGs were recorded before and after treatment intervention. The patient was treated using the ROSHI Complex Adaptive Protocol, Cranial Electrotherapy Stimulation, and Project Read Reading Program. This multimodal treatment lasted six months with follow-up testing administered 15 months after initial diagnostic testing. Before and after objective psychological test results and QEEG changes indicate significant improvement in reading achievement, significant math and spelling achievement, significant reduction in anxiety, and significant reduction in ADD symptoms.

Mechanistic Studies

Effects of cranial electrotherapy stimulation on resting state brain activity

Jamie D. Feusner(a), Sarah Madsen(a), Teena D. Moody(a), Cara Bohon(a), Emily Hembacher(b), Susan Y. Bookheimer(c) & Alexander Bystritsky(a)

(a)Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California; (b)Department of Psychology, University of California, Davis, California; (b)Center for Cognitive Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California


Cranial electrotherapy stimulation (CES) is a U.S. Food and Drug Administration (FDA)-approved treatment for insomnia, depression, and anxiety consisting of pulsed, low-intensity current applied to the earlobes or scalp. Despite empirical evidence of clinical efficacy, itsmechanism of action is largely unknown. The goal was to characterize the acute effects of CES on resting state brain activity. Our primary hypothesis was that CES would result in deactivation in cortical and subcortical regions. Eleven healthy controls were administered CES applied to the earlobes at subsensory thresholds while being scanned with functional magnetic resonance imaging in the resting state. We tested 0.5- and 100-Hz stimulation, using blocks of 22 sec “on” alternating with 22 sec of baseline (device was “off”). The primary outcome measure was differences in blood oxygen level dependent data associated with the device being on versus baseline.

Open Clinical Trials

The Use of Cranial Electrotherapy Stimulation to Block Fear Perception in Phobic Patients

Smith, Ray B, & Shiromoto, Frank N. 

Life Balance International, Draper, Utah and Private Practice consultant, Huntington Beach, California, USA., 1992


Investigated the effect of cranial electrotherapy stimulation (CES) in reducing fear perception in 26 phobic patients (aged 26–66 yrs). Ss were asked to imagine themselves in their worst phobic situation, then rate their fear on a scale from no fear to extreme fear. They were then given 30 min of CES, after which they were asked to frighten themselves again and to rate the fear as before. Ss were successful in generating a fear response, which, in turn, appeared to be mitigated by CES.

Efficacy of cranial electric stimulation for the treatment of insomnia: A randomized pilot study

(a) R. Gregory Lande(a); (b) Cynthia Gragnani

(a)Psychiatric Continuity Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; (b)Psychiatry Continuity Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States, 2012


This pilot study examined the potential efficacy of cranial electric stimulation for the treatment of insomnia. Design: The researchers tested the hypothesis through a randomized, double-blind, and placebo controlled clinical trial. The researchers approached eligible subjects who scored 21 or above on the Pittsburgh Insomnia Rating Scale. The researchers then randomly assigned the subjects to receive either an active or sham device. Each study subject received 60 min of active or sham treatment for five days. Following each intervention the subjects completed a sleep log, as well as three and ten days later.

Safety and effectiveness of cranial electrotherapy stimulation in treating children with emotional disorders

(a) Lu Xiao-yan, Wang Ai-hua, Li Yan, Zhang Ji-shui, Liu Bei-xing, Lu Xiao-yan, Wang Ai-hua, Li Yan, Zhang Ji-shui; (b) Liu Bei-xing; (c) Lu Xiao-yan.

(a)Neurorehabilitation Center, Affiliated Beijing Children’s Hospital, Capital University of Medical Sciences, Beijing 100045, China; (b)Department of Physiology, Capital University of Medical Sciences, Beijing 100054, China; (c)Chinese Academy of Sciences in 2003, Master, Associate Chief Physician, Research direction: clinic research of internal diseases and metal disorders in children.2004.


To evaluate the safety and effectiveness of cranial electrotherapy stimulation (CES) in treating children with emotional disorders. Thirty-two children with emotional disorders were treated with CES by using Alpha-Stim 100 instrument in the psychological clinic of Beijing Children’s Hospital from April 2003 to October 2004, and they were followed up for 6~12 months. 13 cases had significant effect, 17 cases had effect, and the effect was invalid in 2 cases, and the total effective rate was 94%; there was no missing case. 26 cases were followed up by means of telephone visit and regular reexamination in the clinic at 3, 6, 9 and 12 months after the treatment respectively; among them, 24 cases had long lasting efficacy with relieved or eliminated symptoms, and 2 cases had insignificant efficacy without significant emotional improvement and with relapse of symptom.CES is a new technique for the treatment of emotional disorders; it has the advantages of fast effect, significant efficacy, as well as the characteristics of accumulative effect, fewer relapse and no side effects.

Cranial Electrotherapy Stimulation for Treatment of Anxiety, Depression, and Insomnia

Daniel L. Kirsch, PhD(a), Francine Nichols, RN, PhD(b)

(a)The American Institute of Stress, 9112 Camp Bowie West Boulevard #228, Fort Worth, TX 76116, USA; (b) Georgetown University, Washington, DC, USA. 2013


Cranial electrotherapy stimulation (CES) uses medical devices about the size of a cell phone that send a pulsed, weak electrical current (<4 mA) to the brain via electrodes placed on the ear lobes, maxilla-occipital junction, mastoid processes, or temples. CES was first cleared for interstate marketing and export by the US Food and Drug Administration for the treatment of anxiety, depression, and insomnia in 1979 and its use in clinical practice has steadily increased over time. The primary treatments used today for anxiety, depression, and insomnia are pharmaceuticals and psychotherapy. Both approaches have limitations in terms of effectiveness, side effects, costs, or time required. During the last decade, an increasing number of psychiatrists are integrating CES treatments into their clinical practice because it is noninvasive, has few side effects (1% or less), and treats anxiety, depression, and insomnia simultaneously.


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