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Cranial electrotherapy stimulation (CES) is a form of non-invasive neurostimulation utilizing a small, pulsed, alternating current (AC) delivered through electrodes on the temples. Some CES devices also allow the electrodes to be placed on the earlobes through the use of ear clip electrodes. As CES uses a pulsed AC waveform, the polarity of the electrodes is irrelevant and can be placed on either temple. This neuromodulation technique typically uses a current of up to 5 mA with a frequency range of approximately 0.5-500 Hz. A detailed breakdown of the different available CES devices and their frequency can be seen on our CES Device Comparison page.
Because CES technology is classified as a Class III medical device by the FDA, approval from a licensed medical practitioner is required to purchase a CES device. Many CES device providers offer a service to help you obtain a device authorization for a small fee of ~$18-$20.
The most commonly used electrodes with CES devices are sponge electrodes or hydrogel sticky electrodes. In some cases, a CES device may also use ear clip electrodes. Some devices may even come with the option for both. The placement and orientation of the electrodes on the head is designed to allow current to flow through and stimulate the cranial nerves to achieve a certain effect. There are 2 common electrode orientations for CES: bi-temporal (an electrode 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.
CES is FDA cleared for the treatment of depression, anxiety, and insomnia. CES is known to have little 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. CES will require the approval of a licensed health care provider prior to shipment. Many device manufacturers will provide an authorization form to provide to your physician to sign or have an online service in which an authorization can be obtained for a small fee.
There are many CES devices on the market, ranging from ~$300 to $5,000. These devices are very similar and many differ slightly only in the accessories provided. The similarities and differences of the most commonly used CES devices can be viewed in Caputron's CES Device Comparison table.
CES devices typically take 2-3 weeks before a user can see noticable results, though some users see results within the first week. However, some individuals may take longer. For this reason, many providers will offer a 30 day trial period to allow the user to test the device. Caputron extends this trial period to 90 days so you can fully test the device without being rushed to return it should you not feel any benefits.
No, CES is not the same as tDCS. While both are forms of noninvasive electrical brain stimulation, there are some distinct differences between tDCS and CES. CES uses a pulsed alternating current (AC) waveform, whereas tDCS uses a direct current (DC) waveform. CES is FDA cleared for the treatment of depression, anxiety, and insomnia. tDCS is an investigational technology that is not FDA cleared for a medical indication in the US. However, tDCS is an increasingly popular technology that has received CE clearance in Europe for the treatment of depression as well as chronic pain such as migraine and fibromyalgia. For a more detailed analysis of the difference between CES and tDCS, view our tDCS versus CES page.
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