A 74-year-old retired building inspector with a 15-year history of Parkinson’s disease (PD) presented with a severe resting tremor in the right hand, generalized bradykinesia, difficulties with the initiation of gait with freezing, mental depression, and generalized cognitive impairment despite being fully medicated. Testing of constructional abilities employing various drawing tasks demonstrated drawing impairment compatible with severe left hemispheric dysfunction. He had two successive transcranial treatments, 20 minutes duration each, with pulsed electromagnetic fields (PEMFs) of very low intensity and frequencies of 5Hz and 7Hz. His tremor disappeared, and he had dramatically improved drawing performance. As he continued daily treatments with PEMFs for two more days, he had additional striking improvements in his drawing. This treatment demonstrates rapid reversal of drawing impairment in Parkinson’s disease, related to left hemispheric brain dysfunction even by brief transcranial very, low-intensity PEMFs. It also shows that cognitive deficits associated with Parkinsonism, which usually are progressive and unaffected by dopamine replacement therapy, may be partly reversed by these PEMFs. Treatment with PEMFs reflects a “cutting edge” approach to the management of cognitive impairment in Parkinsonism. (Sandyk, Sep 1997)
Parkinsonโs disease (PD) is the second most common neurodegenerative disorder in people over the age of sixty. Aging is the major contributing factor for increased risk of developingย Parkinsonโs disease. With the aging of the population worldwide, the frequency ofย Parkinsonโs diseaseย is expected to increase dramatically in the coming decades. Nearly one million people in the US are living with Parkinsonโs disease. It is estimated that 6-10 million people worldwide haveย Parkinsonโs disease, affecting all races and ethnicities. The incidence ofย Parkinsonโs diseaseย rises rapidly with age, affecting approximately 1% of the population older than sixty years and approximately 4% of those older than eighty years. Every nine minutes, someone in the United States is diagnosed with Parkinsonโs disease. Parkinsonโs disease (PD) is a chronic and progressive movement disorder primarily, meaning that symptoms continue and worsen over time. The cause is unknown, and there is no cure.
Conventional treatment options include medication and surgery to manage symptoms. Neither reduces progression.
Parkinsonโs diseaseย most obviously involves the malfunction and death of vital nerve cells (neurons) in the brain, primarily an area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a neurochemical that sends messages to the part of the brain that controls movement and coordination. Asย Parkinsonโs diseaseย progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally. Loss of cells in other areas of the brain and body contribute to Parkinsonโs. For example, researchers have discovered that the hallmark sign ofย Parkinsonโs diseaseโclumps of a protein alpha-synuclein, which are also called Lewy Bodiesโare found not only in the mid-brain but also in the brain stem and in scent cells.ย These areas of the brain correlate to non-motor functions such as sense of smell and sleep regulation. The presence of Lewy bodies in these areas could explain the non-motor symptoms experienced by some people withย Parkinsonโs diseaseย before any movement (motor) signs of the disease appear. The intestines also have dopamine cells that degenerate in Parkinsonโs, and this may be important in the gastrointestinal symptoms that are part of the disease.
Standard medication treatment ofย Parkinsonโs diseaseย can be only 50% effective overall. As the dose of taken medication is wearing off, there can be a decline in the drugโs efficacy. For example, in the morning shortly after taking it, the medication may be 90% effective, in the afternoon only 50% effective and in the evening only 30% effective. Twice-weekly treatments with extremely low intensity PEMFs applied to the head for ten weeks has been shown to eliminate these medication declining efficacy symptoms. At ten weeks after starting the PEMFs, there was 40% improvement in response to medication with minimum change in efficacy during the course of the day or evening. PEMFs appeared to enhance response to medication. Since decline in the response to medication is a phenomenon associated with progression of the disease, these results suggest that intermittent application of PEMFs may reverse the course of progressiveย Parkinsonโs diseaseย (Sandyk, Oct 1997).
Major aspects ofย Parkinsonโs diseaseย that are not addressed by conventional medical therapies, specifically pharmaceuticals, can be significantly impacted by PEMFs. These include: Neuro-inflammation, the Brain-Gut Axis, Ferroptosis, Mitochondrial Dysfunction, the Braak Hypothesis and Alpha-synuclein, Vagal Nerve Stimulation (VNS) and Deep Brain Stimulation (DBS), medication side effects, stem cell therapy, and comorbidities.
The major role of PEMFs in Parkinsonโs disease is to impact multiple aspects of the condition, unlike most other therapies which tend to be one-dimensional. In any given individual withย Parkinsonโs diseaseย there are often multiple factors that play intoย Parkinsonโs disease, both in terms of initiation, progression and holistic management. PEMFs address multiple factors simultaneously because of their general actions in the body, covered in the books Power Tools for Health and Supercharge Your Health with PEMF Therapy and on the website DrPawluk.com. The impact of PEMFs on all of the aboveย Parkinsonโs diseaseย contributing factors, are all covered in greater depth in the PEMFs and Parkinsonโs Disease e-book. See the e-book section on Dr. Pawluk.com.
The exploration of Pulsed Electromagnetic Fields (PEMFs) in Parkinson’s Disease (PD) represents an innovative frontier in neurodegenerative disorder treatment. The application of PEMFs offers a non-invasive method to potentially mitigate symptoms and alter the disease’s progression through mechanisms that influence cellular and neurological functions.
Electromagnetic stimulation of is a non-invasive rapidly emerging biological tissue treatment technique. PEMFs induce ion currents in the tissue and depolarize the electrical activity of all membranes, neurologic and non-neurologic slightly. Electromagnetic stimulation in animals and in the laboratory enhances cellular activity and stimulates growth-related responses and regeneration. As a result, PEMFs stimulate nerve growth and rebalance nerve abnormalities, increase microvascular blood flow and tissue oxygenation, and increase the amount and density of capillaries. As a result, PEMF treatment would be expected to delay disease progression and even induce neuro-repair inย Parkinsonโs disease. (Jensen)
| PD Symptom | Comments | Ref |
| Yawning and stretching | These are dopamine behaviors. Extremely low intensity PEMFs have been found to increase yawning and stretching. | Sandyk, Mar 1999 |
| Smell | The smell center of the brain also contains large amounts of dopamine neurons. Anti-Parkinsonโs drugs do not affect the smell threshold. Low intensity PEMFs have improved smell in this situation. | Sandyk, Apr 1999 |
| Freezing, arrest of speech or handwriting | Difficulty in initiation and smooth processing of repetitive movements. Usually in PD of long duration and advanced stage and is a major cause of disability often resulting in falling. Seen as sudden attack of immobility usually experienced during walking, attempts to turn while walking, or while approaching a destination.
For resistance to medication, sometimes a reduction or increase in dose may improve this. Brief low intensity PEMFs improve freezing. The effect of each PEMF treatment lasted several days before appearing again. Weekly PEMFs to the head reduced freezing by ~ 50% and falling by ~ 80-90%, in a six-month follow-up period. |
Sandyk, 1996 |
| Disorder of body image | A part or parts of bodies perceived as disproportionately large. Low intensity PEMFs have reversed this. | Sandyk,ย Feb 1998 |
| Speech impairments | More than 89% of PDs. Speech impairments, including severe stuttering, that responded only marginally to medication, improved dramatically.
when PEMF treatments given weekly over four years. The speech impairment reappeared when regular PEMF treatments missed. |
Sandyk Nov 1997 |
| Cognitive impairment | Assessed by drawing tasks, eg drawing a picture of oneself, a bicycle, or a clock face. Drawing impairments indicative of dysfunction of half of the brain. PEMFs of 5 and 7 Hz for 20 minute periodsย dramatically improve drawing performance, even as soon as after 2 treatments. Drawing performance continues to improve as PEMF treatments continue. | Sandyk,ย SEPT 1997 |
Dopamine is considered the most important part of the causes ofย Parkinsonโs diseaseย and is the primary target of medical therapies. Yawning and stretching are dopamine behaviors. When these behaviors are seen in people with neurodegenerative disorders, it is likely that they indicate release of dopamine in the brain. Extremely low intensity PEMFs have been found to increase yawning and stretching.
Various groups also looked at the use of low intensity 8 picoTesla PEMFs in the treatment ofย Parkinsonโs disease, at 2 Hz or 8 Hz, for thirty minutes every forty-eight hours for sixty days. The treatment effects last beyond the time of stimulation depending on symptoms:
less than –ย ย ย ย ย 24 hrs for motor impairment,
More than –ย ย ย ย ย 48 hrs for other symptoms
This shows that chronic stimulation is probably necessary to obtain adequate results withย Parkinsonโs diseaseย (Bardasano).
The work by Sandyk, with the use of very low intensity PEMFs) also showed that longer-term treatments are necessary to achieve more sustainable results.
One study looked at a 25 Hz PEMF with intensity of 10 mT (100 gauss) applied for 20 minutes with 10-12 exposures as part of comprehensive rehab therapy inย Parkinsonโs diseaseย patients. Walking improved significantly and so did the ability to change position. Muscle tension in the lower extremities was reduced in 85% of the patients, vertebral complaints in 85%, and general improvement was reportedly improved in 96% (Jerabek).
In another double-blind clinical study, 97 participants (Hoehn & Yahr stages I-IV) receiving optimal medical anti-Parkinson treatment, were randomized to either active or placebo treatment. Treatment was with transcranial PEMFs daily for a 30-minute home treatment for eight consecutive weeks. The PEMF was 5-8 mT using seven coils over the forehead, two on each side of the head and one in the back of the head.ย The Parkinson’s Disease Questionnaire (PDQ) was used at baseline and at the end. The active group improved in mobility and activities of daily living (ADL), compared to the placebo group. (Morberg, 2018)
The same group used the same PEMF and protocol on 92 study participants. (Morberg, 2017) Those receiving active treatment had an average age of 67, mean Hoehn & Yahr stage of 2.4, and disease duration of 6 years. In this study the Unified Parkinson’s Disease Rating Scale (UPDRS) was used. There were essentially no differences between the groups. The UPDRS scale is subjective and relatively insensitive and does not exclude the possibility of positive objective physiologic effects, compared to the PDQ.
High intensity PEMFs have been in use to stimulate the brain since 2008 after FDA approval. One type is called repetitive Transcranial Magnetic Stimulation (rTMS). In rTMS, a wire coil is used to generate a magnetic field that can pass through the scalp and the skull to change the excitability in the cortex according to the frequency. High-frequency rTMS (โฅ5 Hz) โ a more rapid pulse rate (pulses per second pr PPS for short) ) induces more excitability in the cortex, while low-frequency/pulse rate rTMS (โค1 Hz) induces an inhibitory effect. A longer duration of stimulation is likely to induce a longer duration of effect. Additionally, there are numerous choices of stimulation sites of rTMS intervention; these sites include the primary motor cortex (M1), which is used mostly for motor symptoms; the dorsolateral prefrontal cortex (DLPFC) is used mostly for depression; the supplementary motor area (SMA) for motor symptoms; and, the cerebellum. The SMA is involved in a variety of cognitive and motor-related processes, in particular, the function of complex chains of movement. (Schramm). rTMS to the cerebellum showed an improvement in stroke (spasticity, balance, and gait), cervical dystonia, Parkinsonโs disease (tremor), cerebellar ataxia, and essential tremor but not in multiple sclerosis. (Xia)
Astrocytes (start shaped cells) are specialized brain cells, outnumbering neurons by over five times. Astrocytes are also known collectively as astroglia, and are part of the glial cells in the brain and spinal cord. (Sofroniew) So, the terms astroglia and astrocytes are often used interchangeably. They โtileโ the entire central nervous system (CNS) and exert many essential complex functions in the healthy CNS. Brain astrocytes respond to damage and disease in the central nervous system (CNS) through a complex, multifaceted process, called astrogliosis. Dysfunctions of astrocytes (astrogliosis) can lead to or contribute to a variety of CNS disorders. Astroglia/astrocytes undergo significant structural changes in response to CNS damage and disease.
Reactive astrogliosis and exaggerated pro-inflammatory reactions are key pathologic processes inย Parkinsonโs disease. rTMS has been shown to alleviate neuroinflammation. Higher frequency/pulse rate stimulation of rat brains daily for four weeks had a stronger anti-inflammatory and neuroprotective effect. The Endocannabinoid system (ECS) is integral to neural protection. PEMFs have been found to stimulate the ECS. Actions on the ECS by rTMS are a likely major mechanism of neural protection and anti-inflammatory action positively impacting reactive astrogliosis. (Aceves-Serrano)
High intensity PEMFs like rTMS improve the movement problems ofย Parkinsonโs diseaseย by about 54% overall. Results are better when high pulse rates greater than 5 pulses per second (pps) are used to the motor cortex, for 23% improvement. Results were better for lower than 1 pps applied to the front parts of the brain, with about 50% improvement. A greater number of pulses per session or across sessions have larger benefits. Given the limitations of rTMS treatments, that is, requiring a professional setting with a limited number of treatment options, it appears that treating for more than a week is not much better than treating for less than a week. But this appears to be driven by the number of pulses delivered (Chou).
One rTMS study looked at the treatment of 49ย Parkinsonโs diseaseย patients. Their symptoms had been well controlled for three months with medications. Patients were divided into four groups to receive various protocols of rTMS with stimulation:
(1) once a day at 3,450 gauss;
(2) twice a day at 3,450 gauss;
(3) twice a day at 5,750 gauss;
(4) twice a day at 8,050 gauss.
Treatments took place for 10 days. The patients were evaluated 3 times before rTMS to obtain baseline data, then on days 3 and 7 of treatment, and then at 1 and 3 months after the end of treatment. They measured range of movement and disability in activities of daily living and short-term memory. In group 1, treatment once per day, there were no significant changes in symptoms at any time. By contrast, all other groups (receiving treatment twice per day) had significant improvement in symptoms at the 1-month assessment. But there were no differences in scores between the treated groups. At the 3-month evaluation point, theย Parkinsonโs diseaseย symptom scores were still significantly better than baseline values but there were significant inter-group differences, with group 3 (twice a day at 5,750 gauss) showing the most improvement. The results show that this protocol causes long-lasting dose-related symptom improvements inย Parkinsonโs diseaseย and may even allow dose reduction in medication (Mally).
In another rTMS study,ย Parkinsonโs diseaseย patients were evaluated to see if rTMS could improve muscle function assessed by simple reaction times. It had been previously shown that simple reaction time was significantly improved in normal individuals and in those withย Parkinsonโs disease. Assessments were done at the time of peak medication effect. For comparison, the same tasks were studied in ten normal volunteers. There were significant differences betweenย Parkinsonโs diseaseย patients and normal volunteers during rTMS with the coil on the head. Inย Parkinsonโs diseaseย patients, rTMS significantly shortened reaction time and movement time without affecting errors. The mean performance ofย Parkinsonโs diseaseย patients improved during rTMS and patients reported that it was easier to perform the test during rTMS. All patients were significantly slower in the unmedicated state compared with the medicated state. Their performance in the unmedicated state improved significantly with PEMF stimulation (Pascual-Leone).
In a separate analysis of multiple studies, they evaluated the possible value of rTMS on cognitive function inย Parkinsonโs disease. They evaluated 12 studies and found that there was a mild short-term effect of rTMS on global cognition, executive function, attention and working memory. There were no significant benefits for long-term outcomes. The authors noted that more research is needed with larger numbers of individuals being tested. (He)
There is a frequently expressed concern about using high intensity PEMFs to the brain. Because some studies have suggested that an increase in stimulation pulse rate might enhance therapeutic efficacy, a randomized controlled trial was conducted (Benninger) using 50 pps/Hz rTMS in 26 individuals with mild to moderateย Parkinsonโs disease. Stimulation was to the motor cortex in 8 sessions over 2 weeks. Testing included evaluation of gait, slow movement, UPDRS and additional clinical, neurophysiological and neuropsychological elements. In addition, they studied the safety of our TMS with electromyography โ electroencephalogram (EMG โ EEG) monitoring during and after stimulation. The 50 pps rTMS did not improve gait, slow movement and global and motor UPDRS measures. There was a short-lived improvement in ADL. The neurophysiological and neuropsychological measures did not change. EMG/EEG showed no pathological increase of brain action or epileptic risk. There were no adverse effects. So, while this study did not find any clear benefits in movement and functional status, it did reveal the safety, even in those withย Parkinsonโs disease. Unfortunately, this research focused on stimulation of the motor cortex and not on the source lesions of theย Parkinsonโs diseaseย in the substantia nigra/subthalamic nucleus. So, at this point it is not known whether stimulating the damaged tissue directly would produce any better benefits.
Parkinsonโs diseaseย has traditionally been considered a single-region disease in the basal ganglia but has recently been proposed as a system-level disorder that includes functional interactions between brain regions such as the dopamine dependent motor circuit (cortico-striatal-thalamic circuit) and the cognitive circuit (frontal-striatal circuit). However, structural changes in the brain take time to be produced and eight weeks of treatment is unlikely to be sufficient. Thus, even longer treatment periods are needed to better understand the potential of this treatment modality (Jensen)
Physiologically, it is known that erythropoietin (EPO), vascular endothelial growth factor (VEGF), as well as dopamine are present in the brain. EPO has neuroprotective benefits and neuro repair as seen in animal studies. In spinal cord traumatic injury and Alzheimerโs animal research, EPO improved memory and spatial learning and had a neuroprotective effect. VEGF affects growth of new blood vessels (angiogenesis), neural migration and neuroprotection and, along with EPO has the potential to help neurological disorders.
Since it was speculated that PEMFs could enhance neuroprotection, research was done to test this theory that long-term treatment with transcranial PEMF (T-PEMF) would improve motor performance (in terms of movement speed) and stimulate production of neuroprotective and angiogenetic compounds (EPO and VEGF) in the brain in patients withย Parkinsonโs disease. (Jensen) Using the same protocol as Morberg, the authors tested the idea that long-term treatment with T-PEMF would improve motor performance (in terms of movement speed) and stimulate production of neuroprotective and angiogenetic compounds (EPO and VEGF) in the brain in patients withย Parkinsonโs disease.ย
The active T-PEMF treatment group had 16 patients and 8 were included in theย Parkinsonโs disease-control no T-PEMF treatment group. Disease severity was assessed using the UPDRS. Daily 30 min home T-PEMF of 5-8 mT was applied for three eight-week periods, separated by one-week pauses. The total treatment period was 26 weeks. The primary outcome was movement speed, which was assessed in a timed six-cycle sit-to-stand (STS) task, where the participants were asked to perform the task as fast as possible. Examinations were done at week 17 and week 27. Eight patients from the T-PEMF group had lumbar puncture just before treatment and within one day after treatment completion for their brain EPO and VEGF levels. Results of the STS test improved progressively over the 26 weeks by about 20%. At the previously studied (Morberg, 2017) 8 wk study point it improved only by about 8%. The graph below (taken from Jensen), shows that 26 weeks of treatment improved STS (green line) from 100% at baseline (0%) to 80%. The control group (redline) got worse over that time by about 2%.
Spinal fluid (CSF) EPO concentrations increased significantly in response to the T-PEMF treatment intervention (all patients increased (n = 8)). CSF-VEGF concentration increased in five out of six patients. So, it appears that T-PEMF treatment has contributed to neural repair and protection of the dopamine neurons in this study. In addition, importantly, there was no difference between the longer treatment time group and the placebo group regarding reported adverse events.
The previous study (Morberg, 2017) showed that an eight-week treatment period was beneficial for patients with mildย Parkinsonโs diseaseย whereas the treatment effect was less among the more severely affected participants. However, the present study (Jensen) treatment for 30 min/day for 3×8 weeks showed a benefit for the entire study group including mild as well as more severely affectedย Parkinsonโs diseaseย patients. Itโs also plausible that the longer treatment time would have impacted the amount of EPO and VEGF more as well.ย Finally, even though the treatment group was well medicated, T-PEMF treatment still improved the completion time in the STS-task by 19%, comparably to the healthy control group. This shows that the PEMF treatment improves significantly on the benefits seen from medication management. The question then becomes whether medication management is necessary when doing more intensive longer-term PEMF therapy. However, this difference in benefit may only apply to this study and to the motor function studied, and may not apply to the other aspects of dysfunction inย Parkinsonโs disease.
Freezing of Gait (FOG): The effect of rTMS has been studied on FOG. However, stimulation of neither the motor cortex nor the frontal cortex showed benefit in one study. (Kim KW). Another stimulation site, The supplementary motor area (SMA) has also been explored. When tested on 30ย Parkinsonโs diseaseย patients with FOG, it was shown that 10 sessions of 10โpps rTMS over the SMA improved FOG (Mi). This study also found that the benefit could last at least 4โweeks after stimulation. This result was consistent with those of another study (Kim SJ), where they found significant improvements after 2 sessions of high-PPS SMA stimulation in 12ย Parkinsonโs diseaseย patients, but not after motor cortex stimulation. These results suggested that SMA stimulation may be a more appropriate target inย Parkinsonโs diseaseย patients with FOG.
PEMFs can be extraordinary helpful in the care of Parkinson’s disease and are even more valuable considering that no other therapies to date have been able to cure it or stop its progression. Even the standard medication, the primary line of treatment forย Parkinsonโs disease, is only about 50% effective overall to help with the symptoms ofย Parkinsonโs disease. While research is ongoing to develop new therapies and approaches, PEMF therapy has a long history of helping a myriad of different health conditions, safely and without risk. In fact, when somebody owns a PEMF device, not only do they benefit across many different health needs, but it can also be used by other family or household members, including pets. There are many scientifically backed examples of the extent of usefulness of PEMFs in the book “Power Tools for Health” (Pawluk), including a section on its use forย Parkinsonโs disease.
As mentioned earlier, even twice-weekly treatments twice-weekly treatments with extremely low intensity PEMFs applied to the head for ten weeks has been shown to eliminate the daily drop-off of medication benefit. (Sandyk, Oct 1997) At ten weeks after starting the PEMFs, there was 40% improvement in response to medication with minimum change in efficacy during the course of the day or evening. They have even been found to be helpful for the side effects of the medications. In addition, since decline in the response to medication over time in patients withย Parkinsonโs diseaseย is associated with progression of the disease, even intermittent application of PEMFs may reverse the course of progressiveย Parkinsonโs disease.
Those results are based on a health services delivery model requiring that the treatment be provided in a doctorโs office. This is not only inconvenient and also expensive over time, but also increases the risk of progressive disease. Asย Parkinsonโs diseaseย progresses, becomes much more difficult to manage, and as a result there is a much greater toll on the health, function and vitality of the person.
Because of all the different actions of PEMFs, reviewed in “Power Tools for Health“, PEMFs are not just a treatment forย Parkinsonโs diseaseย but also overall health. Any other health demands place a significant strain on the body in coping withย Parkinsonโs disease, and increase the risk of more rapid progression. As a result, PEMFs not only help withย Parkinsonโs diseaseย but any other health conditions (comorbidities) as well. Sinceย Parkinsonโs diseaseย typically begins after age 50, and especially after age 60, comorbid conditions are common. Per the CDC many people have have 2 or more comorbid conditions: 33% of those between 45-64 years of age and 64% of those 65 or older. (Boersma)
As PEMFs are used there is a progression of benefits, dependent on the amount of healing that happens with use. Often there are significant improvements in symptoms in the first few days to weeks. The extent of these improvements may depend on the pace of increasing treatment time and intensity, that is, the โgoing low and slowโ progression. Clearly, the lower the intensities used and the less the treatment time, the less the expected benefit. While anybody can get benefit even at the lower intensities and time, the better benefits will happen with more treatment time and higher magnetic field intensities.
After the initial โblushโ of changes in symptoms, with continuing treatment there will be gradual improvements in function, either improved function over normal or less functional disability. As healing continues, the improvements in symptoms and function last longer and are less likely to return as quickly. There may come a time when there appear to be no further improvements in symptoms and function. People often worry that this means that โtoleranceโ to the magnetic field therapy is happening. This just means that the โlow hanging fruitโ of the benefits of PEMFs have been achieved. At this point continued therapy will be working at the deeper levels of healing, at the cellular level. Cellular level healing tends to take longer, especially with the brain, and is much less obvious and noticeable. I can generally say that โcells donโt talk to youโ but tissues and organs do. When enough of the deeper cellular healing accumulates, the improvements become more noticeable and are less likely to regress when treatment is reduced. If treatment is reduced too soon, symptoms are more likely to recur. Generally, the longer it takes symptoms to recur after stopping or reducing treatment, the deeper the healing. But if symptoms do recur that means that healing is not completed. Itโs possible that some levels of damage in the body can never be completely fixed and we may have to accept the level of gain obtained to that point.
Letโs not forget thatย Parkinsonโs diseaseย is not just a brain disorder. It is a systemic disorder that has brain effects as a major manifestation. Most of the things that happen to the brain and nervous system from the PEMFs are also happening in the rest of the body. Inย Parkinsonโs diseaseย jargon, there are the motor benefits and the nonmotor benefits. PEMFs help with both groups of needs. The order in which they are helped is controlled by the body and we can prioritize which ones are going to be helped first, and so forth.
In the treatment of Parkinsonโs disease, the actions of PEMFs that are most important (Pawluk) include reductions in:
The intensity of the magnetic field is very important in being able to reach deep into the brain with sufficient magnetic field intensity to reduce inflammation and stimulate many of the other actons of PEMFs. Our experience is that the benefits of very low intensity PEMFs that have been published are typically not long-lasting and not as beneficial as higher intensity PEMFs, as can be seen from the research on rTMS. The challenge in showing long-term effectiveness of rTMS is because of the nature of rTMS research. It usually has not been done long enough to see sustainable and significant benefits.
It is recommended to read about the role of adenosine in reducing inflammation in the body and that the optimal magnetic field intensity for the best impact on inflammation. More can be read about this at https://www.drpawluk.com/pain-inflammation-adenosine/. Also, it is strongly recommended to read the books https://www.drpawluk.com/product/power-tools-for-health/ and https://www.drpawluk.com/product/supercharge-your-health-with-pemf-therapy/ for more in-depth information on PEMF therapies. The โPower Tools for Healthโ book has over 500 references for those who wish more of the scientific background. The โSupercharge Your Healthโ gives much more practical advice on the use of PEMFs, in general and more specifically for about 80 different health conditions.
Given the progression of Parkinsonโs disease over time and the irreversibility of the physical changes with later stages of Parkinsonโs disease, it is strongly recommended to start as early as possible, certainly at the time of initial diagnosis. As screening tests become more available it may be possible to start treatment for prevention purposes very early, before motor symptoms become obvious. Tests are becoming available now for detecting early levels of alpha-synuclein either with intestinal biopsies or spinal fluid. Inflammation is a major driver of causing aggregation of the normal tissue levels of synuclein. As the research is showing, once the aggregated synuclein begins, it starts to migrate, eventually ending up in the nervous system. One of the key drivers of the aggregation of synuclein is inflammation, whether in the gut or elsewhere in the body. Therefore, starting as early as possible in the course of the disease is essential to limit its progression and limits the course of the disease.
Because of its chronic local and systemic nature, lifetime daily home use of a PEMF system with adequate intensity is recommended before irreversible damage happens in the body, and especially in the brain. The minimum recommended intensity is about 4000 Gauss, to be able to reach deep into the abdomen and across the brain. Treatment to the brain should be at the top of the neck with the applicators placed from the back of the head toward the front of the brain. Additional placements could be of a double loop coils over the top of the head, with a loop over each ear. If there are significant cognitive, memory and mood issues, placements could also be across the front of the head. Ultimately, each individual will have to use trial and error to determine the best placements.
In addition to local treatments to the brain, daily or even twice daily whole-body treatment should also be used.
PEMF therapies can be combined readily with almost any other kinds of therapies, and should usually include neuro-supportive nutrition and supplements. PEMFs can also be combined with almost any other kinds of complementary therapies, although many of these do not work deep enough. These other therapies can include red light, intravenous nutrients, such as IV vitamin C, glutathione, and alpha lipoic acid (ALA). It is advised to seek the support of a clinician/professional who is familiar with recommending supplements for neurological disorders. Some of this information about combining PEMFs with other therapies is found in the two books mentioned above.
https://www.drpawluk.com
https://www.drpawluk.com/pain-inflammation-adenosine/.
https://www.drpawluk.com/product/power-tools-for-health/ https://www.drpawluk.com/product/supercharge-your-health-with-pemf-therapy/
To be certain to obtain the right PEMF system and be trained in its proper use, it is recommended to seek the support of a licensed professional who is familiar with PEMF therapy and other complementary therapies to go with it. It PEMF therapies are recommended, always ask about the intensity of the PEMF system being used. Remember, that office-based treatments are not going to be done affordably over extended periods of time to be certain that the best results will be obtained, especially considering that treatment should be lifetime. As yet, there is no cure still, even with PEMF therapy, so, basically, lifetime maintenance and control is necessary as far as we know.
Consultations without charge are available on Dr. Pawluk.com. https://www.drpawluk.com/consult/
So, it appears that PEMFs of various intensities and treatment times can be helpful in the management of Parkinsonโs disease. Longer treatment times and stronger PEMFs are very much likely to produce better and more lasting results. Since the goal is to help to repair the brain, not just improve function temporarily, long-term treatment frequently appears to be necessary. What is not known is whether the combination of periodic high intensity PEMFs along with a home therapy program using a lower intensity PEMF system may be the most helpful. It also appears that PEMFs may be synergistic with medication, which has a history of losing its effectiveness over time. It is not known how well PEMFs alone, without medication, may be able to help the symptoms and progression of Parkinsonโs disease. At this point at least, thereโs still no clear evidence that PEMFs can โcureโ the condition. Much of the research with rTMS follows typical protocols, either to the motor area of the brain or the left frontal lobe. I have not seen any research that focuses treatment directly over the anatomic area in the brain, that is, the substantia nigra, primarily involved in the condition. Whole body treatment is recommended, in addition to the brain, because it appears that the origins of Parkinsonโs disease may well be elsewhere in the body, especially in the intestinal tract.
The ability to recover after stroke depends on many factors, including the regenerativeย capabilities of the brain. Recovery depends on the plasticity of the brain. The plasticity, orย neuroplasticity, required in a damaged brain is very different from the plasticity of a normalย functioning brain. The demand for adaptive healing starts immediately after a stroke eventย where blood supply to the brain is stopped or limited. The availability of various factors in the brain, called neurotrophic or growth factors, affect the potential for the growth of new neurons and the survival of existing neurons. Neurogenesis is regulated by many factors including neurotrophins, growth factors, hormones, neurotransmitters, and micro-environmental factors.
A study was done to evaluate the effect of extremely low-frequency electromagnetic fieldย therapy (PEMF) on brain plasticity in the rehabilitation of patients after stroke.ย (2)ย
The cerebral ischemic event (stroke) in each patient was documented by computer tomography (CT) scan of the brain. Neurological and CT findings were interpreted by 2 or more independent experienced neurologists. All patients were diagnosed with ischemic stroke. Patients with other types of stroke were excluded, as were patients with neurological illness other than stroke; chronic or significant acute inflammatory factors; and/or dementia.
Forty-eight patients were divided into two groups and had the same rehabilitation program.ย In both the groups, the program was provided by a physiotherapist, every day for a period of 4 weeks with weekend breaks. The rehabilitation program included 15 min of psychotherapy, 60 min neurophysiological session in the morning (30 min of function enhancing techniques and 30 min of repetitive task practice or balance) and 30 min aerobic training (2โ3 times a day for 10 min at 60 min intervals).
Neurophysiological rehabilitation consisted mainly of functional rehabilitation techniques and repetitive task practice designed to intensively use the affected upper and lower limbs. The function techniques included activities based on activities of daily living (ADL). However, training time was individually modified depending on the improvement in motor function of the affected limbs, if necessary.
The rehabilitation program in the control group consisted of a 60 min session in the morning (30 min of function improvement techniques and 30 min of balance training), 30 min aerobic training (2โ3 times a day for 10 min at 60 min intervals) and 30 min muscle strengthening exercises. The range of physical effort during the rehabilitation programs in both groups of patients was between 13 and 14 according to the Borg functional scale (moderate effort).
Most of the people in the study were between 3 to 4 weeks after their stroke and were onย average between 45-48 years of age. In the pulsed electromagnetic field therapy (PEMF) study group, the patients additionally were exposed to a standard series of 10 PEMF treatments, forย 15 mins each, at 5 mT (50 G), 40 Hz, to the pelvic girdle. The non-PEMF group received theย same rehabilitation program, without PEMF therapy.
Thatโs right! PEMF treatment was to the pelvis, not to the brain,ย as would normally beย expected. At the time of this research there was a concern about PEMFs precipitating seizures.ย This concern has largely been discounted with the FDA approved high intensity transcranialย magnetic stimulation devices for treatment resistant depression, with seizures beingย extraordinarily rare and much less likely to happen with the relatively low magnetic fieldย intensities used in this research. As it turns out, from this research, stimulation of the pelvicย area with this PEMF set-up still ended up producing significant changes in levels of variousย biochemical markers. These biochemical factors end up in the circulation, and finally in theย brain. In the brain they create various reactions that can help improve the negative effects ofย stroke.
This research group looked at many factors associated with the outcomes of stroke andย associated these outcomes with treatment results. After 4 weeks, during which patients hadย undergone neurorehabilitation and neurological examinations, they assessed functionalย recovery using the Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depressionย Scale (GDS), National Institutes of Health Stroke Scale (NIHSS), and the modified Rankin Scaleย (mRS).
The modified Rankin Scale (mRS) is commonly used for measuring the degree of disability orย dependence in the daily activities of people who have suffered a stroke or other causes ofย neurological disability. It has become the most widely used clinical outcome measure for strokeย clinical trials.
Any kind of damage to the brain causes the brain to adaptively respond. This adaptationย process is called neuroplasticity. Neuroplasticity, also known as neural plasticity or brainย plasticity, is a process that involves adaptive structural and functional changes to the brain. Aย good definition is โthe ability of the nervous system to change its activity in response toย intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections.โ Clinically, itย is the process of brain changes after injury, such as a stroke or traumatic brain injury (TBI).These changes can either be beneficial (restoration of function after injury), neutral (noย change), or negative (can have pathological consequences).ย (2)
Neuroplasticity
Neuroplasticity can be broken down into two major mechanisms:
Neuronal regeneration/collateral sprouting:ย This includes concepts such as synaptic plasticityย and neurogenesis.
Functional reorganization:ย This includes concepts such as equipotentiality, vicariation, andย diaschisis. Vicariation is considered a mechanism for recovery of function following brainย damage. Essentially, this concept involves the ability of one part of the brain to substitute forย the function of another. Diaschisis is a sudden change of function in a portion of the brainย connected to a distant, but damaged, brain area. The site of the originally damaged area and ofย the diaschisis are connected to each other by neurons.
Areas of the brain are connected by vastย organized neuronal pathways that allow one area of the brain to influence other areas moreย farther away from it. Understanding these dense pathways helps to link a lesion causing brainย damage in one area of the brain to degeneration in a more distal brain area. So, a focal lesionย causes damage that also disturbs the structural and functional connectivity to the brain areasย away from the lesion.
This research examined various biochemical aspects of neuroplasticity, specifically, severalย growth factors. They measured the blood level of brain-derived neurotrophic factor (BDNF), theย vascular-endothelial growth factor (VEGF), as well as BDNF RNA gene expression. Additionally,ย they tested the levels of hepatocyte growth factor, stem cell factor, stromal cell-derived factorย 1ฮฑ, nerve growth factor ฮฒ, and leukemia inhibitory factor.(2)ย
They found that PEMF significantly increased growth factors and inflammatory cytokine levelsย involved in neuroplasticity, as well as promoted an enhancement of functional recovery in post-stroke patients. These effects could be related to the increase of gene expression on the mRNAย level. The PEMF group had double the amount of blood serum BDNF and 2.5 times more geneย expression. Moreover, increase in BDNF plasma levels was reflected in improvement of theย Barthel Index, MMSE, and the opposite with the GDS. They concluded that PEMF therapyย improves the effectiveness of rehabilitation of post-stroke patients by improving neuroplasticity processes. PEMF also induced a significant improvement in functional (ADL) and mental (MMSE,ย GDS) status.
VEGF is involved in the improvement of damaged cells by increasing circulation and restoringย function. VEGF levels increased by 50%. The PEMF group also had about 35% better cognitiveย functioning and 45% better depression scores.
In the non-PEMF group, stroke scale severity and function measures were about 65% and 50%ย worse, respectively.
The PEMF significantly increased enzyme antioxidant activity. The significant improvements inย functional (ADL) and mental (MMSE, GDS) status correlated with the level of enzymaticย antioxidant protection.ย (4)
To determine the level of antioxidant gene expression, they evaluated the level of mRNAย expression of catalase, superoxide dismutase, and glutathione peroxidase. After PEMF therapy,ย mRNA expression of the studied genes (CAT, SOD1, SOD2, GPx1, and GPx4) significantlyย increased. These changes enhanced the antioxidant defenses of the body.ย (5)
Apoptosis is programmed cell death, and aims to eliminate damaged cells, including thoseย damaged by the hypoxia of stroke, There are many factors that can induce apoptosis of cells:ย after ischemia, inflammation, cytokine activation, cascade of free radicals, and induction ofย thrombin. Neuronal apoptosis is regulated by various genes, such as BCL-2 (inhibitor ofย apoptosis) and BAX (activator of apoptosis). Induced apoptosis promotes the formation of newย neurons, that is, neurogenesis, in mice.
To assess apoptosis gene expression level,ย (8)ย these researchers measured the mRNAย expression of BAX, BCL-2, CASP8, TNFฮฑ, and TP53 in these patients. PEMF significantlyย increased the expression of BAX, CASP8, TNFฮฑ, and TP53, whereas the BCL-2 mRNA expressionย after PEMF remained similar in both PEMF treatment and control groups. Thus, increasing theย expression of pro-apoptotic genes in post-stroke patients promotes the activation of brainย neurons and hence brain pathways involved in brain plasticity processes.
Plasmaย cytokinesย may be protective (anti-inflammatory) or harmful (pro-inflammatory). Theย measured the levels of the anti-inflammatory/neuroprotective cytokines interleukin 1ฮฒ (IL-1ฮฒ)ย and transforming growth factor ฮฒ (TGF-ฮฒ) and the pro-inflammatory cytokines interleukin 2 (IL-2) and interferon-ฮณ (INF-ฮณ). The level of IL-1ฮฒ mRNA expression that determines the level ofย serum IL-1ฮฒ was also tested. After PEMF treatment, both IL-1ฮฒ plasma level (up 100%) and IL-1ฮฒย mRNA expression level (up 70%). On the other hand, IL-2 plasma level increased 15%, whileย IFN-ฮณ and TGF-ฮฒ had non-significant changes. The PEMF-induced IL-1ฮฒ improvement found inย this study is likely to have a neuroprotective role.ย (7)
The researchers also evaluated the possible association between plasma proteinย oxidative/nitrative damageย and the development of poststroke depression. By analyzing several metabolic parameters, they found significant (P < 0.001) differences in all oxidative/nitrative stress parameters in brain stroke patients compared to a healthy group.ย Oxidative damage of proteins is relates to the degree of poststroke depression. The Geriatricย Depression Scale is worse as the concentration of -SH groups or catalase activity increases.ย (3)
Nitric oxide (NO)ย is a very important signaling molecule, involved in both physiological andย pathological processes. As a neurotransmitter in the central nervous system, NO regulatesย cerebral blood flow, neurogenesis, and synaptic plasticity. They evaluated the effect of theย PEMFs on the generation and metabolism of NO, as a neurotransmitter, in the rehabilitation of poststroke patients.ย (6)ย They also measured the levels of 3-nitrotyrosine, nitrate/nitrite, andย TNFฮฑ in plasma samples, and NOS2 expression in whole blood samples.
PEMF significantly increased 3-nitrotyrosine and nitrate/nitrite levels, while expression of NOS2 was insignificantlyย decreased in both groups. So, PEMF therapy increases the metabolism and generation of NO,ย which has both neuroprotective and cytotoxic properties. An increase in NO level is associatedย with nNOS and/or eNOS activities. It does not influence iNOS expression, which increasesย mainly during inflammation. Therefore, in the poststroke state, NO demonstrates a protectiveย effect as reflected in significant improvement in functional status.
Direct brain stimulation and timing and age of the patient
Two hundred twenty and three patients with the initial stroke were divided into three groups.ย (11)
Besides rehabilitation one group was also treated directly to the brain with TMS beginning
from the 6 -10 days after onset, given once a day for 14 days, In another subgroup TMS wasย begunย withinย 3 months after the initial attack and another subgroup had TMS beginning 3ย monthsย afterย the initial attack. Except for TMS, the basic treatment was the same for all of theย patients. Fugl-Meyer score was measured twice: just before treatment and after the 14thย treatment.
The effective rate was 91% with TMS plus rehabilitation vs 68% in the control group (P < 0.05).
The Fugl-Meyer scores were 36 and 34 in the rehabilitation subgroup and control subgroupย before treatment respectively and were 52 and 40 after treatment respectively (P < 0.01). Theย Fugl-Meyer scores were 41 and 59 before and after TMS respectively in the subgroup with earlyย TMS treatment (P < 0.01) and were 34 and 45 respectively in the subgroup with TMS beginning 3 months after the onset (P < 0.05).
One of the most widely recognized and clinically relevant measures of body functionย impairment after stroke is the Fugl-Meyer (FM) assessment. Of the 5 Fugl-Meyer (FM) domainsย (motor, sensory, balance, range of motion, joint pain), the motor domain, which includes anย assessment of the upper extremity (UE) and lower extremity (LE), has well-establishedย reliability and validity as an indicator of motor impairment severity across different strokeย recovery time points.
So, what they found was that direct brain TMS is effective in the rehabilitation of motorย function in patients with stroke. The effectiveness of TMS treatment depended on the age ofย the patients and timing of beginning treatment. Results are not as good as people get older andย the longer the time treatment is started after the stroke.ย (11)
Since the Cichon research did not compare different intensities, frequencies, durations ofย treatment of various PEMF devices or how long after a stroke PEMF should be started, it is notย known if there is an optimal PEMF protocol. Because of the very low level of risk in usingย PEMFs, whether to the pelvic girdle or to the brain, different PEMF protocols may be practicalย and useful. Both direct brain PEMF stimulation and indirect PEMF stimulation help withย recovery from stroke. We will have to wait for studies where they compare indirect stimulationย with TMS, to see the levels of effectiveness of each. So, for now, both approaches make senseย to help with stroke recovery. Indirect stimulation may be more readily available and able to be used in the home setting at a lower cost.
Benefits of direct brain stimulation with PEMFs
Direct transcranial magnetic stimulation of the brain can induce many of the actions of PEMFsย in the body reviewed in the bookย โPower Tools for Health.โย Almost all these actions may be seen with brain stimulation as well.ย Research shows that TMS can reduce the hyperexcitability seen in pain-related areas of theย brain. TMS can trigger spinal cord inhibitory pathways to inhibit the conduction of pain signalsย to the brainย (1). TMS increases cerebral blood flow in affected areas of the brain. In addition,ย the pain reducing effects of TMS not only influence the endogenous opioid system in the brainย but also the endocannabinoid system. TMS can also reduce the neuroinflammation seen afterย stroke (10), a major contributor to poor stroke outcomes.ย (12)ย PEMFs have also been shown toย increase neural stem cells useful in brain tissue repair.ย (9)
This research on the use of PEMFs in poststroke recovery and rehabilitation is important inย showing some of the mechanisms accounting for the significant benefits from the use of PEMFsย seen in those having ischemic strokes, even when applied between 3 to 4 weeks after theirย stroke. Furthermore, one of the most interesting aspects of this research is the fact that the brain was notย even the target of treatment. Even so, peripheral PEMF stimulation appears to be able toย provide significant benefits.
It might be expected that more direct treatment to the brain wouldย produce even better results, faster. This research was done using relatively low intensity PEMFsย over a short treatment course and short treatment times, ie, 10 PEMF treatments, for 15 minsย each, at 5 mT (50 G), 40 Hz. Therefore, the benefits seen in the PEMF treated group wereย impressive for the amount of treatment effort. Moreover, Even the modified Rankin Scale (mRS), aย measure of the degree of disability or dependence in daily activities of people who haveย suffered a stroke, revealed less disability in those receiving PEMFs.
This is a summary of the results: stroke-related neurological deficit, estimated using NIHSS,ย decreased approximately 65% more in the PEMF group than in the non-PEMF group. mRSย measured disability decreased in both groups, but in the PEMF group the reduction wasย approximately 50% greater than in the non-PEMF group. About 35% greater improvement wasย seen in cognitive impairment, as estimated by MMSE, after PEMF treatment. Depressive syndrome, measured in GDS, decreased significantly, with approximately 45% better results inย the PEMF group than in the non-PEMF group.
The PEMF treatments used in this study were initiated about 4 weeks after the initial stroke. So,ย itโs hard to know whether the effects seen of this treatment would have been either earlier orย later in the course of recovery from stroke. It is rare to get access to individuals with stroke veryย early in their disease process, because of the limitations of the complications related to stroke,ย the hospital environment, the rehabilitation environment and the technology available.
A commonly studied approach to treating stroke is the use of rTMS (repetitive transcranialย magnetic stimulation), which uses high intensity PEMFs delivered in highly specializedย professional settings. At this point, this therapy is not approved by the FDA or covered byย insurance for stroke. Home-based PEMF therapy using medium to high intensity magnetic fieldsย to the brain would be expected to produce good results. This becomes even more feasibleย when one considers that the PEMF therapy can be started at the home setting, that is, usuallyย after a course of facility-based poststroke rehabilitation. Also, PEMF therapy is not currently
offered in most rehabilitation settings.
Bottom line, PEMF therapies can be a very useful adjunct in the care of people who haveย suffered strokes, especially when started as soon after stroke as possible, whether the PEMFsย are applied directly to the brain or as part of an overall care program. Lastly, whole body PEMFย therapy with sufficient intensity PEMF equipment should be used to help the whole person,ย especially considering that people who have a stroke often multiple health needs that wouldย benefit anyway from PEMF therapy. Lastly.
To determine which PEMF system is best to use specifically for any given person, a freeย professional consultation is available atย https://www.drpawluk.com/consult/
1. Chang MC, Kwak SG, Park D. The effect of rTMS in the management of pain associated withย CRPS. Transl Neurosci. 2020 Sep 28;11(1):363-370.
2. Cichoล N, Bijak M, Czarny P, Miller E, Synowiec E, Sliwinski T, Saluk-Bijak J. Increase in Bloodย Levels of Growth Factors Involved in the Neuroplasticity Process by Using an Extremely Lowย Frequency Electromagnetic Field in Post-stroke Patients. Front Aging Neurosci. 2018 Sep
26;10:294.
3. Cichoล N, Bijak M, Miller E, Niwald M, Saluk J. Poststroke depression as a factor adverselyย affecting the level of oxidative damage to plasma proteins during a brain stroke. Oxid Medย Cell Longev. 2015;2015:4
4. Cichoล N, Bijak M, Miller E, Saluk J. Extremely low frequency electromagnetic field (ELF-EMF)ย reduces oxidative stress and improves functional and psychological status in ischemic strokeย patients. Bioelectromagnetics. 2017 Jul;38(5):386-396.
5. Cichon N, Bijak M, Synowiec E, Miller E, Sliwinski T, Saluk-Bijak J. Modulation of antioxidantย enzyme gene expression by extremely low frequency electromagnetic field in post-strokeย patients. Scand J Clin Lab Invest. 2018 Nov-Dec;78(7-8):626-631.
6. Cichoล N, Czarny P, Bijak M, Miller E, ลliwiลski T, Szemraj J, Saluk-Bijak J. Benign Effect ofย Extremely Low-Frequency Electromagnetic Field on Brain Plasticity Assessed by Nitric Oxideย Metabolism during Poststroke Rehabilitation. Oxid Med Cell Longev. 2017;2017:2181942.
7. Cichon N, Saluk-Bijak J, Miller E, Sliwinski T, Synowiec E, Wigner P, Bijak M. Evaluation of theย effects of extremely low frequency electromagnetic field on the levels of some inflammatoryย cytokines in post-stroke patients. J Rehabil Med. 2019 Dec 16;51(11):854-860.
8. Cichon N, Synowiec E, Miller E, Sliwinski T, Ceremuga M, Saluk-Bijak J, Bijak M. Effect ofย Rehabilitation with Extremely Low Frequency Electromagnetic Field on Molecularย Mechanism of Apoptosis in Post-Stroke Patients. Brain Sci. 2020 Apr 30;10(5):266.
9. Cui M, Ge H, Zhao H, Zou Y, Chen Y, Feng H. Electromagnetic Fields for the Regulation ofย Neural Stem Cells. Stem Cells Int. 2017;2017:9898439.
10. Guo B, Zhang M, Hao W, Wang Y, Zhang T, Liu C. Neuroinflammation mechanisms ofย neuromodulation therapies for anxiety and depression. Transl Psychiatry. 2023 Janย 9;13(1):5.
11. Jin X, Wu X, Wang J, et al. Effect of transcranial magnetic stimulation on rehabilitation ofย motor function in patients with cerebral infarction. Zhonghua Yi Xue Za Zhi. 2002 Aprย 25;82(8):534-7. Chinese.
12. Jurcau A, Simion A. Neuroinflammation in Cerebral Ischemia and Ischemia/Reperfusionย Injuries: From Pathophysiology to Therapeutic Strategies. Int J Mol Sci. 2021 Decย 21;23(1):14.
13. Puderbaugh M, Emmady PD. Neuroplasticity. 2022 May 8. In: StatPearls [Internet]. Treasureย Island (FL): StatPearls Publishing; 2022 Janโ. PMID: 32491743.
Stress incontinence, primarily urinary, is a very common problem in women of childbearing age and older. Treatment is either nonsurgical or surgical. Nonsurgical treatment includes biofeedback, vaginal cones, and electrostimulation, with success rates ranging from 9-63%, side effects and embarrassment from probe insertion into the vagina. The gold standard surgical intervention is a mid-urethral mesh sling which has a success rate of 56-98% at one year. Unfortunately, about 6% require further surgery, 15% do not respond and 8% are surgical failures at five years. At nine years about 15% of women need repeat surgery. There have been about 75,000 lawsuits against mesh manufacturers due to false and misleading information about safety and effectiveness.
High-intensity pulsed magnetic field (HIPMF) stimulation of the pelvis has been available as a non-surgical option since 1998. It has the advantage of not requiring disrobing, insertion of electrical probes or continuous exercises. HIPMF given to women sitting on a PEMF coil penetrates deep into the pelvic floor, providing nerve and muscle stimulation. The pelvic muscle contractions are not uncomfortable and lead to strengthening of the pelvic floor muscles, thus reducing the symptoms of incontinence. While these contractions are similar to Kegel exercises they are much more complete and more intense.
A recent study reported on the treatment of 120 women, half of whom received either active or sham PEMF stimulation. The sham stimulation was actually a much weaker active PEMF signal which could still be felt. Treatment was for 20 minutes twice a week for 16 sessions. After two months women who were not responding or not satisfied could opt for 16 additional sessions. Outcome measures were international consultation on incontinence questionnaire (ICIQ-UI SF) and various physical measures of continence.
At two months, 75% receiving active stimulation were treatment responders versus 22% receiving sham treatment. A little more than ยฝ of the women received an extra 16 sessions of stimulation, that is, up to four months of treatment. When they were assessed at 14 months after the start of treatment, those who received 32 sessions of active treatment had a 75% response rate, followed by those who had only 16 sessions [68 โ 72%]. At the end only 19 of 60 women did not get any active stimulation, but, still had a final response rate of 21%.
This study shows that high intensity PEMF training of pelvic muscles for stress incontinence has a 68 โ 72% success rate at about a year following treatment with 16 treatment sessions, improving slightly to 75% in women with 32 treatment sessions. Results appear to show that 16 sessions of stimulation give impressive results at the end of treatment but, as might be expected, some women lose this benefit after about a year. This would indicate that โtuneupsโ may be necessary periodically to maintain benefit.
The value of PEMF pelvic muscle training for stress incontinence is that it is safe, nonintrusive and convenient. The downside is the need to go to a professional for treatment, which may or may not be covered by insurance. A home-based PEMF system with a sufficient intensity to cause pelvic muscle contractions could potentially be effective as well.
Delayed onset muscle soreness [DOMS] is a common painful condition that arises chiefly from exercise-induced muscle damage after unaccustomed physical activities, including intentional exercise. DOMS can happen after yardwork, snow shoveling, strenuous physical work, muscle strengthening and gym workouts. Whiplash from a motor vehicle accident can be very similar. Various treatments have been used to reduce this, including ice packs, persistent pressure, electrical stimulation, stretching, massage and medications. In a review of 35 studies, massage proved only slightly effective in the relief of symptoms and signs ofย exercise-inducedย muscleย damage. Therefore, its benefit was too small to be practical. There was a lack ofย evidenceย to support the use of cryotherapy, stretching and low-intensity exercise. However, there is research to support using pulsed electromagnetic fields therapy to help support muscle soreness.
As a result, a randomized, double-blind, placebo-controlled study was done to examine the effects of a 7000 Gauss PEMF. It was applied for 15 minutes daily for three days to the biceps muscle. 30 healthy volunteers had repeated iso-kinetic exercise of the biceps at low and fast speeds. The PEMF was applied after the exercise and objective and subjective measurements were made of muscle function and symptoms. Overall, PEMF stimulation was more effective than sham in reducing symptoms, including perceived soreness, and and in improving electrical function tests of the muscles. Muscle strength [peak torque] recovered to pre-exercise levels earlier than the sham group.
In this study a relatively high intensity PEMF signal was used to obtain the benefits seen. Nevertheless, Iโve had personal experience using lower intensity PEMFs after yardwork right after exercise that would normally induce muscle soreness, before the muscle soreness began. Iโve also had benefits when I did the therapy the morning after when the muscle soreness was already established. In this study, a small PEMF applicator was applied to the muscle that was exercised.
In the case of yardwork or other exercises involving many muscles, a larger PEMF pad should be used or a higher intensity whole body PEMF system. Moreover, It may also be possible to prevent muscle soreness by using a portable PEMF system over specific muscles while exercising or immediately afterwards. In addition, PEMFs applied to muscles before exercise will increase ATP production and circulation to the muscles to potentially not only increase the peak torque of the muscle but also reduce the likelihood of development of post exercise soreness.
Study reviewed by Dr. William Pawluk, MD
Vascular disease within the heart and throughout the body is one of the top causes of death and disability. Additionally, most vascular disease is associated with blockages of blood vessels, called arteriosclerosis or atherosclerosis. Atherosclerosis is a leading cause of vascular disease worldwide. Its major clinical manifestations include ischemic heart disease (IHD), stroke, and peripheral arterial disease (PAD). Moreover, atherosclerosis is a progressive disorder, developing with age. The incidence of PAD is 1% at age 40 to 49 years and 15% at age โฅ70 years. The incidence of ischemic stroke in the United States for 2010 was 143 per 100,000 person-years. The IHD risk of death is 200/100,000/year. Many factors lead to arteriosclerotic vascular disease. Controlling cholesterol is one of the most common strategies, but it is not a reliable method of reducing the progression of arteriosclerosis. So, can PEMFs be used for this purpose?
Bypasses and stents are commonly used to provide circulation around a blood vessel blocked (stenosis) by atherosclerosis. These bypasses have the same risk of becoming blocked as the rest of the vascular system. This is called restenosis. Nonetheless, restenosis often happens very rapidly compared to the gradual progression of stenosis in the general vascular system.
I discovered a study from 2003 where a relatively low intensity of 700 micro Tesla (7 Gauss) 50 Hz magnetic field was meticulously studied in mice, which had undergone a vascular bypass operation. Firstly, in mice, thickening of the inside lining of the blood vessel (intima) is seen as early as one week after bypass. This thickening usually increases an average of 10-fold after just four weeks and 15-fold after eight weeks. The mice received either active or sham PEMF treatments for two hours a day, five days a week for one, two, or three weeks. The mice were positioned about 12 cm away from the magnetic field coil.
Mice exposed to the PEMF for one week had significantly less intimal thickening compared to the sham field. However, intriguingly, those mice exposed for two or three weeks showed no differences, although, at three weeks, the sham mice had a higher level of thickening.
This study evidently shows that even a very low intensity PEMF of 700 micro Tesla has a modest amount of impact in slowing the initial progression of atherosclerosis. Nevertheless, a major drawback of the study is that, while 700 micro Tesla was used, the actual magnetic field delivered to the mouse would be less than one micro Tesla. Consequently, since the process of progression is likely more aggressive than the benefit received from the PEMF beyond one week, it may be reasonably assumed that higher intensity PEMFs would provide more substantial benefit.
Extending research results from mice to humans is always challenging, but changes happen in mice much faster than in humans, so it can also be reasonably assumed that long-term use of higher intensity PEMFs in humans would be undoubtedly effective in reducing the progression of the atherosclerosis that leads to ischemic heart disease, stroke, and PAD. Additionally, other research, such as that by Jerabek, unquestionably shows that PEMFs can significantly improve vascular disease in humans.
References
Diabetes is an increasing problem around the world. Vascular disease is one of the most common complications of diabetes. Because of this, wound healing in diabetics is a major health challenge. Short of curing and reversing diabetes, managing the complications such as foot ulcers is difficult. However, it would be much improved by the use of such technologies as pulsed electromagnetic fields (PEMFs). Because of the diabetic vascular disease and wound healing problems, 15% of diabetics eventually develop the disastrous and disabling problem of a foot ulcer, which, in 12% to 24% of cases, requires amputation.
Diabetes is the leading cause of non-injury-related lower leg and foot amputations in the United States. PEMF therapy initiated early in someoneโs history of diabetes can be useful to prevent the development of vascular complications. Even if or when vascular problems become obvious, higher intensity local PEMF therapy should be strongly considered.
Significant experimental scientific evidence has shown that PEMF therapy:
A study (Caรฑedo-Dorantes et al., 2015) was done to evaluate the use of specific PEMFs applied indirectly to different parts of the body to induce healing of diabetic foot ulcers. The study also evaluated whether exposing different volumes of circulating blood to electromagnetic fields would produce better results.
Procedure
In the study, 26 diabetics whose diabetic foot ulcers had not been helped by conventional treatments were divided into groups. There was a forearm group and a chest groupโto receive treatment and record healing time. In both groups, 120 Hz sinusoidal wave PEMFs were applied twice a week for about 14 weeks or until complete healing was seen.
The forearm group received 8 gauss (0.8 milli-tesla) for 2 hours per treatment. The chest group received 6 gauss (0.6 milli-tesla) for 25 minutes per treatment. (Gauss and tesla are units that measure the strength of magnetic fields.)
Ulcer recurrences and adverse effects were investigated during short-term (less than 1 year) and long-term (3.4 years to 7.8 years) follow-up.
Results
Healing time ranged from 28 days to 94 days (mean, 61 days) in the forearm group, and 34 days to 92 days (mean, 63 days) in the chest group. By the end of the 100-day treatment period, 88% of the diabetic foot ulcers in the forearm group were healed and 94% in the chest group.
There were no adverse effects or ulcer recurrences in the original ulcer site during treatment, during the short-term follow-up period, or during the long-term follow-up period in both groups. All participants with diabetic foot ulcers that healed during the study and were examined 3.4 to 7.8 years after treatment ended continued to show healed ulcer areas regardless of their electromagnetic stimulation regime or individual characteristics.
The size of the pool of circulating blood treated (chest versus forearm) did not appear to matter even though the treatment time for the chest was only 20% of the forearm time. Also, itโs quite possible that higher intensity PEMFs would have produced even better results.
Comparing the Healing Rates of PEMFs to Other Diabetic Ulcer Therapies
It would be helpful to have a sense of how well other therapies work versus PEMFs. Various studies have shown the following results:
Because each of these studies used different treatment periods, itโs easiest to speak about the percentage of healing during the time of the study. Most of these studies used 84 days for the study period; others used 56 days and 43 days. So, even the indirect approach to healing diabetic foot ulcers with these PEMFs produced a healing benefit comparable toโor better thanโconventional therapies. This suggests common physiologic effects that result in the healing action.
Moreover, recent evidence suggests that PEMFs stimulate certain cell receptors known as adenosine receptors. These are on most types of white blood cells. White blood cells are needed to decrease inflammation and stimulate tissue healing. This research indicates that the optimal PEMF intensity to stimulate white blood cells is about 15 gauss (1.5 milli-tesla). So, stimulating white blood cells in the circulation can still impact ulcers away from the area of stimulation. It can also be expected that PEMF treatment of an ulcer directly, with or without whole body treatment, would get even better results and faster.
Nonetheless, routine whole body PEMF treatment is advisable for every diabetic. It can prevent or reduce vascular complications using a sufficient electromagnetic field intensity to adequately and routinely stimulate circulating white blood cells.
I have previously stated that almost all magnetic fields, static and PEMF, stimulate circulation and microcirculation. Within certain limits, almost any magnetic field intensity will increase circulation. Improvements in circulation are not the limited domain of any single magnetic therapy device. In fact, I came across a study done in Korea using a high intensity 2.5 Tesla coil. The coil was kept away from the body so that it would not touch the skin.
The actual measured intensity at the skin was 7000 Gauss (0.7 T) PEMF at a pulse rate of 1 per second, applied for 10 minutes in healthy individuals, using their own limbs as controls. Thermography was used to detect the impact on circulation. Thermography is a standard scientific and clinical tool to assess circulation. When one part of the body is stimulated with PEMFs, other areas in the body also respond with improvements in circulation, although to a weaker extent.
The surface of the human body, that is, the temperature of the skin, reflects the temperature of the deeper tissues in the area of stimulation, so that the temperature of the skin and the blood flow are proportional to each other. There are a number of mechanisms that cause blood vessels to open to improve circulation. These include the movement of ions, production of nitric oxide, among others, the cause blood vessels to dilate, improving circulation. This includes all sizes of blood vessels. When blood vessels dilate there is increased blood flow with increased oxygenation of tissues. Increase circulation is considered one of the primary benefits of PEMFs in helping to heal the body, reduce swelling and increase nutrients and immune factors to tissues.
Once you better understand the process of PEMF therapy, what it targets, and the benefits that it can have for things like blood flow and circulation, the first thing to do is decide whether or not you may have an issue that needs addressing through treatment. Here are just some of the numerous symptoms of poor blood flow in the body:
This situation can occur at any time and can either be an indicator of nerve or tissue damage or, when left untreated can actually lead to nerve and tissue damage. This is a serious and dangerous symptom that should never be ignored.
This symptom may also appear without warning at any given time. It is especially telling in those who do not live in an area where the temperatures drop significantly enough to cause this problem on their own. This is often called Raynaudโs phenomenon, or when more severe Raynaudโs disease.
It is very important to remember to stay active and to keep moving. Short, brisk walks, taking the stairs instead of the elevator, riding a bike around the corner instead of driving and many other simple activities can help, in addition to PEMF therapy.
People tend to forget that poor circulation can also have a tremendous impact on neurological function. This can lead to brain fog or haze. In these cases, people often have difficulty remembering simple things and, in the more serious cases, trouble focusing and concentrating on even the most basic of tasks. Unusual headaches and increased memory loss may also develop when left unaddressed.
Many people try to deal with this problem with skin moisturizers and hydrators. This may be an effective solution when it is caused by something other than poor circulation. However, an issue like this needs to be treated at its source, not by the symptom itself.
Swelling is usually the result of some type of inflammation or blockage of veins in the legs (varicose veins) and is often painful. The discomfort can vary greatly depending on the severity of the swelling. The problem is generally a blockage of the flow of blood in the veins.
Blockages of the flow of blood in the arteries, is called ischemia. Over time, this problem can lead to significant and increasingly intense pain. It is called claudication.
Many people dismiss hair loss as a hereditary trait or simply as the result of aging. While in most cases this may true, at times it can also be caused by poor blood flow. One of the indictors that your problem may be circulatory is that you experience rapid and sudden hair loss. It is common in the legs in those with chronic circulation problems.
When your lungs do not receive the proper amount of oxygen, bouts with shortness of breath will become more and more common. It can escalate to the point of having significant difficulties breathing when ignored, especially with exertion,. This is a very serious problem and should be treated as such.
Finally, one of the biggest medical concerns that result from low blood flow is cardiovascular problems. The continual lack of oxygen rich blood cells circulating throughout your body does damage over time. That can ultimately lead to more significant and long term issues with many organs in your body. These events, all combined, can lead to heart failure. This is definitely not something that you want to take lightly.
It is also important to note that any of these individual issues may be caused by a number of other factors. Presenting one or more of them does not necessarily mean that you have poor circulation. However, these are all valid medical concerns that should be immediately investigated regardless of their source. Nonetheless, if it turns out that blood flow and its regulation are the primary cause, PEMFS may be able to help.
Some of these symptoms might apply to you but bear in mind you donโt have to present any, multiple or all or of these symptoms to know your circulation isnโt functioning properly. You know your body and how it works better than anyone else, including your doctor. When something is wrong you can feel it. It is important to trust your body when it is telling you that something isnโt right, even if the symptoms arenโt there to prove it.
Now that you know more about what PEMFs are, what they may be able to treat, as well as the symptoms of low blood circulation, letโs take a look at the precise ways this form of therapy actually improves circulation:
Moreover, thermography is often used to study circulation. The thermogram images below clearly demonstrate a significant difference in circulation between the unstimulated and stimulated parts of the body. In figure 4 only the sole of the right foot was stimulated. In figure 5 the palms, knees and soles of the feet were each stimulated separately. The images on the left are before stimulation and the images on the right are after stimulation.
Study reviewed by Dr. William Pawluk, MD
September 20, 2018
From: Effect of Pulse Magnetic Field Stimulus on Blood Flow using Digital Infrared Thermal Imaging. Lee Hyun Sook. J Korean Magnetics Society, October 2011, 21 (5), 180-184.
One in four Americans, ages 45 and older or almost 32 million take a statin. Statins are used to lower cholesterol into what are considered to be optimal ranges. Cholesterol is a fundamental molecule made by the body for many health maintaining purposes, including helping to fight infection, reducing cancer rates, producing coenzyme Q 10, vitamin D, the sex hormones and the bodyโs own natural cortisone. Life canโt exist without cholesterol. About 80% of the cholesterol in our blood is made by the body. If you eat only 200 to 300 milligrams (mg) of cholesterol a day (one egg yolk has about 200 mg), your liver will make an additional 800 mg per day from raw materials such as fat, sugars, and proteins. When less is taken in, the body simply makes more.
Moreover, modern medicine considers cholesterol a problem, primarily related to the possibility of it causing cardiovascular disease. It is associated with cardiovascular disease but many believe that it is not the cause. The late modern medicine deals with high cholesterol is to reduce it by using statin lowering agents. The use of statins is not innocuous. Most doctors prescribe them like candy, not really being convinced that there are significant problems with their use.
However, there are significant health issues from taking these drugs. 7% to 29% of patients are reported to develop muscle complaints while receiving statin treatment. These muscle issues can show up in a high percentage of people as simply weakness, without any pain or discomfort. Complaints are often made worse by exercise. Statins have been shown to reduce mitochondrial oxidative capacity and content in human muscle and impair mitochondrial adaptations needed in muscle during muscle activity. This issue of the statins causing weakening of muscles, is especially important as we try to have everyone increase their activity and exercise levels, to maintain health and longevity. This means that people on statins are less likely to be as active or exercise as much as they should be doing. And, most people tend to follow their doctorsโ advice and take the statin medicine as prescribed.
Few studies have examined the effects of statins on muscle contraction function and exercise performance, and even fewer studies have examined this in statin users with muscle complaints. For example, the Effect of Statins on Skeletal Muscle Function and Performance (STOMP) trial is, to our knowledge, the only randomized, double-blind clinical trial that has examined aerobic exercise performance and muscle strength before and after treatment with placebo or high-dose atorvastatin (STOMP) (Parker). STOMP researchers found that more patients in the atorvastatin group than in the placebo group developed muscle complaints. However, this study only recruited individuals who had never taken statins. So, the absence of damaging changes in muscle function and performance would not apply to those who were already statin users, and especially not those with symptoms.
An optimized study was done to further assess the damage caused to muscles by statins. (Allard) This study not only assessed people who had been long-term statin users but also did bicycling tests, involuntary electrically stimulated isometric quadriceps-muscle contractions, and muscle biopsies. The study checked for maximal exercise capacity, use of muscle fuel during exercise, muscle function, and mitochondrial energy metabolism. They checked the results of statin users who are symptomatic and those who werenโt. These individuals are compared to control individuals who were not on statins.
At the end of the study, they found that symptomatic statin users had ~28% lower muscle ATP production capacity than control individuals. Symptomatic statin users had 69% of the ATP of the controls and asymptomatic statin users had 81%. ATP production capacity was lowest in the symptomatic group of statin users and highest in control subjects. Oxidation rates, mitochondrial respiration and mitochondrial density measurements were significantly lower in symptomatic statin users. Mitochondrial density, in turn, was directly related to exercise capacity, VO2peak.
Therefore, they found statin-induced changes in muscle fuel use during maximal exercise performance, muscle fatigue during repeated muscle contractions, and disturbances in the mitochondrial oxidative capacity of the muscle. When participants were exposed to multiple contractions typical of exercise to assess fatiguing of the muscle, statin users clearly showed increased fatiguing than control individuals. In addition, statins impact calcium balance in the muscles which can also contribute to cramps and muscle pain.
The mitochondrial energy generating capacity of the asymptomatic statin users was reduced even compared to healthy people. Statin users had increased lactic acid production at a lower level of their maximal capacity and symptomatic statin users also had higher lactate levels late in exercise. More muscle energy was required in asymptomatic statin users at rest and this extra demand was still present in people with muscle damage after stopping statin therapy.
PEMFs are known to enhance muscle function. They do this through a number of mechanisms, including nerve stimulation, mainly by increasing energy supply in the muscle, improving circulation, reducing swelling in the muscles after activity, stimulating stem cell production, and probably other actions as well. This means that PEMFs can be very effective for reducing and limiting the muscle damage caused by statins in the very large proportion of the population. Moreover, especially those who are using these drugs.
For various reasons, people who are taking these drugs may not be able to stop them, following doctorsโ orders. At the very least, they can increase their activity and ability to exercise, while still taking their statins. Since there is evidence that the damage to muscles goes on long after the medication is stopped, PEMFs can be continued until muscles have repaired. Beyond this, of course, one can get all the other benefits of PEMFs for the various health issues that people have, including slowing aging.
Since the effect of statins is on all the muscles in the body and felt most in the skeletal muscles being used during activity, any kind of PEMF may help, but whole body PEMFs, which cover a majority of the body muscles may be the most beneficial. Otherwise, small area PEMFs may still be able to help with smaller areas which may be affected most. Higher intensity PEMFs would work the best. Frequency is not likely to be that important, since most frequencies between 5-75 Hz will increase ATP.
Essential tremor (ET) is a neurological condition that most commonly causes a rhythmic trembling of the hands while performing a task like eating, writing, dressing, drinking, or holding a posture such as holding the arms stretched out in front of the body. The tremor may affect the head, voice, legs, and trunk as well. Some people even feel a shake from within. ET is often mistaken for Parkinsonโs disease, but it is 8 times more common, affecting an estimated 10 million Americans and millions more worldwide. It was once known as familial tremor, benign tremor, or hereditary tremor. Essential tremor is more than just a tremor. Itโs a condition that changes lives. Many people with ET never seek medical care because of stereotypes and lack of awareness.
The incidence (the current risk of getting a disease) of ET is approximately 4% of individuals 40 years of age and older and becomes increasingly more common with age. The most common treatment for ET is medication (primidone and propranolol) and surgery (deep brain stimulation, focused ultrasound, and thalamotomy). Although various approaches report a reduction of tremors, drug and surgical approaches are limited by costs and potential side effects. As a result, there is a continuing search for more effective treatment options for tremor reduction in ET patients.
Essential tremor is considered a neurodegenerative disease. Research has shown that there is a progressive worsening in tremor scores over time. There is an average increase in tremor severity from baseline by 3.1% to 5.3%. Stages of severity vary from Glass Scale I to IV. Glass Scale score I is mild severity, when the patient may need occasional medication. Score II is moderate severity, during which people commonly need continuous drug therapy. Scores at stages III and IV have high severity, when the patient often needs multiple therapies and surgery.
Of patients with ET for more than 40 years, 20% to 60% have a high severity tremor, with fewer than 10% being incapacitated. Tremor on one side of the body at the first medical visit helps clinicians predict future disease severity. The rate of change in severity is also higher in those with a family history of ET. Age at onset affects the rate of progression. Those with onset after 60 years of age progress more rapidly. In tremor beginning before 40 years of age, the rate of progression is low.
If the tremors are mild, some simple lifestyle changes may help:
For more bothersome tremors, medications may be tried. A good result with medication would be reduction in tremor by about 50%, which is not consistently seen. Medications are typically only for symptoms and do not stop the progression of the condition.
In more severe situations, surgical treatments may be recommended. These are restricted to very bothersome or disabling tremor that is not adequately managed on medication. A good result with surgery would be elimination or near elimination of tremor. Major complications and side effects are a risk, and treatment results are not predictable. Also, surgical treatments may not delay progression or the development of new tremors.
Noninvasive brain stimulation (NIBS) techniques have been investigated by ET researchers as alternatives to the conventional ET treatments over the past decade. NIBS involves transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). tDCS is very uncomfortable to achieve adequate levels of stimulation.
Researchers have reviewed and comprehensively analyzed multiple studies investigating the effects of 1 pulse per second (PPS) NIBS treatments on reducing tremor in ET patients. They addressed four leading questions:
The results of their research showed that NIBS reduced both symptoms and objective measurements of tremorโ54% reduction in clinical symptoms and 62% in objective measures. Treatment over the cerebellum and over the motor cortex were 55% and 75% effective, respectively, but statistically were not significantly different. This means that stimulating either brain location would produce similar benefit.
In many neurological conditions, treatment of the brain is opposite to the side of the predominant symptoms. For example, in stroke, weakness or paralysis in the left side of the body would be the result of damage to the right side of the brain. In the case of ET, symptoms can be one-sided or involve both sides. The location of brain treatment in people with symptoms more on one side of the body or both sides may not make a difference. In other words, treatment of the opposite side of the brain may still produce benefits as same side treatment. This may be because stimulation effects reverberate throughout the brain.
As for the number of treatment sessions needed, treatment for only one session or multiple sessions both have benefitโ53% versus 69% improvement. Other studies with neurological disease have suggested that repetitive stimulation over time is more likely to induce better improvements in brain activity and cognitive and motor functions than a single session of stimulation. But, reductions in tremor were not directly related to the number of sessions. So, a threshold number of treatment sessions would produce optimal improvements in tremor over time, and there may be less unpredictability in longer-term benefits with multiple treatments over time. That means that longer term benefits of repeated stimulation are more likely.
The benefits of PEMF therapy (NIBS) will also be related to the severity of the condition at the time the treatment is begun and the age of the individual. It is expected that starting earlier in the course of ET is essential to producing the best results. This has been seen in many other conditions for which PEMF therapy has been used.
Since the intensity of the PEMFs used in most essential tremor research was done using very high intensity systemsโusually greater than 1.5 Teslaโit is likely that longer term, regular treatment with lower intensity PEMF systemsโbetween 0.5 Tesla and 1 Teslaโwill be needed to produce similar results. The much higher intensity TMS studies used between 300 and 1200 pulses per treatment session safely. At 2 PPS and using a home-based PEMF device at about half the intensity of a typical professional TMS device, a treatment session of about 10 minutes would be needed to achieve what would be equivalent to TMS at 300 pulses per treatment session.
On the other hand, to achieve 1200 pulses per treatment would require a 40-minute session. At a higher intensityโthat is, at 1 PPSโusing a similar lower intensity-based home system as above would require about 5 minutes of treatment to deliver the dose equivalent of TMS at 300 pulses per session and about 20 minutes to deliver the equivalent of TMS at 1200 pulses per session.
The decision on how long a treatment session should be would have to be a personal decision based on the time available and knowing the intensity of the PEMF system being used. The key difference between most of the cited research and home-based therapy is that home-based therapy can be continued over much longer periods to obtain and maintain more durable and sustainable results.
Kang N and Cauraugh JH. Does non-invasive brain stimulation reduce essential tremor? A systematic review and meta-analysis. PLoS One. 2017 Sep 28;12(9):e0185462.
Gironell A, Ribosa-Noguรฉ R, Gich I, et al. Severity stages in essential tremor: a long-term retrospective study using the glass scale. Tremor Other Hyperkinet Mov (N Y). 2015 Mar 13;5:299.
I have often said that combining PEMF therapies with other modalities produces better results than either modality alone. Likewise, I have found that if one could only afford to have one system, PEMFs would likely give the most value because of the broad spectrum of conditions that can be treated and the fact that PEMFs can be used in the home setting. Many other modalities have to be delivered in the professional setting, taking the time and inconvenience of traveling to appointments and preparation for treatment. PEMF therapy does not require preparation of the patient since it goes through clothing and dressings without a problem.
The World Health Organization (WHO) estimates that there are 347 million people around the world with diabetes and one in 20 will develop foot ulcers. In addition, any leg wounds in diabetics tend to heal slowly and poorly. Conventional treatment can be frustrating and slow with many treatment failures. Because of poor circulation and reduced immune function, diabetic foot and leg ulcers are susceptible to infection, which hinders the healing process. One in 6 people with diabetic foot ulcers end up with foot or leg amputations. There are about 80,000 foot amputations annually due to DFU, or about a lower limb amputation every 30 seconds. Lower limb amputations due to diabetes are about 28 times that of any other causes. Lower limb amputations are usually the result of poor wound care. A diabetic wound that doesnโt heal within 2 weeks requires more aggressive management, including PEMFs.
The benefits of PEMF therapy have been proven in recent research. It studied PEMFs’ effectiveness in reducing bacterial infection in diabetic foot ulcers (DFU). They combined PEMFs with laser, comparing it to PEMFs alone. Thirty (30) Type 2 diabetics with foot ulcers were randomly assigned to either treatment. The PEMF used was two Gauss (0.2 mT) at 20 Hz, applied for 10 minutes in 12 sessions every other day. All received standard diabetic medications and nursing care. Wound area was measured initially and after one month. Bacterial count was also measured pre and post-treatment.
PEMF therapy alone drastically reduced bacterial count by 99% [from 100,000 to 1000), while the combination reduced it by 99.9% [from 100,000 to 100). This study shows PEMF therapy is more effective in reducing bacterial contamination compared to adding infrared laser, even with only 10-minute sessions over 12 treatments. More intensive daily treatments may yield even better results. It doesn’t indicate wound healing directly, but it supports PEMFs’ ability to speed healing of leg ulcers, including diabetic ones.
Other research supports using PEMFs alone to reduce bacterial growth, while some suggest infrared laser is better than 0.5 Gauss/20 Hz PEMF, unlike this study. Increased PEMF intensity appears crucial, supported by research on PEMFs’ effects on adenosine. Although this study only focused on bacterial counts in diabetic foot ulcers, not wound healing, other research backs PEMF therapy for speeding foot ulcer healing. PEMFs aid wound healing through various mechanisms, including inflammation reduction, stem cell stimulation, collagen production, and new blood vessel growth.
I once had a patient with a chronic diabetic foot wound. It wouldn’t heal despite 2 years of intensive professional wound management. After just one month of daily home PEMF therapy with a portable 200 Gauss 10/100 Hz PEMF device, the wound significantly reduced in size. It eliminated the need for ongoing professional wound management.
Consider PEMF therapy at home as the primary treatment for diabetic foot ulcers, along with basic wound care. It reduces the need for intensive professional therapy, cutting costs and inconvenience. Combining professional treatments with daily at-home PEMF treatments would likely lead to even faster healing.