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PEMFs and Brain Recovery After Stroke

Man stands with a side profile and waves re going through his brain (a drawing) after a stroke

PEMFS AND BRAIN RECOVERY AFTER STROKE

Table of Contents

Man stands with a side profile and waves re going through his brain (a drawing) after a stroke

The ability to recover after stroke depends on many factors, including the regenerative capabilities of the brain. Recovery depends on the plasticity of the brain. The plasticity, or neuroplasticity, required in a damaged brain is very different from the plasticity of a normal functioning brain. The demand for adaptive healing starts immediately after a stroke event 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 PEMF STUDY IS CONDUCTED

A study was done to evaluate the effect of extremely low-frequency electromagnetic field therapy (PEMF) on brain plasticity in the rehabilitation of patients after stroke. (2) 

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. 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 (2–3 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 (2–3 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 on 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, for 15 mins each, at 5 mT (50 G), 40 Hz, to the pelvic girdle. The non-PEMF group received the same rehabilitation program, without PEMF therapy.

That’s right! PEMF treatment was to the pelvis, not to the brain, as would normally be expected. At the time of this research there was a concern about PEMFs precipitating seizures. This concern has largely been discounted with the FDA approved high intensity transcranial magnetic stimulation devices for treatment resistant depression, with seizures being extraordinarily rare and much less likely to happen with the relatively low magnetic field intensities used in this research. As it turns out, from this research, stimulation of the pelvic area with this PEMF set-up still ended up producing significant changes in levels of various biochemical markers. These biochemical factors end up in the circulation, and finally in the brain. In the brain they create various reactions that can help improve the negative effects of stroke.

This research group looked at many factors associated with the outcomes of stroke and associated these outcomes with treatment results. After 4 weeks, during which patients had undergone neurorehabilitation and neurological examinations, they assessed functional recovery using the Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), National Institutes of Health Stroke Scale (NIHSS), and the modified Rankin Scale (mRS).

The modified Rankin Scale (mRS) is commonly used for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. It has become the most widely used clinical outcome measure for stroke clinical trials.

RESULTS OF PEMF STUDY ON BRAIN RECOVERY AFTER STROKE

Any kind of damage to the brain causes the brain to adaptively respond. This adaptation process is called neuroplasticity. Neuroplasticity, also known as neural plasticity or brain plasticity, is a process that involves adaptive structural and functional changes to the brain. A good definition is “the ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections.” Clinically, it 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 (no change), or negative (can have pathological consequences). (2)

Neuroplasticity 

Neuroplasticity can be broken down into two major mechanisms:
Neuronal regeneration/collateral sprouting: This includes concepts such as synaptic plasticity and neurogenesis.
Functional reorganization: This includes concepts such as equipotentiality, vicariation, and diaschisis. Vicariation is considered a mechanism for recovery of function following brain damage. Essentially, this concept involves the ability of one part of the brain to substitute for the function of another. Diaschisis is a sudden change of function in a portion of the brain connected to a distant, but damaged, brain area. The site of the originally damaged area and of the diaschisis are connected to each other by neurons. 

Areas of the brain are connected by vast organized neuronal pathways that allow one area of the brain to influence other areas more farther away from it. Understanding these dense pathways helps to link a lesion causing brain damage in one area of the brain to degeneration in a more distal brain area. So, a focal lesion causes damage that also disturbs the structural and functional connectivity to the brain areas away from the lesion.

This research examined various biochemical aspects of neuroplasticity, specifically, several growth factors. They measured the blood level of brain-derived neurotrophic factor (BDNF), the vascular-endothelial growth factor (VEGF), as well as BDNF RNA gene expression. Additionally, they tested the levels of hepatocyte growth factor, stem cell factor, stromal cell-derived factor 1α, nerve growth factor β, and leukemia inhibitory factor.(2) 

They found that PEMF significantly increased growth factors and inflammatory cytokine levels 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 mRNA level. The PEMF group had double the amount of blood serum BDNF and 2.5 times more gene expression. Moreover, increase in BDNF plasma levels was reflected in improvement of the Barthel Index, MMSE, and the opposite with the GDS. They concluded that PEMF therapy 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, GDS) status.

VEGF is involved in the improvement of damaged cells by increasing circulation and restoring function. VEGF levels increased by 50%. The PEMF group also had about 35% better cognitive functioning and 45% better depression scores.

In the non-PEMF group, stroke scale severity and function measures were about 65% and 50% worse, respectively.

The PEMF significantly increased enzyme antioxidant activity. The significant improvements in functional (ADL) and mental (MMSE, GDS) status correlated with the level of enzymatic antioxidant protection. (4)

To determine the level of antioxidant gene expression, they evaluated the level of mRNA expression of catalase, superoxide dismutase, and glutathione peroxidase. After PEMF therapy, mRNA expression of the studied genes (CAT, SOD1, SOD2, GPx1, and GPx4) significantly increased. These changes enhanced the antioxidant defenses of the body. (5)

Apoptosis is programmed cell death, and aims to eliminate damaged cells, including those damaged by the hypoxia of stroke, There are many factors that can induce apoptosis of cells: after ischemia, inflammation, cytokine activation, cascade of free radicals, and induction of thrombin. Neuronal apoptosis is regulated by various genes, such as BCL-2 (inhibitor of apoptosis) and BAX (activator of apoptosis). Induced apoptosis promotes the formation of new neurons, that is, neurogenesis, in mice.

To assess apoptosis gene expression level, (8) these researchers measured the mRNA expression of BAX, BCL-2, CASP8, TNFα, and TP53 in these patients. PEMF significantly increased the expression of BAX, CASP8, TNFα, and TP53, whereas the BCL-2 mRNA expression after PEMF remained similar in both PEMF treatment and control groups. Thus, increasing the expression of pro-apoptotic genes in post-stroke patients promotes the activation of brain neurons and hence brain pathways involved in brain plasticity processes.

Plasma cytokines may be protective (anti-inflammatory) or harmful (pro-inflammatory). The measured the levels of the anti-inflammatory/neuroprotective cytokines interleukin 1β (IL-1β) and transforming growth factor β (TGF-β) and the pro-inflammatory cytokines interleukin 2 (IL-2) and interferon-γ (INF-γ). The level of IL-1β mRNA expression that determines the level of serum IL-1β was also tested. After PEMF treatment, both IL-1β plasma level (up 100%) and IL-1β mRNA expression level (up 70%). On the other hand, IL-2 plasma level increased 15%, while IFN-γ and TGF-β had non-significant changes. The PEMF-induced IL-1β improvement found in this study is likely to have a neuroprotective role. (7)

The researchers also evaluated the possible association between plasma protein oxidative/nitrative damage 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. Oxidative damage of proteins is relates to the degree of poststroke depression. The Geriatric Depression Scale is worse as the concentration of -SH groups or catalase activity increases. (3)

Nitric oxide (NO) is a very important signaling molecule, involved in both physiological and pathological processes. As a neurotransmitter in the central nervous system, NO regulates cerebral blood flow, neurogenesis, and synaptic plasticity. They evaluated the effect of the PEMFs on the generation and metabolism of NO, as a neurotransmitter, in the rehabilitation of poststroke patients. (6) They also measured the levels of 3-nitrotyrosine, nitrate/nitrite, and TNFα in plasma samples, and NOS2 expression in whole blood samples. 

PEMF significantly increased 3-nitrotyrosine and nitrate/nitrite levels, while expression of NOS2 was insignificantly decreased in both groups. So, PEMF therapy increases the metabolism and generation of NO, which has both neuroprotective and cytotoxic properties. An increase in NO level is associated with nNOS and/or eNOS activities. It does not influence iNOS expression, which increases mainly during inflammation. Therefore, in the poststroke state, NO demonstrates a protective 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. (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 was begun within 3 months after the initial attack and another subgroup had TMS beginning 3 months after the initial attack. Except for TMS, the basic treatment was the same for all of the patients. Fugl-Meyer score was measured twice: just before treatment and after the 14th 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 subgroup before treatment respectively and were 52 and 40 after treatment respectively (P < 0.01). The Fugl-Meyer scores were 41 and 59 before and after TMS respectively in the subgroup with early 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 function impairment after stroke is the Fugl-Meyer (FM) assessment. Of the 5 Fugl-Meyer (FM) domains (motor, sensory, balance, range of motion, joint pain), the motor domain, which includes an assessment of the upper extremity (UE) and lower extremity (LE), has well-established reliability and validity as an indicator of motor impairment severity across different stroke recovery time points.

So, what they found was that direct brain TMS is effective in the rehabilitation of motor function in patients with stroke. The effectiveness of TMS treatment depended on the age of the patients and timing of beginning treatment. Results are not as good as people get older and the longer the time treatment is started after the stroke. (11)

Since the Cichon research did not compare different intensities, frequencies, durations of treatment of various PEMF devices or how long after a stroke PEMF should be started, it is not known if there is an optimal PEMF protocol. Because of the very low level of risk in using PEMFs, whether to the pelvic girdle or to the brain, different PEMF protocols may be practical and useful. Both direct brain PEMF stimulation and indirect PEMF stimulation help with recovery from stroke. We will have to wait for studies where they compare indirect stimulation with TMS, to see the levels of effectiveness of each. So, for now, both approaches make sense 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 PEMFs in the body reviewed in the book “Power Tools for Health.” Almost all these actions may be seen with brain stimulation as well. Research shows that TMS can reduce the hyperexcitability seen in pain-related areas of the brain. TMS can trigger spinal cord inhibitory pathways to inhibit the conduction of pain signals to the brain (1). TMS increases cerebral blood flow in affected areas of the brain. In addition, the pain reducing effects of TMS not only influence the endogenous opioid system in the brain but also the endocannabinoid system. TMS can also reduce the neuroinflammation seen after stroke (10), a major contributor to poor stroke outcomes. (12) PEMFs have also been shown to increase neural stem cells useful in brain tissue repair. (9)

CONCLUSION

This research on the use of PEMFs in poststroke recovery and rehabilitation is important in showing some of the mechanisms accounting for the significant benefits from the use of PEMFs seen in those having ischemic strokes, even when applied between 3 to 4 weeks after their stroke. Furthermore, one of the most interesting aspects of this research is the fact that the brain was not even the target of treatment. Even so, peripheral PEMF stimulation appears to be able to provide significant benefits. 

It might be expected that more direct treatment to the brain would produce even better results, faster. This research was done using relatively low intensity PEMFs over a short treatment course and short treatment times, ie, 10 PEMF treatments, for 15 mins each, at 5 mT (50 G), 40 Hz. Therefore, the benefits seen in the PEMF treated group were impressive for the amount of treatment effort. Moreover, Even the modified Rankin Scale (mRS), a measure of the degree of disability or dependence in daily activities of people who have suffered a stroke, revealed less disability in those receiving PEMFs.

This is a summary of the results: stroke-related neurological deficit, estimated using NIHSS, decreased approximately 65% more in the PEMF group than in the non-PEMF group. mRS measured disability decreased in both groups, but in the PEMF group the reduction was approximately 50% greater than in the non-PEMF group. About 35% greater improvement was seen in cognitive impairment, as estimated by MMSE, after PEMF treatment. Depressive syndrome, measured in GDS, decreased significantly, with approximately 45% better results in 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, it’s hard to know whether the effects seen of this treatment would have been either earlier or later in the course of recovery from stroke. It is rare to get access to individuals with stroke very early in their disease process, because of the limitations of the complications related to stroke, the hospital environment, the rehabilitation environment and the technology available.

A commonly studied approach to treating stroke is the use of rTMS (repetitive transcranial magnetic stimulation), which uses high intensity PEMFs delivered in highly specialized professional settings. At this point, this therapy is not approved by the FDA or covered by insurance for stroke. Home-based PEMF therapy using medium to high intensity magnetic fields to the brain would be expected to produce good results. This becomes even more feasible when one considers that the PEMF therapy can be started at the home setting, that is, usually 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 have suffered strokes, especially when started as soon after stroke as possible, whether the PEMFs are applied directly to the brain or as part of an overall care program. Lastly, whole body PEMF therapy with sufficient intensity PEMF equipment should be used to help the whole person, especially considering that people who have a stroke often multiple health needs that would benefit anyway from PEMF therapy. Lastly.

To determine which PEMF system is best to use specifically for any given person, a free professional consultation is available at https://www.drpawluk.com/consult/

REFERENCES

1. Chang MC, Kwak SG, Park D. The effect of rTMS in the management of pain associated with CRPS. Transl Neurosci. 2020 Sep 28;11(1):363-370.
2. Cichoń N, Bijak M, Czarny P, Miller E, Synowiec E, Sliwinski T, Saluk-Bijak J. Increase in Blood
 Levels of Growth Factors Involved in the Neuroplasticity Process by Using an Extremely Low Frequency Electromagnetic Field in Post-stroke Patients. Front Aging Neurosci. 2018 Sep
26;10:294.
3. Cichoń N, Bijak M, Miller E, Niwald M, Saluk J. Poststroke depression as a factor adversely affecting the level of oxidative damage to plasma proteins during a brain stroke. Oxid Med Cell Longev. 2015;2015:4
4. Cichoń N, Bijak M, Miller E, Saluk J. Extremely low frequency electromagnetic field (ELF-EMF)
 reduces oxidative stress and improves functional and psychological status in ischemic stroke patients. Bioelectromagnetics. 2017 Jul;38(5):386-396.
5. Cichon N, Bijak M, Synowiec E, Miller E, Sliwinski T, Saluk-Bijak J. Modulation of antioxidant
 enzyme gene expression by extremely low frequency electromagnetic field in post-stroke patients. Scand J Clin Lab Invest. 2018 Nov-Dec;78(7-8):626-631.
6. Cichoń N, Czarny P, Bijak M, Miller E, Śliwiński T, Szemraj J, Saluk-Bijak J. Benign Effect of
 Extremely Low-Frequency Electromagnetic Field on Brain Plasticity Assessed by Nitric Oxide 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 the
 effects of extremely low frequency electromagnetic field on the levels of some inflammatory 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 of Rehabilitation with Extremely Low Frequency Electromagnetic Field on Molecular
 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 of Neural Stem Cells. Stem Cells Int. 2017;2017:9898439.
10. Guo B, Zhang M, Hao W, Wang Y, Zhang T, Liu C. Neuroinflammation mechanisms of neuromodulation therapies for anxiety and depression. Transl Psychiatry. 2023 Jan
 9;13(1):5.
11. Jin X, Wu X, Wang J, et al. Effect of transcranial magnetic stimulation on rehabilitation of motor function in patients with cerebral infarction. Zhonghua Yi Xue Za Zhi. 2002 Apr 25;82(8):534-7. Chinese.
12. Jurcau A, Simion A. Neuroinflammation in Cerebral Ischemia and Ischemia/Reperfusion Injuries: From Pathophysiology to Therapeutic Strategies. Int J Mol Sci. 2021 Dec 21;23(1):14.
13. Puderbaugh M, Emmady PD. Neuroplasticity. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32491743.

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Urinary Stress Incontinence Improved By High Intensity PEMF Therapy

Urinary Stress | Incontinence | High Intensity | PEMF Therapy

Urinary Stress Incontinence Improved By High Intensity PEMF Therapy

Table of Contents

Urinary Stress | Incontinence | High Intensity | PEMF Therapy

WHAT IS STRESS INCONTINENCE?

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.

HOW CAN PULSED MAGNETIC FIELDS HELP WITH STRESS INCONTINENCE?

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 STUDY OF PEMFS AND STRESS INCONTINENCE

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 ½ 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 – 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 – 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 “tuneups” 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.

Link to study:
Pulsed Magnetic Stimulation for Stress Urinary Incontinence: 1-Year Followup Results.
Lim R, Liong ML, Leong WS, Karim Khan NA, Yuen KH. J Urol. 2017 May;197(5):1302-1308.

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Pulsed ElectroMagnetic Fields (PEMFs) help with Muscle Soreness After Exer

Pulsed ElectroMagnetic Fields | PEMFS | Muscle Soreness | Exercise | Bicep Pain

Pulsed ElectroMagnetic Fields Help with Muscle Soreness After Exercise

Table of Contents

Pulsed ElectroMagnetic Fields | PEMFS | Muscle Soreness | Exercise | Bicep Pain

MUSCLE SORENESS FROM EXERCISE

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 of exercise-induced muscle damage. Therefore, its benefit was too small to be practical. There was a lack of evidence 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.

STUDY OF PEMFS ON 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, I’ve had personal experience using lower intensity PEMFs after yardwork right after exercise that would normally induce muscle soreness, before the muscle soreness began. I’ve 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

Study link:
Effects of pulsed electromagnetic field therapy on delayed-onset muscle soreness in biceps brachii.
Jeon HS, Kang SY, Park JH, Lee HS. Phys Ther Sport. 2015 Feb;16(1):34-9.

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PEMFs Reduce Progression of Arteriosclerosis

Red Blood Cells | Reduce Progression | Arteriosclerosis | Artery

PEMFs Reduce Progression of Arteriosclerosis

Table of Contents

Red Blood Cells | Reduce Progression | Arteriosclerosis | Artery

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 ≥70 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.

PEMF STUDY ON VASCULAR DISEASE

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

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PEMFs for Healing Diabetic Foot Ulcers

PEMFS | Healing Diabetes | Foot Ulcer | PEMFS for Diabetes

PEMFs for Healing Diabetic Foot Ulcers

Table of Contents

PEMFS | Healing Diabetes | Foot Ulcer | PEMFS for Diabetes

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 someone’s 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.

PEMFS PROMOTE WHITE BLOOD CELLS TO HEAL

Significant experimental scientific evidence has shown that PEMF therapy:

  • Encourages white blood cells to heal the endothelium (the linings of blood vessels)
  • Stimulates angiogenesis (the growth of new blood vessels) when there are blockages of blood vessels
  • Boosts the rapid growth of myofibroblasts and keratinocytes (cells necessary to build new blood vessels)
  • Improves the symptoms of diabetic peripheral neuropathy
  • Promotes diabetic wound healinHuman studies have shown that full body PEMFs stimulate mononuclear cells (tissue rebuilding cells) that promote angiogenesis and healing of chronic foot ulcers.

PEMF STUDY OF DIABETIC FOOT ULCER HEALING

A study (Cañedo-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 group—to 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, it’s 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:

  • Silver dressings: 22% to 31%
  • Graft materials: 30% to 56%
  • Platelet concentrates: 79%
  • Casting: 82% to 95%
  • PEMF therapy: 88% to 94%

Because each of these studies used different treatment periods, it’s 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 to—or better than—conventional therapies. This suggests common physiologic effects that result in the healing action.

Further Evidence Supporting PEMF Therapy

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.

Conclusion

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.

Reference

Cañedo-Dorantes L, Soenksen LR, García-Sánchez C, et al. Efficacy and safety evaluation of systemic extremely low frequency magnetic fields used in the healing of diabetic foot ulcers—phase II data. Arch Med Res. 2015 Aug;46(6):470-8.

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PEMF for Microcirculation and Increasing Blood Flow

Thermogram | Plantar skin | PEMF | Improvement | Stimulus

PEMF for Microcirculation and Increasing Blood Flow

Table of Contents

Thermogram | Plantar skin | PEMF | Improvement | Stimulus

CAN PEMFS HELP IMPROVE BLOOD FLOW AND CIRCULATION?

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.

COMMON SYMPTOMS ASSOCIATED WITH POOR CIRCULATION

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:

TOTAL NUMBNESS AND LOSS OF SENSATION IN THE HANDS, FINGERS, FEET, AND TOES 

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.

EXTRA SENSITIVITY TO COLDER TEMPERATURES IN YOUR HANDS, FINGERS, LEGS AND FEET

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 Raynaud’s phenomenon, or when more severe Raynaud’s disease.

SEVERE OR CHRONIC FATIGUE IS AN ISSUE FOR PEOPLE WHO AREN’T MOVING AROUND AND BEING ACTIVE

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.

DIZZY SPELLS AND/OR FREQUENT BOUTS OF VERTIGO

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.

FLAKY AND DRY SKIN

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 IN ANY OF THE EXTREMITIES

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.

PAIN IN ANY OF THE EXTREMITIES

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.

A SIGNIFICANT AMOUNT OF HAIR LOSS

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.

SHORTNESS OF BREATH OR DIFFICULTY BREATHING

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.

POTENTIAL ISSUES WITH YOUR HEART

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 don’t have to present any, multiple or all or of these symptoms to know your circulation isn’t 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 isn’t right, even if the symptoms aren’t there to prove it.

SPECIFIC WAYS PEMFS INCREASE CIRCULATION

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, let’s take a look at the precise ways this form of therapy actually improves circulation:

  • Reduces Inflammation Which Restricts the Flow of Blood
  • Provides Energy to the Cells and Keeps Red Blood Cells From Clumping Up Together
  • Dilates the Capillaries for Improved Micro-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.

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PEMFs Reverse the Muscle Damage Cause By Cholesterol Lowering Drugs (Statins)

Statin tablets | 40mg | Muscle Damage | Cholesterol Lowers Drugs | Statins

PEMFs Reverse the Muscle Damage Caused By Cholesterol Lowering Drugs (Statins)

Table of Contents

Statin tablets | 40mg | Muscle Damage | Cholesterol Lowers Drugs | Statins

STATIN DRUG USE

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 body’s own natural cortisone. Life can’t 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.

PROBLEMS CAUSED BY STATINS

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 doctors’ advice and take the statin medicine as prescribed.

MUSCLE PROBLEMS CAUSED BY STATINS

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.

STATIN MUSCLE DAMAGE STUDY

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 weren’t. 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.

PEMF EFFECTS ON MUSCLE

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 doctors’ 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.

WHAT IS THE EVIDENCE FOR PEMFS HELPING MUSCLES?

  1. Muscle soreness is a common result of muscle exercise, even in those not on statins. Delayed muscle soreness after exercise has been shown to be improved by PEMFs. (Jeon)
  2. One of the most basic actions of PEMFs is on adenosine, which forms adenosine triphosphate (ATP). PEMF stimulation of body tissues increases the energy production of ATP. Because of this PEMFs allow muscles to work longer, harder and recover faster. See more on this molecule at this link. Since statins block ATP production in muscles, PEMF can reverse this problem.
  3. High intensity PEMFs used outside under the pelvis have been found to reduce urinary incontinence in women by strengthening pelvic muscles. (Bakar) The PEMF induces controlled activation of nerves in the stimulation area and hence muscle contractions. As a result, PEMFs directly stimulate pelvic floor muscles and sacral roots.
  4. Also, high intensity PEMFs can generate very powerful muscle contractions with much less discomfort than electrical stimulation. (Han; Gorodnichev)
  5. There is even evidence that magnetic fields can accelerate the development of new muscle cells. (Surma; Eldashev; De Carlo)

WHICH PEMFS WOULD WORK BEST?

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.

References

  • Allard NAE, Schirris TJJ, Verheggen RJ, et al. Statins Affect Skeletal Muscle Performance: Evidence for Disturbances in Energy Metabolism. J Clin Endocrinol Metab. 2018 Jan 1;103(1):75-84.
  • De Carlo F, Ledda M, Pozzi D, et al. Nonionizing radiation as a noninvasive strategy in regenerative medicine: the effect of Ca(2+)-ICR on mouse skeletal muscle cell growth and differentiation. Tissue Eng Part A. 2012 Nov;18(21-22):2248-58.
  • Eldashev IS, Shchegolev BF, Surma SV, Belostotskaia GB. Effect of low-intensity magnetic fields on the development of satellite muscle cells of a newborn rat in the primary culture. Biofizika. 2010 Sep-Oct;55(5):868-74.
  • Gorodnichev RM, Beliaev AG, Pivovarova EA, et al. Muscular strength development by electromagnetic stimulation. Fiziol Cheloveka. 2014 Jan-Feb;40(1):76-81.
  • Han TR, Shin HI, Kim IS. Magnetic stimulation of the quadriceps femoris muscle: comparison of pain with electrical stimulation. Am J Phys Med Rehabil. 2006 Jul;85(7):593-9.
  • Jeon HS, Kang SY, Park JH, Lee HS. Effects of pulsed electromagnetic field therapy on delayed-onset muscle soreness in biceps brachii. Phys Ther Sport. 2015 Feb;16(1):34-9.
  • Parker BA, Capizzi JA, Grimaldi AS, et al. Effect of statins on skeletal muscle function. Circulation. 2013;127(1):96–103.
  • Surma SV, Belostotskaya GB, Shchegolev BF, et al. Effect of weak static magnetic fields on the development of cultured skeletal muscle cells. Bioelectromagnetics. 2014 Dec;35(8):537-46.
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Essential Tremor and Treatment with PEMF Devices

Tremor | Treatment | PEMF Devices

Essential Tremor and Treatment with PEMF Devices

Table of Contents

Tremor | Treatment | PEMF Devices

ESSENTIAL TREMOR AND TREATMENT WITH PEMF DEVICES

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 Parkinson’s 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. It’s 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.

THERAPEUTIC OPTIONS

If the tremors are mild, some simple lifestyle changes may help:

  • Follow an appropriate sleep schedule. For some people, physical exhaustion can cause tremors.
  • Try relaxation techniques. This can work well for tremors brought on by stress or heightened emotions.
  • Consider occupational therapy. An occupational therapist can help you adjust to living with the tremors. Some simple changes can make life easier. Use eating utensils with larger handles. Wear wrist weights to stabilize the hand. Select clothes that are easy on and off — no buttons!
  • Avoid aggravating substances. Medications (like certain antidepressants, antiepileptics, or asthma inhalers) or foods (caffeine, energy drinks) can worsen tremor.

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.

  • Propranolol, beta blocker: These meds are commonly used to treat high blood pressure. Don’t use beta blockers if you have asthma or a heart problem. Side effects can include fatigue and lightheadedness.
  • Primidone: This antiseizure drug is typically used to treat epileptic seizures. Side effects can include short-term drowsiness, concentration problems, and nausea.
  • Botox: This injectable drug is an accepted treatment for such conditions as migraine, bladder dysfunction, and excessive sweating. It is also used to treat hand, head, or voice tremors. When used for hand tremors, you may notice finger or wrist weakness. When used for voice tremors, Botox can cause a raspy voice or swallowing difficulties.
  • Various other medications can be tried, including clonazepam, gabapentin, topiramate, and zonisamide although these are generally less effective.

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

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:

  1. Do NIBS interventions improve tremor as based on clinical tests or objective tremor assessment?
  2. Does stimulation of the cerebellum (the base of the brain) or over the motor cortex (the side of the head above the ear) show improvement in tremor?
  3. Do single versus multiple treatment sessions influence the results?
  4. Is there a reduction in tremor at 1 day before or 1 day after treatment ends?

The results of their research showed that NIBS reduced both symptoms and objective measurements of tremor—54% 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 benefit—53% 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.

HOW PEMF THERAPY (NIBS) CAN HELP ESSENTIAL TREMORS

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 systems—usually greater than 1.5 Tesla—it is likely that longer term, regular treatment with lower intensity PEMF systems—between 0.5 Tesla and 1 Tesla—will 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 intensity—that is, at 1 PPS—using 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.

References

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-Nogué 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.

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Diabetic Foot Ulcer Infections – Combining Therapy with PEMF and Lasers

Diabetes | Foot Ulcers | Infections | PEMF Therapy | Lasers

Diabetic Foot Ulcer Infections - Combining Therapy with PEMF and Lasers

Table of Contents

Diabetes | Foot Ulcers | Infections | PEMF Therapy | Lasers

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 doesn’t heal within 2 weeks requires more aggressive management, including PEMFs.

Benefits

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.

References

Additional effect of pulsed electromagnetic fields to laser therapy on management of diabetic foot ulcer: A single blind randomized controlled trial. Elrashid NAA, Hamada A. Hamada HA, Abdelmoety AM, et al.
Bioscience Research (2018) 15(4):3322-3328.

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Age-Associated Memory Impairment Reversed with PEMF Therapy

Age Associated Memory | Impairment Reversed | PEMF Therapy | Dr. Pawluk | Hippocampus

Age-Associated Memory Impairment Reversed with PEMF Therapy

Table of Contents

Age Associated Memory | Impairment Reversed | PEMF Therapy | Dr. Pawluk | Hippocampus

About 40% of people over age 65 experience some memory loss. It is known as “age-associated memory impairment,” if there is no medical condition that causes this loss of memory. Then, it is considered part of normal aging. Alzheimer’s disease and other dementias are not part of normal aging.

Age-associated memory changes are often seen as:

  1. Not being able to remember the details of a discussion or incident that took place a year earlier.
  2. Not being able to remember the name of a friend.
  3. Forgetting stuff and incidents.
  4. Occasionally have trouble finding words.
  5. You’re concerned about your memory, but your family isn’t.
 

The hippocampus is responsible for memory and shrinks with age. It’s deep inside each brain, near the ear. It links unrelated things into memory, like where you left your keys or your neighbor’s name. It’s vital for forming new memories about experienced events. When it’s not normal, spatial orientation falters; people get lost, a common symptom of amnesia.

At Northwestern University, researchers studied PEMFs to stimulate older adults’ brains to improve memory. Since the hippocampus is deep, they targeted the parietal lobe, closely linked to it. Stimulation of the parietal lobe is expected to boost hippocampus function.

The study had 16 adults, ages 64-80. They compared memory tests with a younger control group before stimulation. Older individuals were correct about 40% compared to the younger group, around 55%.

Stimulation was done using a high intensity PEMF at about 10 pulses per second for 20 minutes in each session, over five consecutive daily sessions to the left side of the head. Full intensity stimulation was compared to low intensity “sham” stimulation. This allowed the researchers to evaluate the changes in memory within the same individuals, a more realistic form of assessment, as would be seen in a clinical setting. At the end of the study. The researchers also used functional MRI (fMRI) of the brain to check brain function and the functional relationship of the parietal lobe with the hippocampus.

Results

The results were as follows:

  1. Recollection improved relative to baseline about 31% due to active stimulation compared to -3% with sham stimulation at 24 hours.
  2. One week after stimulation memory remained significant better relative to baseline for active group.
  3. At one week after active stimulation memory was not significantly better compared to sham, indicating that the gains seen at 24 hours after stimulation were not retained.
  4. The fMRI imaging validated that stimulation of the parietal area did communicate with the hippocampus significantly enough to improve memory.
  5. The fMRI evaluation comparison also validated increased brain activity for active versus sham stimulation.
  6. Also, very impressively, the memory tasks of the older individuals improved so much that they now appeared similar to the younger control group. In other words, memory loss was reverse-aged with active PEMF stimulation.

One of the lead authors said, “Older people’s memory got better up to the level that we could no longer tell them apart from younger people.”

This research also shows that stimulation of the parietal area of the brain impacts the memory associated with the hippocampus. The other words, the magnetic field penetrates deep enough into the brain through the parietal area into the hippocampal area to improve memory. The research also supports the idea that dysfunction of these connections increases with age, explaining the causes of memory loss as he will get older.

This research seems to indicate that the memory improvements do not last up to a week. It is not known whether longer episodes of stimulation would work better, whether stimulation beyond five sessions would work better, whether high intensity PEMF stimulation to other areas of the brain would produce similar or better results and whether stimulation with lower intensity PEMF systems would be as effective, and whether similar memory improvements could be seen in dementia or early-stage Alzheimer’s disease. Other high intensity brain stimulation research has already found benefits for Alzheimer’s disease. But, as is seen with many other conditions, the sooner treatment begins relative to memory loss the better the results. Waiting until Alzheimer’s disease has clearly been established is less likely to produce the same benefits as treating earlier age-related memory loss.

Nevertheless, these results are exciting, not only ensuring the safety of high intensity PEMF stimulation, but also that this PEMF therapy actually improves age-related memory decline.

Based on the results of this research I would recommend daily use of a home-based PEMF system, to encourage not only temporary improvement in memory but also to rebalance the tissues, hopefully age-reversing the age-related decreases in function of the hippocampal area. For convenience a portable PEMF unit may be likely to be used regularly, and certainly more affordable. Otherwise if someone already has a higher intensity PEMF system this can be used regularly to the parietal area of the brain, preferably daily.

References

Network-targeted stimulation engages neurobehavioral hallmarks of age-related memory decline.
Neurology. 2019 May 14;92(20):e2349-e2354. Nilakantan AS, Mesulam MM, Weintraub S, Karp EL, VanHaerents S, Voss JL.