Optimization of therapy in patients with lichen ruber planus by means of cranial electrotherapy stimulation

Rationale: Taking into account the significance of psychogenic factor in the onset of lichen planus, its correction is advisable. Transcranial electric stimulation is promising, given its autonomous regulating, analgesic, antipruritic, reparative and regenerative, and immunomodulatory effects, in addition to the anti-stress one.Aim: To assess the effectiveness of the combination therapy including cranial electrotherapy stimulation (CES) with lichen ruber planus.Materials and methods: This was an open label, prospective, comparative study in 61 patients with common typical form of lichen ruber planus (39 (63%) women and 22 (37%) men) aged 18 to 74 years (mean age 41 ± 14.29 years). The duration of the disease was 11.88 ± 10.15 months (range, 1 to 42 months). The patients were adaptively randomized into two groups of similar gender distribution, age, and disease duration. The patients in the comparison group (n = 30) were treated conventionally in accordance with the Federal Clinical Guidelines (chloroquine, hydroxyzine, topical corticosteroids). The main group (n = 31) was administered similar therapy; however, instead of hydroxyzine, CES was performed. The duration of in-patient treatment in both groups was 14 days, with the follow-up lasting for up to 3 months. The results of treatment were assessed by dynamics of pathological changes of the skin (Index of Lichen Planus, ILP), impact of dermatosis on various domains of the patient’s life (Dermatology Life Quality Index, DLQI), changes in psychological status (Hamilton Anxiety Scale and Hamilton Depression Scale). In addition, the impact of pruritus on the patients' daily activities was assessed by Behavioral Rating Scores questionnaire (BRS).Results: At baseline, there were no significant differences between the groups in ILP (p = 0.801), DLQI (p = 0.501), BRS (p = 0.521), Hamilton Anxiety Scale (p = 0.301), and Hamilton Depression Scale (p = 0.493). At the end of treatment, ILP in the CES group decreased 3.25-fold (p < 0.001), whereas in the group treated with conventional therapy the decrease was 2.1-fold (p < 0.001); DLQI decreased 2.5-fold (p < 0.001) and 1.8-fold (p < 0.001), respectively. The corresponding decreases of Hamilton Anxiety Scale in the treatment groups were 2.3-fold and 1.3-fold, respectively, and those in Hamilton Depression Scale – 2-fold and 1.6-fold, respectively (all p < 0.001). In addition, statistically significant intergroup differences were found for ILP (p = 0.04), DQLI (p < 0.001), Hamilton Anxiety and Depression scale scores (p = 0.021 and p = 0.006, respectively). As for the BRS changes, in both groups there was an equally significant (p < 0.001) decrease, but the intergroup differences were not statistically significant (p = 0.485).Conclusion: The proposed combination therapy of patients with lichen ruber planus including CES has led to a decrease in the indicators of the skin process activity within a shorter time period than in the patients under conventional treatment. In addition, the patients of both groups showed normalization of psychological parameters and improvement in dermatological quality of life; however, only in the CES group, these changes were significant.

Prototipe Cranial Electrotherapy Stimulation

Cranial Electrotherapy Stimulator merupakan alat kedokteran yang berfungsi untuk terapi. Alat ini bekerja dengan cara memberikan arus listrik melalui kepala pasien untuk mengobati insomnia, depresi dan ansietas (anxiety) melalui elektroda yang dipasang pada daun telinga (earlobes) dengan menggunakan arus listrik yang sangat rendah. Adanya sifat arus kelistrikan pada tubuh manusia memungkinkan kita dapat memberikan rangsangan ke dalam tubuh manusia secara langsung. Tujuan dari penelitian ini adalah mengembangkan Prototype Cranial Electrotherapy Stimulation yang diharapkan dapat mengatasi penyakit depresi, insomnia dan ansietas. Prototipe Cranial Electrotherapy Stimulation menggunakan elektroda earclip sebagai media output terapi dan OLED 96 inch sebagai display timer dan menu. Rangkaian utama Prototipe Cranial Electrotherapy Stimulation terdiri dari rangkaian minimum sistem ATMega328P, rangkaian pembangkit frekuensi, dan rangkaian battery level. Pada pengujian frekuensi output didapatkan hasil rata-rata nilai frekuensi sebesar 0,5021 Hz dengan persentase error sebesar 0,42 %. Pada pengujian arus didapatkan range rata-rata sebesar 68,15 µA-744,9 µA dengan rata-rata arus titik default sebesar 100,2 µA. Pada pengujian lain seperti pengujian spesifikasi gelombang dan kepresisian timer diketahui jenis gelombang berupa gelombang kotak dengan tinggi gelombang 9 Vp dan durasi positif 400 ms - 500 ms, timer pada alat pun sangat presisi karena tidak memiliki nilai error lebih dari 1 detik.

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

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.