Electrotherapy

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Electrotherapy or electromedicine is the name given to the therapeutic applications of electrical current in medicine and physical therapy . For some of the procedures, the terms stimulation current therapy or fine current therapy are also used synonymously .

What these procedures have in common is that direct or alternating currents flow through the body or parts of the body during use. The corresponding voltages are supplied either via electrodes that are conductively connected to the skin surface or via electrodes in a water bath. In contrast, when implants are used for functional electrical stimulation, the current-emitting electrodes are in the tissue. Procedures in which magnetic fields inside the body generate electrical alternating voltages according to the law of induction ( transcranial magnetic stimulation , pulsating signal therapy , etc.) have a special position .

The iontophoresis of medicinal substances through the skin is a special form. An electrical charge that is present in a medicinal product can transport it into the tissue in an electrical field. The effect can lead to the fact that a multiple of the corresponding drugs get into the tissue in a shorter time than when they are applied to the skin. The active ingredient of the drug is distributed via the blood vessels in the skin.

When nerves in the periphery of the body fail , especially on the arms and legs, muscle cells in the muscle supplied by the damaged nerve break down . To avoid this, electrodes are attached during a therapy session and the function of the affected nerves is stimulated with low current impulses ( stimulation current ). As a result, the threatened muscle moves again and atrophies less quickly.

The muscles react differently to different types of current, depending on the duration of the denervation . In general, with long-standing denervations with exponential currents with relatively long triangular pulses, the best results are achieved because the muscles only respond to longer current pulses. Triangular pulses are used because the healthy muscles do not respond to this type of pulse due to the ability to adapt. But faradization and rectangular current are used. Constant direct current (called galvanization) cannot cause contractions.

history

Electromagnetic alternating fields have been used in medicine since 1764, mainly to warm up and increase blood flow (see diathermy ), associated with improving wound and bone healing.

Thereafter, electrotherapeutic procedures in modern medicine were described by Christoph Heinrich Ernst Bischoff (1781–1861), who later worked as a professor of pharmacology at the University of Bonn , in his Jena dissertation from 1801 in the treatment of neurological diseases in humans. From 1818 until his death, Bischoff was professor of pharmacology and state medicine in Bonn. Bischoff used silver electrodes in his electrotherapy device to heal the "paralyzed organ" of his patients.

In 1903, Fritz Kaufmann used Faradization ("Faradic brushing") (named after Michael Faraday ) as an assistant in the Erb's Clinic in Heidelberg to treat "hysterical paralysis". In a similar way, as a medical officer around 1916, he applied the “Kaufmann cure” (referred to by Kaufmann as “surprise therapy”), a setting of short pain stimuli using the “Erlanger pantostat” (however not with “faradic current”, but the more dangerous “sinusoidal alternating current” "), Which was supposed to make soldiers suffering from war trauma (especially war neuroses ) fit for military service again, but was" in almost no case "successful. According to Jellinek, 20 soldiers are said to have died from electrotherapy in German hospitals during the First World War . Because of the dangerous nature of the sinusoidal currents, they were banned in 1917.

Electrotherapy also found its way into anesthesiology .

Electromedical treatment procedures

Heat effect of high-frequency fields
Current flow therapies
Magnetic effects

Historical literature

  • Josef Kowarschik: Electrotherapy. A textbook. Berlin / Heidelberg 1920.

Individual evidence

  1. ↑ Oscar Frankl: The physical healing methods in gynecology. Archived online, accessed December 17, 2011.
  2. ^ Nagelschmidt: Diathermy. 2nd Edition. Archived online, accessed December 17, 2011.
  3. ↑ Commentatio De Vsv Galvanismi In Arte Medica Speciatim Vero In Morbis Nervorvm Paralyticis: Additis tab. aeneis II, Ienae, In Bibliopolio Academico, 1801.
  4. ↑ Article in Deutsches Ärzteblatt
  5. ↑ Even Sigmund Freud had v at his patient Emmy. N. carried out a “faradic brushing of the anesthetic leg” on May 16, 1889. See Sigmund Freud: Medical Stories, Mrs. Emmy v. N ..., forty years old, from Livonia. In: Sigmund Freud, Collected Works, Studies on Hysteria, Early Writings on Neuroses. Volume 1. Frankfurt am Main 1999, pp. 99–162, here: p. 125.
  6. ^ Fritz Kaufmann: The planned healing of complicated psychogenic movement disorders in soldiers in one session. In: Münchner medical Wochenschrift. Volume 64, 1916, pp. 802-804.
  7. ↑ See also Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology. 4th edition. Munich / Vienna / Baltimore 1990, under the heading Protreptik (“By soothing persuasion together with harsh verbal suggestion and with the help of apparatus (faradizing) an unpleasant affect is created in the patient, which leads to the disappearance of the phenomena within a single session”).
  8. ↑ Ludwig Mann: New methods and points of view for the treatment of the war neuroses. In: Berliner Klinische Wochenschrift. Volume 53, 1916, pp. 1333-1338, especially p. 1335.
  9. ↑ See also Sigmund Freud : Expert opinion on the electrical treatment of war neurotics. In: Sigmund Freud, Collected Works, supplementary volume, texts from the years 1885–1938. Pp. 704-710.
  10. ↑ Reinhard Platzek to: Reinhard Steinberg, Monika Pritzel (ed.): 150 years of the Pfalzklinikum . Psychiatry, psychotherapy and neurology in Klingenmünster . Franz Steiner Verlag, Stuttgart 2012, ISBN 978-3-515-10091-5 . In: Specialized prose research - Crossing borders. Volume 8/9, 2012/2013 (2014), pp. 578-582, here: p. 579.
  11. ↑ Kurt Robert Eissler: Freud and Wagner-Jauregg before the commission for the survey of military breaches of duty , Vienna: Löcker, 1979 (new edition 2006), p. 222.
  12. ↑ Stefanie Caroline Linden, Edgar Jones: German Battle Casualities: The Treatment of Functional Somatic Disorders during World War I. In: Journal of the history of medicine and allied sciences. Volume 68, 204, pp. 627-658, here: p. 634.
  13. ↑ Reinhard Platzek: The psychiatric treatment according to Kaufmann - is it really medical torture? A reflection on the modern perception of electrosuggestive therapy. In: Medical historical messages. Journal for the history of science and specialist prose research. Volume 34, 2015 (2016), pp. 169-193.
  14. ^ Gerhard Endres: Electrotherapy of the anesthetist. Medical habilitation thesis, Jena 1964.
  15. ↑ TM Proebstle, HA Lehr et al: Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. In: Journal of vascular surgery. Volume 35, Number 4, April 2002, pp. 729-736. PMID 11932671 .
  16. ↑ R. Weiss: Varicose Veins Treated With Radio Frequency Ablation Therapy. In: Emedicine. September 2, 2009.