title: The influence of transcutaneous electrical neurostimulation (TENS) on human cerebral blood flow velocities.
abstract: BACKGROUND
  It has been shown that transcutaneous electrical neurostimulation (TENS) reduces sympathetic tone. Spinal cord stimulation (SCS) has proven qualities to improve coronary, peripheral, and cerebral blood circulation. Therefore, we postulate that TENS and SCS affect the autonomic nervous system in analogous ways. In this line of thought, cervical application of TENS might be a useful and simple adjunct in the treatment of cerebrovascular disease by improving cerebral blood flow. Experiments were performed in order to assess whether cervical TENS is safe and whether an effect on cerebral blood flow velocity (CBFV) can be shown in healthy subjects.
  
  
  METHODS
  A controlled, non-randomized, phase 1 study was performed with 20 healthy volunteers. Cervical TENS was applied in several frequencies, with and without hyperventilation. Continuous registration of blood pressure, pulse, CBFV (estimated by transcranial Doppler sonography) and end-tidal carbon dioxide concentration was performed.
  
  
  RESULTS
  Cervical TENS was well-tolerated by all subjects. Despite small effects on heart rate (HR) and mean arterial blood pressure (MAP), a significant effect on middle cerebral artery (MCA) blood flow velocity was not demonstrated. No effect of age, gender, current or session order on MCA, HR, or MAP was found. TENS did not influence the effect of hyperventilation.
  
  
  CONCLUSIONS
  In these experiments, application of cervical TENS is proven to be a safe procedure. However, no effects on cerebral blood flow velocity could be detected, perhaps due to the intact cerebral autoregulation in the healthy volunteers.
authors.affiliation: Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.ter.laan@nchir.umcg.nl
authors.forename: Mark
authors.initials: M
authors.lastname: Ter Laan
authors.forename: J Marc C
authors.initials: JM
authors.lastname: van Dijk
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Elting
authors.forename: Vaclav
authors.initials: V
authors.lastname: Fidler
authors.forename: Michiel J
authors.initials: MJ
authors.lastname: Staal
mesh_terms: D000328:Adult; D000368:Aged; D002536:Cerebral Arteries / Q000502:physiology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002561:Cerebrovascular Disorders / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000502:physiology; D013564:Sympathetic Nervous System / Q000502:physiology; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
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