Cranial electrotherapy stimulation (CES) is a form of non-invasive neurostimulation utilizing a small, pulsed, alternating current (AC). This current is delivered through electrodes placed on the temples of the head. Some CES devices also allow the electrodes to be placed on the earlobes, made possible through the use of ear clip electrodes. Since CES uses a pulsed AC waveform, the polarity of these electrodes is irrelevant, meaning they can be placed on either temple and still produce the stimulation results desired by the wearer. This neuromodulation technique typically uses a current of up to 5 mA with a frequency range of approximately 0.5-to-500 Hz.
The most commonly used electrodes along with CES devices are sponge-based electrodes or hydrogel sticky variants. In some cases, a CES device may also use the aforementioned ear clip electrodes. Some of these devices may even include support for multiple electrode types. The placement and orientation of the electrodes on the head are designed to allow current to flow through and stimulate the cranial nerves to achieve a certain effect. There are two common electrode orientations for CES: Bi-temporal (representing an electrode placed on each temple) or an electrode clipped on each earlobe. Specific electrode placements cited by manufacturers of specific FDA-cleared CES devices can be found on their respective websites.
Is CES FDA Cleared?
CES is FDA-cleared for the treatment of depression, anxiety, and insomnia. A significant benefit of this form of mental stimulation is that it is known to have very few side effects, limited to mild skin irritation or slight headaches when using standard protocols and guidelines. These side effects are alleviated when the stimulation stops, meaning the wearer will not suffer any long-term negative effects. If you wish to purchase a CES device, be aware that it will require the approval of a licensed healthcare provider prior to shipment. Many device manufacturers will provide an authorization form to provide to your physician to sign; alternatively, they will have an online service in which an authorization can be obtained through a telemedicine provider.
There are many CES devices on the market, ranging from less than $300 to $5,000 or more, but do not believe that you require the highest-end solution to get great results. These devices are very similar to one another, and many differ slightly only in terms of the accessories provided or user interface. Caputron provides a detailed CES Device Comparison table that breakdowns the specs of the most popular devices on the market.
How Long Does CES Take to Work?
In most cases, 2-3 weeks of consistent CES device treatments are necessary before a user can see noticeable results, though some may see more tangible results within as little as the first week. On the other hand, a smaller number of users may see results after three weeks or more – it all depends on the behavior of the mind in question and this cannot be controlled. For this reason, many providers will offer a 30-90 day trial period to allow the user to test the device.
Is CES the same as tDCS?
No, CES is not the same as tDCS. While both are forms of non-invasive electrical brain stimulation, there are some distinct differences between the two. For instance, CES uses a pulsed alternating current (AC) waveform, whereas tDCS uses a direct current (DC) waveform. As for approvals in specific use cases, CES is FDA-cleared for the treatment of depression, anxiety, and insomnia. tDCS, in the meantime, is an investigational technology that is not yet FDA cleared for a medical indication in the US. However, the latter is becoming an increasingly popular technology; tDCS has received CE clearance in Europe for the treatment of depression as well as chronic pain such as migraines and fibromyalgia.
Is CES the Same as TMS?
No, these are two completely different types of treatments as well. Transcranial magnetic stimulation (TMS) devices utilize magnetic fields managed by a dedicated specialist and high-end equipment, utilizing a unique coil-based system placed over the patient’s head. These magnetic fields stimulate nerve cells within the brain in specific targeted areas, making it a more particular technology to work with. CES works by administering safe and non-invasive energy-based stimulation via the aforementioned electrodes. Additionally, CES devices are much smaller and more portable compared to TMS devices, which are typically quite costly, cumbersome, and more complex to operate (hence the need for a dedicated practitioner to operate it).