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Brunyé TT, Patterson JE, Wooten T, et al. A Critical Review of Cranial Electrotherapy Stimulation for Neuromodulation in Clinical and Non-clinical Samples. Front Hum Neurosci. 2021;15:625321doi: 10.3389/fnhum.2021.625321.
Brunyé, T. T., Patterson, J. E., Wooten, T., & Hussey, E. K. (2021). A Critical Review of Cranial Electrotherapy Stimulation for Neuromodulation in Clinical and Non-clinical Samples. Frontiers in human neuroscience, 15625321. https://doi.org/10.3389/fnhum.2021.625321
Brunyé, Tad T, et al. "A Critical Review of Cranial Electrotherapy Stimulation for Neuromodulation in Clinical and Non-clinical Samples." Frontiers in human neuroscience vol. 15 (2021): 625321. doi: https://doi.org/10.3389/fnhum.2021.625321
Brunyé TT, Patterson JE, Wooten T, Hussey EK. A Critical Review of Cranial Electrotherapy Stimulation for Neuromodulation in Clinical and Non-clinical Samples. Front Hum Neurosci. 2021 Feb 01;15:625321. doi: 10.3389/fnhum.2021.625321. eCollection 2021. PMID: 33597854; PMCID: PMC7882621.
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Front Hum Neurosci. 2021 Feb 01;15:625321. doi: 10.3389/fnhum.2021.625321. eCollection 2021.

A Critical Review of Cranial Electrotherapy Stimulation for Neuromodulation in Clinical and Non-clinical Samples.

Frontiers in human neuroscience

Tad T Brunyé, Joseph E Patterson, Thomas Wooten, Erika K Hussey

Affiliations

  1. U. S. Army Combat Capabilities Development Command Soldier Center, Cognitive Science Team, Natick, MA, United States.
  2. Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA, United States.
  3. Department of Psychology, Tufts University, Medford, MA, United States.

PMID: 33597854 PMCID: PMC7882621 DOI: 10.3389/fnhum.2021.625321

Abstract

Cranial electrotherapy stimulation (CES) is a neuromodulation tool used for treating several clinical disorders, including insomnia, anxiety, and depression. More recently, a limited number of studies have examined CES for altering affect, physiology, and behavior in healthy, non-clinical samples. The physiological, neurochemical, and metabolic mechanisms underlying CES effects are currently unknown. Computational modeling suggests that electrical current administered with CES at the earlobes can reach cortical and subcortical regions at very low intensities associated with subthreshold neuromodulatory effects, and studies using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) show some effects on alpha band EEG activity, and modulation of the default mode network during CES administration. One theory suggests that CES modulates brain stem (e.g., medulla), limbic (e.g., thalamus, amygdala), and cortical (e.g., prefrontal cortex) regions and increases relative parasympathetic to sympathetic drive in the autonomic nervous system. There is no direct evidence supporting this theory, but one of its assumptions is that CES may induce its effects by stimulating afferent projections of the vagus nerve, which provides parasympathetic signals to the cardiorespiratory and digestive systems. In our critical review of studies using CES in clinical and non-clinical populations, we found severe methodological concerns, including potential conflicts of interest, risk of methodological and analytic biases, issues with sham credibility, lack of blinding, and a severe heterogeneity of CES parameters selected and employed across scientists, laboratories, institutions, and studies. These limitations make it difficult to derive consistent or compelling insights from the extant literature, tempering enthusiasm for CES and its potential to alter nervous system activity or behavior in meaningful or reliable ways. The lack of compelling evidence also motivates well-designed and relatively high-powered experiments to assess how CES might modulate the physiological, affective, and cognitive responses to stress. Establishing reliable empirical links between CES administration and human performance is critical for supporting its prospective use during occupational training, operations, or recovery, ensuring reliability and robustness of effects, characterizing if, when, and in whom such effects might arise, and ensuring that any benefits of CES outweigh the risks of adverse events.

Copyright © 2021 Brunyé, Patterson, Wooten and Hussey.

Keywords: electrotherapy; human performance; neuromodulation; non-invasive brain stimulation; psychiatry

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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