Scientific Articles Abstracts

8/11/2019 Scientific Articles Abstracts

1/27

ScientificArticlesandAbstracts

AwealthofarticlesonPulsingElectromagneticFieldtherapy(PEMF)technologyisavailable.Followingisa

selectionofabstracts,articlesandreferencesonPEMF.Thisinformationhasbeencollectedtoindicatethe

benefitsontheuseofpulsingelectromagneticfieldtherapyandmanyaredoubleblind,placebocontrolled

studies.

TheEffectofPulsedElectromagneticFieldsintheTreatmentofOsteoarthritisoftheKneeandCervicalSpine.

Reportof

Randomized,

Double

Blind,

Placebo

Controlled

Trials.

Lowamplitude,extremelylowfrequencymagneticfieldsforthetreatmentofosteoarthriticknees.Adoubleblind

clinicalstudy.

PulsedElectromagneticFieldTherapy,PEMT.Howdoesitwork?

Magneticpulsetreatmentforkneeosteoarthritis:arandomised,doubleblind,placebocontrolledstudy.

Electrochemicaltherapyofpelvicpain:effectsofpulsedelectromagneticfields(PEMF)ontissuetrauma.

Evaluationofelectromagneticfieldsinthetreatmentofpaininpatientswithlumbarradiculopathyorwhiplash

syndrome.

Weassessedtheefficacyandtolerabilityoflowfrequencypulsedelectromagneticfields(PEMF)therapyin

patientswithclinicallysymptomatickneeosteoarthritis(OA)inarandomised,placebocontrolled,doubleblind

studyofsixweeks'duration.

Pulsedmagneticfieldtherapyandthephysiotherapist

Treatmentofmigrainewithpulsingelectromagneticfields:adoubleblind,placebocontrolledstudy.

TheEffectofPulsedElectromagneticFieldsintheTreatmentofOsteoarthritisoftheKneeandCervicalSpine.

ReportofRandomized,DoubleBlind,PlaceboControlledTrials

OBJECTIVE.Weconductedarandomized,doubleblindclinicaltrialtodeterminetheeffectivenessofpulsed

electromagneticfields(PEMF)inthetreatmentofosteoarthritis(OA)ofthekneeandcervicalspine.METHODS.A

controlledtrialof18halfhouractiveorplacebotreatmentswasconductedin86patientswithOAofthekneeand

81patientswithOAofthecervicalspine,inwhichpainwasevaluatedusinga10cmvisualanalogscale,activities

ofdailylivingusingaseriesofquestions(answeredbythepatientasnever,sometimes,mostofthetime,or

always),painonpassivemotion(recordedasnone,slight,moderate,orsevere),andjointtenderness(recorded

usingamodifiedRitchiescale).Globalevaluationsofimprovementweremadebythepatientandexamining

physician.Evaluations

were

made

at

baseline,

midway,

end

of

treatment,

and

one

month

after

completion

of

treatment.

RESULTS.Matchedpairttestsshowedextremelysignificantchangesfrombaselineforthetreatedpatientsin

bothkneeandcervicalspinestudiesattheendoftreatmentandtheonemonthfollowupobservations,whereas

thechangesintheplacebopatientsshowedlesserdegreesofsignificanceattheendoftreatment,andhadlost

significanceformostvariablesattheonemonthfollowup.MeansofthetreatedgroupofpatientswithOAofthe

kneeshowedgreaterimprovementfrombaselinevaluesthantheplacebogroupbytheendoftreatmentandat

theonemonthfollowupobservation.Usingthe2tailedttest,attheendoftreatmentthedifferencesinthe

meansofthe2groupsreachedstatisticalsignificanceforpain,painonmotion,andboththepatientoverall

assessmentandthephysicianglobalassessment.ThemeansofthetreatedpatientswithOAofthecervicalspine


2/27

showedgreaterimprovementfrombaselinethantheplacebogroupformostvariablesattheendoftreatment

andonemonthfollowupobservations;thesedifferencesreachedstatisticalsignificanceatoneormore

observationpointsforpain,painonmotion,andtenderness.

CONCLUSION.PEMFhastherapeuticbenefitinpainfulOAofthekneeorcervicalspine.

TrockD.et.al.DepartmentofMedicine,DanburyHospital,CT.J.ofRheumatology

Lowamplitude,

extremely

low

frequency

magnetic

fields

for

the

treatment

of

osteoarthritic

knees:

adouble

blindclinicalstudy.

CONTEXT:Noninvasivemagnetotherapeuticapproachestobonehealinghavebeensuccessfulinpastclinical

studies.OBJECTIVE:Todeterminetheeffectivenessoflowamplitude,extremelylowfrequencymagneticfieldson

patientswithkneepainduetoosteoarthritis.DESIGN:Placebocontrolled,randomized,doubleblindclinical

study.SETTING:4outpatientclinics.PARTICIPANTS:176patientswererandomlyassignedto1of2groups,the

placebogroup(magnetoff)ortheactivegroup(magneton).INTERVENTION:6minuteexposuretoeachmagnetic

fieldsignalusing8exposuresessionsforeachtreatmentsession,thenumberoftreatmentsessionstotalling8

duringa2weekperiod,yieldedpatientsbeingexposedtouniformmagneticfieldsfor48minutespertreatment

session8timesin2weeks.Themagneticfieldsusedinthisstudyweregeneratedbyaresonator,whichconsists

oftwo18inchdiameter(46cmdiameter)coilsconnectedinseries,inturnconnectedtoafunctiongeneratorvia

anattenuatortoobtainthespecificamplitudeandfrequency.Therangeofmagneticfieldamplitudesusedwas

from2.74x10(7)to3.4x10(8)G,withcorrespondingfrequenciesof7.7to0.976Hz.OUTCOMEMEASURES:

Eachsubjectratedhisorherpainlevelfrom1(minimal)to10(maximal)beforeandaftereachtreatmentand2

weeksaftertreatment.Subjectsalsorecordedtheirpainintensityinadiarywhileoutsidethetreatment

environmentfor2weeksafterthelasttreatmentsession(session8)twicedaily:uponawakening(within15

minutes)anduponretiring(justbeforegoingtobedatnight).RESULTS:Reductioninpainafteratreatment

sessionwassignificantly(P


3/27

increasestoapproximately+30mV,allowingasodiumflow.Thisinturntriggersthesynapticvesicletoreleasethe

chemicaltransmitterandsotransferthepainsignalacrossthesynapticgaporcleft.Afterthetransmission,the

voltagereducesbacktoitsnormalquiescentleveluntilthenextpainsignalarrives.

Theapplicationofpulsedmagnetismtopainfulsitescausesthemembranetobeloweredtoahyperpolarization

levelofabout90mV.Whenapainsignalisdetected,thevoltagemustnowberaisedtoarelativelyhigherlevel

inordertofirethesynapticvesicles.Sincetheaveragechangeofpotentialrequiredtoreachthetriggervoltageof

nearly+30mVis+100mV,therequiredchangeistoogreatandonly+10mVisattained.Thisvoltageisgenerally

toolow

to

cause

the

synaptic

vesicle

to

release

the

chemical

transmitter

and

hence

the

pain

signal

is

blocked.

The

mosteffectivefrequenciesthathavebeenobservedfromresearchinordertocausetheabovechangesto

membranepotentials,areabasefrequencyofaround100Hzandpulseratesettingsofbetween5and25Hz.

LectureabstractDr.D.Laycock,Ph.D.Med.Eng.MBES,MIPEM,B.Ed.

Magneticpulsetreatmentforkneeosteoarthritis:arandomised,doubleblind,placebocontrolledstudy.



studyofsixweeks'duration.Whilethetreatedgroupdemonstratedimprovementoverdifferentindicestothe

contrary,thecontrolgroupdemonstratednone.Therewerenoclinicallyrelevantadverseeffectsattributableto

activetreatment.Theseresultssuggestthattheunipolarmagneticdevicesarebeneficialinreducingpainand

disabilityinpatientswithkneeOAresistanttoconventionaltreatmentintheabsenceofsignificantsideeffects.

PipitoneN.et.al.RheumatologyDepartment,King'sCollegeHospital(Dulwich),London,UK.

Electrochemicaltherapyofpelvicpain:effectsofpulsedelectromagneticfields(PEMF)ontissuetrauma.

Unusuallyeffectiveandlonglastingreliefofpelvicpainofgynaecologicaloriginhasbeenobtainedconsistentlyby

shortexposuresofaffectedareastotheapplicationofamagneticinductiondevice.Treatmentsareshort,fasting

acting,economicalandinmanyinstanceshaveobviatedsurgery.Thisreportdescribestypicalcasessuchas

dysmenorrhoea,endometriosis,rupturedovariancyst,acutelowerurinarytractinfection,postoperative

haematoma,and

persistent

dyspareunia

in

which

pulsed

magnetic

field

treatment

has

not,

in

most

cases,

been

supplementedbyanalgesicmedication.Of17femalepatientspresentingwithatotalof20episodesofpelvic

pain,16patientsrepresenting18episodes(90%)experiencedmarked,evendramaticrelief,whiletwopatients

representingtwoepisodesreportedlessthancompletepain.

JorgensenW.et.al.InternationalPainResearchInstitute,LosAngeles,California.

Evaluationofelectromagneticfieldsinthetreatmentofpaininpatientswithlumbarradiculopathyorwhiplash

syndrome.

Backpainandwhiplashsyndromeareverycommondiseasesinvolvingtremendouscostsandextensivemedical

effort.A

quick

and

effective

reduction

of

symptoms,

especially

pain,

is

required.

In

two

prospective

randomized

studies,patientswitheitherlumbarradiculopathyinthesegmentsL5/S1orwhiplashsyndromewere

investigated.Electromagneticdevicesarepulsedfield(PEMF)andconstantwave(CW)types.Thesestudies

indicatebothareeffective,PEMFusuallymorequicklythanCW.Pulsedmagneticfieldsappeartohavea

considerableandstatisticallysignificantpotentialforreducingpainincasesoflumbarradiculopathyandwhiplash

syndrome.

ThuileCh.et.al.InternationalSocietyofEnergyMedicine,Vienna,Austria.



4/27


studyofsixweeks'duration.

PatientswithradiographicevidenceandsymptomsofOA(incompletelyrelievedbyconventionaltreatments),

accordingtothecriteriaoftheAmericanCollegeofRheumatology,wererecruitedfromasingletertiaryreferral

centre.75PatientsfulfillingtheabovecriteriawererandomisedtoreceiveactivePEMFtreatmentbyunipolar

magneticdevicesorplacebo.Sixpatientsfailedtoattendafterthescreeningandwereexcludedfromanalysis.

Theprimary

outcome

measure

was

reduction

in

overall

pain

assessed

on

afour

point

Likert

scale

ranging

from

nil

tosevere.SecondaryoutcomemeasuresincludedtheWOMACOsteoarthritisIndex(Likertscale)andtheEuroQol

(EuroQualityofLife,EQ5D).Baselineassessmentsshowedthatthetreatmentgroupswereequallymatched.

Althoughtherewerenosignificantdifferencesbetweenactiveandshamtreatmentgroupsinrespectofany

outcomemeasureaftertreatment,pairedanalysisofthefollowupobservationsoneachpatientshowed

significantimprovementsintheactivelytreatedgroupintheWOMACglobalscore(p=0.018),WOMACpainscore

(p=0.065),WOMACdisabilityscore(p=0.019)andEuroQolscore(p=0.001)atstudyendcomparedtobaseline.

Incontrast,therewerenoimprovementsinanyvariableintheplacebotreatedgroup.Therewerenoclinically

relevantadverseeffectsattributabletoactivetreatment.TheseresultssuggestthatPEMFmagneticdevicesare

beneficialinreducingpainanddisabilityinpatientswithkneeOAresistanttoconventionaltreatmentinthe

absenceofsignificantsideeffects.Furtherstudiesusingdifferenttypesofmagneticdevices,treatmentprotocols

andpatientpopulationsarewarrantedtoconfirmthegeneralefficacyofPEMFtherapyinOAandother

conditions.

NicolPipitone,DavidL.Scott

Pulsedmagneticfieldtherapyandthephysiotherapist

Thetherapeuticeffectoftheapplicationofpulsedmagneticfieldtherapy(PMFT)hasatlastreceivedworldwide

recognition,althoughforalongtimemanypractitionerssawitonlyasanaidtofractureunion.Researchhasnow

shownthatithasthepotentialtoimproveawiderangeofconditions,althoughfewunderstoodjusthowit

achieveditseffectiveness.Extensiveresearchhassincebeencarriedouttodeterminethemechanismbywhich

thisoccurs.Forthephysiotherapist,presentedwithawiderangeofclinicalproblems,PMFTisaninvaluableaidto

theclinic.

Resolutionofsofttissueinjuries:

Overthepastfewyears,researchhasshownthatitseffectivenessisnotthroughheatproduction asisthecase

withsomemoderntreatments butisatthecellularlevel.Onesignificantoutcomeofthisistheeffectithason

softtissueinjuries.Asearlyas1940itwassuggestedthatmagneticfieldsmightinfluencemembrane

permeability.IthassincebeenestablishedthatmagneticfieldscaninfluenceATP(AdenosineTriphosphate)

production;increasethesupplyofoxygenandnutrientsviathevascularsystem;improvetheremovalofwastevia

thelymphaticsystem;andhelptorebalancethedistributionofionsacrossthecellmembrane.Healthycellsin

tissuehaveamembranepotentialdifferencebetweentheinnerandoutermembrane.Thiscausesasteadyflow

ofionsthroughitspores.Inadamagedcellthepotentialisraisedandanincreasedandanincreasedsodium

inflowoccurs.Asaresult,interstitialfluidisattractedtothearea,resultinginswellingandoedema.

Theapplication

of

PMFT

to

damaged

cells

accelerates

the

re

establishment

of

normal

potentials

(Sansaverino)

increasingtherateofhealingandreducingswelling.Thiscanhelptodispersebruisingalso.Amagneticfield

pulsedat5Hzwithabasefrequencyof50Hzcanhavethesameeffectasanicepackinthatinthatitcauses

vasoconstriction.

Effectsonfracturerepair:

Acceptanceofmagneticfieldsinmedicinecameaboutforemostinthefieldoforthopedics.Lowfrequencyand

lowintensityfieldshavebeenusedextensivelyforthetreatmentofnonunionfractures.By1979thismethodwas

approvedintheUSAasasafeandeffectivetreatmentfornonunionfractures;forfailedarthroses;andfor

congenitalpseudoarthroses.AccordingtoBassettthismethodhasbeenusedbymorethan6,000surgeons.The

successratewasover80%fortibiallesions.Nopatientsufferedcomplicationsandbiologicalsideeffectsincluded


5/27

improvedhealingandincreasedneuralfunction.Indepthresearchcarriedouttoinvestigatethis,showsthat

magneticfieldsinfluencetheprocessofboneformationintheintercellularmedium.Madroneroshowedthat

bonehealingwaspromotedbymeansoftheinfluenceofthemagneticfieldonthecrystalformationofcalcium

salts.

Painreduction:

Pulsedmagneticfieldtherapyhasbeenshowntobringaboutareductionofpain,whichagainisduetoactionat

thecellularlevel.Painistransmittedasanelectricsignal,whichencountersgapsatintervalsalongitspath.The

signalis

transferred

in

the

form

of

achemical

signal

across

the

synaptic

gap

and

this

is

detected

by

receptors

on

thepostsynapticmembrane.Achargeofabout70mVexistsacrosstheinnerandoutermembranes,butwhena

painsignalarrivesitraisesthisto+30mV.Thisactioncauseschannelstoopeninthemembrane,triggeringthe

releaseofachemicaltransmitterandallowingionstoflowintothesynapticgap.Thecellthenrepolarizestoits

previousrestinglevel.ResearchbyWarnkesuggeststhatPMFTaffectsthequiescentpotentialofthemembrane,

loweringittoahyperpolarizedlevelof90mV.Transmissioniseffectivelyblockedsincethepainsignalisunable

toraisethepotentialtothelevelrequiredtotriggerthereleaseofthechemicaltransmitter.Again,thefrequency

oftheappliedmagneticfieldisimportant,asthemosteffectivefrequencytoproducethiseffectwasfoundtobe

abasefrequencyof100Hzpulsedatbetween5and25pulsespersecond.

Clinicalapplications:

Thevalueofpulsedmagneticfieldtherapyhasbeenshowntocoverawiderangeofconditions,withwell

documentedtrialscarriedoutbyhospitals,rheumatologistsandphysiotherapists.Forexample,thedepartmentof

rheumatologyatAddenbrookesHospitalcarriedoutinvestigationsintotheuseofPMFTforthetreatmentof

persistentrotatorcufftendinitis.Thetreatmentwasappliedtopatientswhohadsymptomsrefractorytosteroid

injectionandotherconventionaltreatments.Attheendofthetrial,65%oftheseweresymptomfree,with18%

oftheremainderbeinggreatlyimproved.

Lau(SchoolofMedicine,LomaUniversity,USA)reportedontheapplicationofPMFTtotheproblemsofdiabetic

retinopathy.Patientsweretreatedovera6weekperiod,76%ofthepatientshadareductioninthelevelof

numbnessandtingling.Allpatientshadareductionofpain,with66%reportingthattheyweretotallypainfree.

Manyresearchstudies,includingLau,reportedontheapplicationofPMFTforconditionssuchassportsinjuries

andforpatientswithjointandspinalproblems.Althoughthesearetoonumeroustomentionindividually,in

almosteveryinstancetherewasareduction,ifnotcompleteresolutionofsymptoms.Softtissueinjuriesandjoint

painstendedtoberesolvedwithin5daysoftreatment.Patientswithcervicalproblemsandlowbackpainwere

alsosuccessfully

treated,

whereas

previous

treatment

with

ice,

traction

and

other

therapies

had

been

unsuccessful.Inyetanothertrial,theeffectofapplyingPMFTtosufferersofMultipleSclerosiswasinvestigated

(Geseo)70%ofsufferershadareductionofweakness,painandspasticity,with50%reportingimprovementof

theirbladderincontinence.Throughtheevaluationofhundredsofresearchpapers,anumberofpointshavebeen

establishedregardingPMFT:Thefieldmustbepulsed,withlowfrequencytoachievethebesteffect.

Differentconditionsrequiredifferentfrequencies.Forexample,5Hzcausesvasoconstrictionwhilst10Hzand

abovecausesvasodilatation.Biologicaleffectivenessisachievedinjust10minutesformostinjuries,sothatlong

treatmentsessionsarenotrequired.Whenusedatthecorrectleveltherearenorecordedsideeffects.Although

PMFTisnotyetrecommendedforuseduringpregnancyorinthepresenceoftumors,therearepaperstosuggest

thatmagneticfieldscaninhibitthegrowthoftumors.

Dr.D.C.Laycock,Ph.D.Med.Eng.WestvilleConsultants

Treatmentofmigrainewithpulsingelectromagneticfields:adoubleblind,placebocontrolledstudy.

Theeffectofexposuretopulsingelectromagneticfieldsonmigraineactivitywasevaluatedbyhaving42subjects

(34womenand8men),whomettheInternationalHeadacheSociety'scriteriaformigraine,participateina

doubleblind,placebocontrolledstudy.Duringthefirstmonthoffollowup,73%ofthosereceivingactual

exposure,reporteddecreasedheadaches(45%substantialdecrease,14%excellentdecrease)comparedtohalfof

thosereceivingtheplacebo(15%worse,20%good,0%excellent).Tenofthe22subjectswhohadactualexposure

received2additionalweeksofactualexposure,aftertheirinitial1monthfollowup.Allshoweddecreased


6/27

headacheactivity(50%substantial,38%excellent).Eightofthesubjectsintheplacebogroupelectedtoreceive2

weeksofactualexposureaftertheinitial1monthfollowupwith75%showingdecreasedheadacheactivity(38%

substantial,38%excellent).Inconclusion,exposuretopulsingelectromagneticfieldsforatleast3weeksisan

effective,shortterminterventionformigraine.

ShermanR.et.al.OrthopedicSurgeryService,MadiganArmyMedicalCenter,Tacoma,WA,USA

Spinefusionfordiscogeniclowbackpain:outcomeinpatientstreatedwithorwithoutpulsedelectromagnetic

fieldstimulation.

Sixtyonerandomlyselectedpatientswhounderwentlumbarfusionsurgeriesfordiscogeniclowbackpain

between1987and1994wereretrospectivelystudied.Allpatientshadfailedtorespondtopreoperative

conservativetreatments.Fortytwopatientsreceivedadjunctivetherapywithpulsedelectromagneticfield(PEMF)

stimulation,and19patientsreceivednoelectricalstimulationofanykind.Averagefollowuptimewas15.6

monthspostoperatively.Fusionsucceededin97.6%ofthePEMFgroupandin52.6%oftheunstimulatedgroup(P


7/27

technicalmodificationinthePMFgenerator,ledtotheconclusionthatmagneticfieldtreatmentisanexcellent

physicaltherapyincasesofjointdiseases.Ahypothesisisadvancedthatexternalmagneticfieldsinfluencetrans

membraneionicactivity.

RivaSanseverino,E.et.al.UniversitadiBologna,Italy.

ModificationofbiologicalbehaviorofcellsbyPulsingElectromagneticfields,(PMFT)

Onthemajorpartofthecalcifiedmassofadultbonetherearenochangesinbonemass,howeverthereisapart

onwhichboneisbeingformedandapartonwhichboneisbeingresorbed.Decalcificationoccurswhenbone

resorptionisgreaterthanboneformation.Boneformationcomprisestwosteps,thelayingdownoftheextra

cellularmatrixandthedepositionthereinofbonesalts.Thedynamicprocessesofformationanddestructionof

boneareundercellularcontrol.BoneformationiscontrolledbysinglenuclearcellscalledOsteoblasts,andbone

resorptionbymultinucleargiantcellsarecalledOsteoclasts.Boneisaspecializedconnectivetissue,inwhicha

matrixconsistingofcollagenfibersandalargevarietyofotherproteinsandgroundsubstanceareimpregnated

withasolidmineral.Thebonematrixisresponsiblefortheresistanceofbonetotractionalandtorsionalforces.

Thecollagenformsmorethan25%ofthebonesandissynthesizedbyosteoblasts.Onthebonesurfacecollagen

fibersarenormallyarrangedinconcentricringsofhardcalcifiedmatrix.

Thebonemineralsprovidetothebonecompressivestrengthandrigidity.Itcontainsthemineralsalts

hydroxyapatiteandcalcium.Inadditiontherearesmallamountsofmagnesiumhydroxide,fluorideandsulphate.

Asthesesaltsaredepositedintheframeworkformedbythecollagenfibersofthematrix,crystallizationoccurs

andthetissuehardens.Thisprocessiscalledcalcificationormineralisation.Boththeconcentrationsofionsof

calciumandphosphateintheextracellularfluidmaintaincrystallization.Iftheconcentrationisnotadequatethe

tissuewillnotbehardenoughresultinginincreasedbonefracturerisk.

Therearetwotypesofbonestructure.Cortical(compact)boneandtrabecular(spongy)bone.Corticalboneis

moredenseandconstitutesof80%oftheskeletalmassandformstheexternallayerofallbonesinthehuman

body.Trabecularboneconsistsoflamellaearrangedinanirregularlatticeworkofthinplatesofboneandhelps

longbonestoresistthestressofweightplacedonthem.

Theprocessbywhichboneformsiscalledossification.Boneformseitherbythemineralisationofcartilageor

directlybyosteoblastsinacollagenousmatrix.Duringthefirsttwodecadesoflifebonegrows,followedby

consolidationand

reaching

its

peak

value

around

thirty

five

years.

After

this

peak,

bone

loss

starts.

Nutritional

factors,especiallycalciumintake,thelevelofphysicalactivityandgenericfactorsareimportantindetermining

thepeakbonemass.

Whenaboneisfractured,ithealswithbone.Boneistheonlysolidtissueinthebodythatcanreplaceitself.Bone

healingissimplewhenitoccurssmoothly,complicatedwhenitdoesnot.Theprocessisbeinginitiatedbystimuli

fromtheboneitself.Fracturesthroughbonewithagoodbloodsupply,surroundedbymuscleandwithoutsoft

tissuetrauma,haveanexcellentchanceofhealing,butfracturesatthemiddleoflongbones,particularlywith

extensivesofttissuedamage,haveahighincidenceofnonunion.

Selectedlowenergytimevaryingelectromagneticfieldshavebeenusedduringthepast15yearstotreatun

unitedfractures(nonunions).Morethan100,000patients,mainlyintheUSA,havebeentreated.Retrospective

studieshavesubstantiatedtheirbiologicaleffectivenessinlargenumbers.Boneisresponsivetothemechanical

demandsplaced

on

it.

When

loading

diminishes,

as

it

does

during

bed

rest,

immobilization

and

weightlessness,

bonemassislost.Ontheotherhandwhenloadingisincreasedcorrectly,bonemassincreases.

Resultsofbiomechanicalandhistologicinvestigationsprovethatelectromagneticfieldsnotonlypreventbone

loss,butalsorestoresbonemass,oncelost.AprogramwassetupatMcGillUniversityofMontreal,wherewas

foundthatelectromagneticfieldsdampboneresorptionactivity.Furthermoreprovewasfoundthatselected

electromagneticfieldsincreaseboneformation.

Theresorptionofboneislowestandformationofnewbonegreatest,whenenergyoftheimposedfieldsis

concentratedinthelowerfrequencycomponents.Theseresultsareconsistentwithotherstudiesshowing,that

cellsrespondtoabroadspectrumoffrequencies.Theyappeartobemostsensitivetofrequenciesintherangeof

thoseproducedendogenously,thatisintherangeof100Hzorless.


8/27

Tissuedosimetrystudiesshowthatthefrequencyresponseofcorticalboneoverarangeof100Hzto20kHzshow

asteeprolloffbetween100and200Hz.

Electromagneticfieldsatspecificfrequencieshaveshowntoproduceosteogeniceffectsinaturkeyulnamodel.

Furthermorelowamplitudesignalsdecreaseboneresorptioninacaninefibularmodel.Lifestylefactorslike

malnutrition,smoking,excessiveuseofalcoholandasedentarylifestylecontributeto,andworsen,osteoporosis.

Itisnotknownwhetherthisresponsederivesfromdecreasedosteoblasticactivity,increasedosteoclastic

resorption,orboth.Elderlypersonscanhealfracturesinnormalintervals,showingthatosteoblastscanbe

activatedby

appropriate

stimuli.

AstudyattheUniversityofHawaiiSchoolofMedicinewasdesignedtoprovideconcretedataontherestoration

ofbonemassinpostmenopausalfemales.Atotalof20subjectsbetween57and75years,allwithdecreased

bonemineraldensityasdefinedbyabonedensitometer,weretreatedduringaperiodof12weeks.Afteraperiod

of6weeksthebonedensityroseinthosepatientswithanaverageof5.6%.

Electromagneticfieldsdomodifybiologicalbehaviorbyinducingelectricalchangesaroundandwithinthecell.

Thekeytorationaluseofelectromagneticfieldsliesintheabilitytodefinethespecifictreatmentparameters

(amplitude,frequency,orientationandtiming).Properlyappliedpulsedelectromagneticfields,ifscaledforwhole

bodyuse,hasclearclinicalbenefitsinthetreatmentofbonediseasesandrelatedpain,oftencausedbymicro

fracturesinvertebrae.Inaddition,jointpaincausedbywornoutcartilagelayerscanbetreatedsuccessfully,

throughelectromagneticstimulation,increasingthepartialoxygenpressureandresultinginincreasedcalcium

transport.Repairandgrowthofcartilageisthusstimulated,preventinggrindingofthebones.

BenPhilipson.

Howcanpulsedelectromagneticfieldtherapyassistinthehealingofbonesandligaments?

Boneisessentiallycalciumstructurewhichcontainstraceelements.Oneparticularelementrecentlyidentifiedis

AlphaQuartz.Thisisthesametypeofmaterialusedincomputersanddigitalorelectronicwatches.Whenthis

materialiscompressed,itdevelopsavoltageacrossitstwocompressivefaces,aphenomenonknownasthe

piezoelectriceffect.Theoldcrystalpickupsonrecordplayersusedthiseffecttogenerateelectricalsoundsignals.

Gasappliancesandsomecigarlightersalsoutilizethesameeffecttogenerateasparkforignition.

Inbone,areasofstressgeneratesmallelectricchargeswhicharegreaterthanthoseoflessstressedareas,sothat

polarizedbonelayingcells(osteoblasts)arebelievedtobeattractedtotheseareasandbegintobuildupextra

bonematerial

to

counter

the

stress.

Withboneinjuries,bleedingoccurstoformahaematomainwhichcapillariesquicklyform,transportingenriched

bloodtotheinjurysite.PulsedMagneticFieldtherapyofabasefrequencyof50Hz,pulsedatabove12Hz,causes

vasodilatationandcapillarydilatation,sohelpingtospeeduptheprocessofcallusformation.Withinthebone

itself,pulsedelectromagnetismcausestheinductionofsmalleddycurrentsinthetraceelements,whichinturn

purifyandstrengthenthecrystalstructures.Thesehavethesameeffectasthestressinducedvoltagescausedby

thealphaquartzandassuch,attractbonecellstotheareaundertreatment.Thiscan,therefore,acceleratethe

bonehealingprocesstoallowearliermobilizationandeventualfullunion.Ligamentsandtendonsareaffectedin

similarwaystosolidbonebypulsedelectromagnetictherapy,sincetheyareuncalcifiedbonestructuresin

themselves.

Dr.D.C.Laycock,Ph.D.Med.Eng.WestvilleConsultants.

Preventionofosteoporosisbypulsedelectromagneticfields.

Usingananimalmodel,weexaminedtheuseofpulsedelectromagneticfields,inducedataphysiological

frequencyandintensity,topreventtheosteoporosisthatisconcomitantwithdisuse.Byprotectingtheleftulnae

ofturkeysfromfunctionalloading,wenotedalossofboneof13.0percentcomparedwiththeintact

contralateralcontrolulnaeoveraneightweekexperimentalperiod.Usingatreatmentregimenofonehourper

dayofpulsedelectromagneticfields,weobservedanosteogenicdoseresponsetoinducedelectricalpower,with

amaximumosteogeniceffectbetween0.01and0.04teslapersecond.Pulsepowerlevelsofmoreorlessthan


9/27

theselevelswerelesseffective.Themaximumosteogenicresponsewasobtainedbyadecreaseinthelevelof

intracorticalremodeling,inhibitionofendostealresorption,andstimulationofbothperiostealandendosteal

newboneformation.Thesedatasuggestthatshortdailyperiodsofexposuretoappropriateelectromagnetic

fieldscanbeneficiallyinfluencethebehaviorofthecellpopulationsthatareresponsibleforboneremodelingand

thatthereisaneffectivewindowofinducedelectricalpowerinwhichbonemasscanbecontrolledintheabsence

ofmechanicalloading.

RubinC.et.al.Dep.ofOrthopaedics,StateUniversityofNewYorkJBoneJointSurgAm

Adoubleblindtrialofpulsedelectromagneticfieldsfordelayedunionoftibialfractures.

Atotalof45tibialshaftfractures,allconservativelytreatedandwithuniondelayedformorethan16butless

than32weekswereenteredinadoubleblindmulticentretrial.Thefractureswereselectedfortheirliabilityto

delayedunionbythepresenceofmoderateorseveredisplacement,angulationorcomminutionoracompound

lesionwithmoderateorsevereinjurytoskinandsofttissues.Treatmentwasbyplasterimmobilisationinall,with

activeelectromagneticstimulationunitsin20patientsanddummycontrolunitsin25patientsfor12weeks.

Radiographswereassessedblindlyandindependentlybyaradiologistandanorthopaedicsurgeon.Statistical

analysisshowedthetreatmentgroupstobecomparableexceptintheiragedistribution,butagewasnotfoundto

affecttheoutcomeandtheeffectoftreatmentwasconsistentforeachagegroup.Theradiologist'sassessmentof

theactivegroupshowedradiologicalunioninfivefractures,progresstounioninfivebutnoprogresstounionin

10.Inthecontrolgrouptherewasunioninonefractureandprogresstowardsunioninonebutnoprogressin23.

UsingFisher'sexacttest,theresultswereverysignificantlyinfavouroftheactivegroup(p=0.002).The

orthopaedicsurgeon'sassessmentshowedunioninninefracturesandabsenceofunionin11fracturesinthe

activegroup.Therewasunioninthreefracturesandabsenceofunionin22fracturesinthecontrolgroup.These

resultswerealsosignificantlyinfavouroftheactivegroup(p=0.02).Itwasconcludedthatpulsed

electromagneticfieldssignificantlyinfluencehealingintibialfractureswithdelayedunion.

SharrardWJRoyalHallamshireHospital,Sheffield,England.JBoneJointSurg

Arandomizeddoubleblindprospectivestudyoftheefficacyofpulsedelectromagneticfieldsforinterbody

lumbarfusions.

Arandomizeddoubleblindprospectivestudyofpulsedelectromagneticfieldsforlumbarinterbodyfusionswas

performedon195subjects.Therewere98subjectsintheactivegroupand97subjectsintheplacebogroup.A

bracecontainingequipmenttoinduceanelectromagneticfieldwasappliedtopatientsundergoinginterbody

fusionintheactivegroup,andashambracewasusedinthecontrolgroup.Intheactivegrouptherewasa92%

successrate,whilethecontrolgrouphada65%successrate(Pgreaterthan0.005).Theeffectivenessofbone

graftstimulationwiththedeviceisthusestablished.

MooneyV.OrthopaedicSurgery,UniversityofCaliforniaSpine

Fundamentalandpracticalaspectsoftherapeuticusesofpulsedelectromagneticfields(PEMFs).

Thebeneficialtherapeuticeffectsofselectedlowenergy,timevaryingmagneticfields,calledPEMFs,havebeen

documentedwithincreasingfrequencysince1973.Initially,thisformofathermalenergywasusedmainlyasa

salvageforpatientswithlongstandingjuvenileandadultnonunions.Manyoftheseindividualswerecandidates

foramputation.Theirclearlydocumentedresistancetotheusualformsofsurgicaltreatment,includingbone

grafting,servedasareasonablecontrolinjudgingtheefficacyofthisnewtherapeuticmethod,particularlywhen

PEMFswerethesolechangeinpatientmanagement.Morerecently,thebiologicaleffectivenessofthisapproach

inaugmentingbonehealinghasbeenconfirmedbyseveralhighlysignificantdoubleblindandcontrolled

prospectivestudiesinlesschallengingclinicalcircumstances.Furthermore,doubleblindevidenceoftherapeutic

effectsinotherclinicaldisordershasemerged.Thesedata,coupledwithwellcontrolledlaboratoryfindingson


10/27

pertinentmechanismsofaction,havebeguntoplacePEMFsonatherapeuticparwithsurgicallyinvasivemethods

butatconsiderablylessriskandcost.Asaresultoftheseclinicalobservationsandconcernsabout

electromagnetic"pollution",interactionsofnonionizingelectromagneticfieldswithbiologicalprocesseshave

beenthesubjectofincreasinginvestigationalactivity.Overthepastdecade,thenumberofpublicationsonthese

topicshasrisenexponentially.Theynowincludetextbooks,specialityjournals,regularreviewsbygovernment

agencies,inadditiontoindividualarticles,appearinginthewidespectrumofpeerreviewed,scientificsources.In

arecenteditorialinCurrentContents,theeditorreviewsthefrontiersofbiomedicalengineeringfocusingon

ScienceCitation

Index

methods

for

identifying

core

research

endeavors.

Dr.

Garfield

chose

PEMFs

from

among

otherbiomedicalengineeringeffortsasanexampleofarapidlyemergingdiscipline.Threenewsocietiesinthe

bioelectromagnetics,bioelectrochemistry,andbioelectricalgrowthandrepairhavebeenorganizedduringthis

time,alongwithanumberofnationalandinternationalcommitteesandconferences.Theseactivitiesaugmenta

continuinginterestbytheIEEEintheU.S.andtheIEEintheU.K.Thisreviewfocusesontheprinciplesandpractice

behindthetherapeuticuseof"PEMFs".Thistermisrestrictedtotimevaryingmagneticfieldcharacteristicsthat

inducevoltagewaveformpatternsinbonesimilartothoseresultingfrommechanicaldeformation.These

asymmetric,broadbandpulsesaffectanumberofbiologicprocessesathermally.Manyoftheseprocessesappear

tohavetheabilitytomodifyselectedpathologicstatesinthemusculoskeletalandothersystems.

BassettC.Dep.OrthopedicSurgery,ColumbiaUniversity,NewYork.CritRevBiomedEng

Pulsedelectromagneticfieldspromotecollagenproductioninbonemarrowfibroblastsviaathermal

mechanisms.

Primaryandpassagedculturesoffibroblasts(RBMFs)raisedfromthebonemarrowstromaofyoungrabbitswere

treatedwithpulsedelectromagneticfields(PEMFs)fromthestartofeachcultureuntil1weekaftertheybecame

confluent.ThePEMFtreatmenthadnoeffectoncellproliferation,estimatedbyphasecontrastmicroscopy,by

3HthymidineincorporationintoDNA,orbytotalDNAassay.Collagenproduction,estimatedbyconversionof3H

prolineto3Hhydroxyprolineinnondialyzablematerialwasmarkedlyelevatedinpostconfluentcultures,butnot

inculturesthathadonlyjustreachedconfluence.About65of3Hhydroxyprolinewasinlowmolecularweight

form,andacorrelationbetweencollagenbreakdownandcyclicAMP(cAMP)levelsinRBMFswasdemonstrated

byaddingdibutyrylcAMPorprostaglandinE3(PGE2)totheculturemediumconcurrentlywith3Hproline.The

PEMFapparatus

caused

an

insufficient

temperature

rise

(less

than

0.1

degree

C)

to

account

for

these

results.

We

proposethattheriseincollagenproductionisconsistentwiththehypothesisthatPEMFsactbyreducingcAMP

levelsinRBMFs,andthatthermaleffectsareinsignificant.

FarndaleR.et.alCalcifTissueInt

Modulationofcollagenproductioninculturedfibroblastsbyalowfrequencypulsedmagneticfield.

Primaryculturesofchickentendonfibroblastshavebeenexposedforvariousperiodstoalowfrequency,pulsed

magneticfield,andtheeffectsonproteinandcollagensynthesishavebeenexaminedbyradioisotopic

incorporation.Totalproteinsynthesiswasincreasedinconfluentcellstreatedwithapulsedmagneticfieldforthe

last24

hof

culture

as

well

as

in

cells

treated

for

atotal

of

6days.

However,

in

6day

treated

cultures,

collagen

accumulationwasspecificallyenhancedascomparedtototalprotein,whereasaftershorttermexposure,

collagenproductionwasincreasedonlytothesameextentastotalprotein.LevelsofcyclicAMPweresignificantly

decreasedafter6daypulsedmagneticfieldtreatment,probablyasaconsequenceofdiminishedadenylate

cyclaseactivity.Exposuretopulsedmagneticfieldhadnoeffectoncellproliferationorcollagenphenotype.These

resultsindicatethatapulsedmagneticfieldcanspecificallyincreaseproductionofcollagen,themajor

differentiatedfunctionoffibroblasts,possiblybyalteringcyclicAMPmetabolism.

MurrayJ.et.al.BiochimBiophysActa


11/27

Resultsofpulsedelectromagneticfields(PEMFs)inununitedfracturesafterexternalskeletalfixation.

Of147patientswithfracturesofthetibia,femurandhumerus,inwhomanaverageof3.3operationshadfailed

toproduceunion,allweretreatedwithexternalskeletalfixationinsituandpulsedelectromagneticfields

(PEMFs).Ofthe147,107patientsunitedforanoverallsuccessrateof73%.Unionofthefemuroccurredin81%

andthetibiain75%.Onlyfiveof13humeriunited.FailuretoachieveunionwithPEMFswasmostclosely

associatedwithverywidefracturegapsandinsecureskeletalfixationdevices.

MarcerM.

et.al.

Clin

Orthop

Osteonecrosisofthefemoralheadtreatedbypulsedelectromagneticfields(PEMFs):apreliminaryreport.

Thishasbeenapreliminaryreportwithashorttermfollowupofasmallnumberofobservations(28hipsof24

patients).Thefollowupsrangedfrom6to36months,withanaverageof17.8months.Onlyelevenhips(in

elevenpatients)werefollowedanaverageof8monthsaftercessationofthetreatment.Itshouldbeemphasized

thatthiswasa"pilot"study,inwhichnocontrolserieswasusedtodeterminethenaturalcourseofthediseasein

acomparableclinicalsetting.Ofnotewasthepainrelief,in19of23patientswithmoderatetosevere

pretreatmentpain.Alsotherewasanimprovedfunction,whichsuggeststhatatleastinapproximatelytwothirds

ofthepatientstherewassomeclinicalbenefitfromthismodeoftreatment.Ineighthips,clinicalconditionsdid

notchange;andintwotheyworsened,requiringfurthertreatment.Eighteenremaininghipswerethoughtto

havebenefitedbythetreatment.Sixfemoralheadsthathadalreadydevelopedvaryingdegreesofcollapse(Ficat

TypeIII)collapsedfurther(1to2mm),andtworoundheads(FicatII)progressedtooffround(FicatIII).This

preliminarystudysuggeststhatfurtherexplorationofpulsedelectromagneticfields(PEMFs)iswarrantedinthe

treatmentofosteonecrosisofthefemoralhead.

EftekharN.et.al.Hip

Treatmentoftherapeuticallyresistantnonunionswithbonegraftsandpulsingelectromagneticfields.

Thisstudyreviewsthecasesofeightythreeadultswithununitedfractureswhoweretreatedconcomitantlywith

bonegrafting

and

pulsed

electromagnetic

fields.

An

average

of

1.5

years

had

elapsed

since

fracture

and

the

use

of

thiscombinedapproach.Nearlyonethirdofthepatientshadahistoryofinfection,andanaverageof2.4prior

operationshadfailedtoproduceboneunion.Thirtyeightpatientswhowereinitiallytreatedwithgraftsand

pulsedelectromagneticfieldsforununitedfractureswithwidegaps,synovialpseudarthrosis,andmalalignment

achievedarateofsuccessfulhealingof87percent.Fortyfivepatientswhohadinitiallybeentreated

unsuccessfullywithpulsingelectromagneticfieldsalonehadbonegraftingandwereretreatedwithpulsing

electromagneticfields.Ninetythreepercentofthesefractureshealed.Theresidualfailurerateaftertwo

therapeuticattempts,oneofwhichwasoperative,was1.5percent.Themediantimetounionforbothgroupsof

patientswasfourmonths.

BassettC.Et.al.JBoneJointSurgAm

Effectsofapulsedelectromagneticfieldonamixedchondroblastictissueculture.

Amixedtissueculturepredominantlycomposedofchondroblastictissuewasperturbedbyapulsed

electromagneticfield(PEMF).Somecultureswerenonconfluent,andpurposelyretardedingrowthtoresemble

anatrophicnonunion,whileothersweregrowntoconfluenceinaboutonehalfthetimeasamodelfora

hypertrophicnonunion.Thesetwogroupstestedtheeffectofgrowthrateupontheproductsofcellproliferation

anddifferentiation.Theslowlygrowingcultureswerestimulatedtosynthesizehydroxyproline.Therapidly

growingculturesshowedalargeincreaseinlysozymeactivity,andincreaseinhyaluronateandDNA,anda

decreaseinglycosaminoglycan.Exogenouslysozymefurtherdecreasedtheglycosaminoglycansynthesisinthe


12/27

presenceofPEMF.Chitotriose,aspecificlysozymeinhibitorabolishedthiseffect.Cycloheximide,aprotein

synthesisinhibitor,didnotabolishtheactivationoflysozymefoundinthematrix.Thuslysozymeappearstobe

activatedbyPEMF.Theseobservationsoftherapidlygrowingconfluentculturesareconsistentwithevents

describedinthenormalhealingofabonefractureorendochrondralgrowth.Thus,PEMFappearstopromote

normalhealing,probablybyalteringcartilaginouslysozymeactivityinthematrix,andpossiblythesequenceof

eventsleadingtocalcification.

NortonLAClinOrthop

Biologicaleffectsofmagneticfields:studieswithmicroorganisms.

Fivebacteriaandoneyeastweregrowninmagneticfieldsof50900gausswithfrequenciesof00.3HZand

square,triangular,orsinewaveform.Growthofthesemicroorganismscouldbestimulatedorinhibiteddepending

uponthefieldstrengthandfrequencyofthepulsedmagneticfield.Sporegerminationandmutationfrequency

wereunaffectedbythemagneticfieldsusedinthisstudy.

MooreR.CanJMicrobiol

Influenceofmagneticfieldsoncalciumsaltscrystalformation:anexplanationofthe'pulsedelectromagnetic

field'techniqueforbonehealing.

Inthesearchforamechanismbymeansofwhichamagneticfielddeparalysesnonunionsandenhancesbone

tissueformation,theinfluenceofcontinuousmagneticfieldsontheformationofcalciumphosphatecrystalseeds

hasbeeninvestigated.Fromthisperspective,anexplanationisgivenofaworkingmodeinconventional

equipmentforpulsedelectromagneticfieldtreatment;thisiscomparedwithmultifunctionequipment.

MadroneroAJBiomedEng

Treatmentofnonunionusingpulsedelectromagneticfields:aretrospectivefollowupstudy.

Pulsedelectromagneticfields(PEMF)areausefulmeansoftreatingcasesoffracturenonunion.In67.7%of

nonunionswith

adisability

time

of

at

least

24

months,

complete

consolidation

was

obtained.

This

success

rate

is

increasedto76.6%ifweexcludenonunion,thatpresentedcontraindicationsfortreatmentwithPEMF.The

disabilitytimehadnoeffectonthesuccessrate.Lesionsofthehumerusandatrophicnonunionhadan

unfavorableprognosis.

MeskensM.et.al.Dep.OrthopedicSurgery,UniversityHospital,Pellenberg,Belgium.ActaOrthopBelg

EffectsofpulsedelectromagneticfieldsonSteinbergratingsoffemoralheadosteonecrosis.

95Patientswithfemoralheadosteonecrosismettheprotocolfortreatmentof118hipswithselectedpulsed

electromagneticfields(PEMFs).Etiologiesincludedtrauma(17),alcohol(9),steroiduse(46),sicklecelldisease(2),

andidiopathy

(44).

The

average

age

was

38

years,

and

the

average

follow

up

period

since

the

onset

of

symptoms

was5.3years.PEMFtreatmenthadbeeninstitutedanaverageof4.1yearsearlier.BytheSteinbergquantitative

stagingmethodofroentgenographicanalysis,noneofthe15hipsinStages0IIIshowedprogression,andgrading

improvedinnineof15.Eighteenof79hips(23%)withStageIVlesionsprogressedandnoneimproved.Inthe

StageVcategory,oneof21hips(5%)worsenedandnoneimproved.ThreeStageVIlesionswereunchanged.The

overallrateofquantifiedprogressionforthe118hips,87%ofwhichhadcollapsepresentwhenenteringthe

program,was16%.Thisvaluerepresentsareversalofthepercentageofprogressionreportedrecentlybyother

investigatorsusingconservativeandselectedsurgicalmethods.PEMFpatientsalsohaveexperiencedlongterm

improvementsinsymptomsandsigns,togetherwithareductionintheneedforearlyjointarthroplasty.

BassettC.et.al.OrthopaedicHospital,Riverdale,NYClinOrthop


13/27

Stimulationofexperimentalendochondralossificationbylowenergypulsingelectromagneticfields.

Pulsedelectromagneticfields(PEMFs)ofcertainconfigurationhavebeenshowntobeeffectiveclinicallyin

promotingthehealingoffracturenonunionsandarebelievedtoenhancecalcificationofextracellularmatrix.In

vitrostudieshavesuggestedthatPEMFsmayalsohavetheeffectofmodifyingtheextracellularmatrixby

promotingthe

synthesis

of

matrix

molecules.

This

study

examines

the

effect

of

one

PEMF

upon

the

extracellular

matrixandcalcificationofendochondralossificationinvivo.Thesynthesisofcartilagemoleculesisenhancedby

PEMF,andsubsequentendochondralcalcificationisstimulated.Histomorphometricstudiesindicatethatthe

maturationofbonetrabeculaeisalsopromotedbyPEMFstimulation.TheseresultsindicatethataspecificPEMF

canchangethecompositionofcartilageextracellularmatrixinvivoandraisesthepossibilitythattheeffectson

otherprocessesofendochondralossification(e.g.,fracturehealingandgrowthplates)mayoccurthrougha

similarmechanism.

AaronR.et.al.Dep.BiochemistryandBiophysics,UniversityofRhodeIslandJBoneMinerRes

Roleofpulsedelectromagneticfieldsinrecalcitrantnonunions.

Twentyninepatientsofrecalcitrantnonunionoflongbonesweretreatedbypulsedelectromagneticfieldsinan

attempttobringaboutosteogenesis.Thepulseusedwasrectangular,equalmarkspacewaveintheastable,

continuousmodeoperatingatafrequencyof40Hertz.Thesuccessratewas82.5%.Theresultwasnotdependent

ontheage,sex,timeofnonunionorthepresenceofinfection.However,theresultswereuniformlypoorwhen

infectionandfractureinstabilitywerecoexistentinthesamepatient.

DelimaDF,TannaDDJPostgradMed

Invitrolowfrequencyelectromagneticfieldeffectonfastaxonaltransport.

Theobjectiveofthisstudywastoevaluatetheeffectsofalowfrequencyelectromagneticfieldonfastaxonal

transportfor

future

neuroprosthetic

applications.

Changes

in

speeds

and

densities

of

retrograde

fast

organelle

transportinratsciaticnervepreparationsweremeasuredinvitrouponexposureto15and50Hzpulsedmagnetic

fieldswithpeakintensitiesof4.4and8.8mT.Maximumcurrentdensityoftheinducededdycurrentwas

calculatedtobeabout40microA/cm2.Videoenhanceddifferentialinterferencecontrastmicroscopywasusedto

recordaxonssupportingactiveorganelletransport.Strongeffectswereobservedinmyelinatedaxons(cessation

oftransportinupto10min).Sucheffectsmayeventuallybeusedaspartofaneuroprosthesistononinvasively

modifyorcoupletovariouspartsofthenervoussystem.

ZborowskiM.et.al.Dep.ArtificialOrgans,ClevelandClinicFound.ASAIOTrans

Effectsofpulsedextremelylowfrequencymagneticfieldsonskinwoundsintherat.

Ratswithskinwoundssurgicallycreatedontheirbackswereexposedimmediatelyaftersurgeryandevery12h

thereaftertopulsed,extremelylowfrequencymagneticfields.Theshapeofthepulsewasapositivetriangle(50

Hz,8mTpeak).Therateofhealingofskinwoundswasevaluatedmacroscopicallyandbylightandelectron

microscopyat6,12,21,and42daysaftertheoperation.Asignificantincreaseintherateofwoundcontraction

wasfoundinratstreatedwithmagneticfields.Fortytwodaysaftersurgeryalltreatedanimalsshowfullyclosed

wounds,whilecontrolratsatthesametimeintervalsstilllackedafinal6%ofthewoundsurfacetobecovered.

Treatedratsshowedearliercellularorganization,collagenformationandmaturation,andaveryearlyappearance

ofnewlyformedvascularnetwork.

OttaniV.et.al.IstitutodiAnatomia,Bologna,Italy.Bioelectromagnetics


14/27

Treatmentofdelayedunionandnonunionofthetibiabypulsedelectromagnetic

fields.Aretrospectivefollowup.

Theresultsofaclinicalfollowupof57tibiallesionstreatedwithpulsedelectromagneticfieldsatleastsixmonths

aftertheprimarylesionoccurredprovedthatthisnoninvasivemethodcanbeavaluablealternativetoother

commonlyaccepted

modes

of

therapy.

The

overall

success

rate

was

75%

but

could

be

improved

to

81%

when

the

properindicationsweremet.

MeskensM.et.al.Dep.Orthopaedics,UniversityHospital,PellenbergBullHospJtDisOrthopInst

Enhancedresponsivenesstoparathyroidhormoneandinductionoffunctionaldifferentiationofculturedrabbit

costalchondrocytesbyapulsedelectromagneticfield.

Pulsedelectromagneticfieldspromotehealingofdelayedunitedandununitedfracturesbytriggeringaseriesof

eventsinfibrocartilage.Weexaminedtheeffectsofapulsedelectromagneticfield(recurrentbursts,15.4Hz,of

shorterpulsesofanaverageof2gauss)onrabbitcostalchondrocytesinculture.Apulsedelectromagneticfield

slightlyreducedtheintracellularcyclicadenosine3',5'monophosphate(cAMP)levelintheculture.However,it

significantlyenhancedcAMPaccumulationinresponsetoparathyroidhormone(PTH)to140%ofthatinducedby

PTHinitsabsence,whileitdidnotaffectcAMPaccumulationinresponsetoprostaglandinE1orprostaglandinI2.

TheeffectoncampaccumulationinresponsetoPTHbecameevidentafterexposureoftheculturestothepulsed

electromagneticfieldfor48h,andwasdependentuponthefieldstrength.cAMPaccumulationinresponseto

PTHisfollowedbyinductionofornithinedecarboxylase,agoodmarkerofdifferentiatedchondrocytes,afterPTH

treatmentfor4h.ConsistentwiththeenhancedcAMPaccumulation,ornithinedecarboxylaseactivityinducedby

PTHwasalsoincreasedbythepulsedelectromagneticfieldto170%ofthatincellsnotexposedtoapulsed

electromagneticfield.Furthermore,stimulationofglycosaminoglycansynthesis,adifferentiatedphenotype,in

responsetoPTHwassignificantlyenhancedbyapulsedelectromagneticfield.Thus,apulsedelectromagnetic

fieldenhancedaseriesofeventsinrabbitcostalchondrocytesinresponsetoPTH.Thesefindingsshowthat

exposureofchondrocytestoapulsedelectromagneticfieldresultedinfunctionaldifferentiationofthecells.

HirakiY.

et.al.

Dep.

Biochemistry

and

Calcified

Tissue

Metabolism,

Faculty

of

Dentistry,

Osaka

University,

Japan.

BiochimBiophysActa

Impulsemagneticfieldtherapyforerectiledysfunction:adoubleblind,placebocontrolledstudy.

Thisdoubleblind,placebocontrolledstudyassessedtheefficacyof3weeksofpulsingmagneticfieldtherapyfor

erectiledysfunction(ED).Intheactivetreatmentgroup,allefficacyendpointsweresignificantlyimprovedat

studyend(P


15/27

NayciA.et.al.CakmakM,AksoyekS,RendaN,YucesanS.DepartmentofPediatricSurgery,MersinUniversity

MedicalFaculty,Turkey.

Theefficacyofununitedtibialfracturetreatmentusingpulsingelectromagneticfields:relationtobiological

activityonnonunionboneends.

Thirtyun

united

tibial

fractures

with

amedian

time

since

injury

of

18+/

9months

were

treated

by

electrical

stimulationusingpulsingelectromagneticfieldtherapy.Unionwasachievedin25cases(83.3%)inamedian

intervalof8.6+/3.2months.Patientage,gender,thepresenceofsurgicalhardware,lengthofdisability,andthe

numberofsurgicalproceduresdidnotaffecttheoutcome.Ununitedfracturesthatappearedtobehypertrophic

orsclerotic,indicatingagoodbloodsupplytotheboneends,allhealed..Pulsingelectromagneticfieldtherapyis

aneffectivetreatmentforununitedtibialfractureswithgoodbloodsupplytotheboneends.

ItoH.et.al.DepartmentofOrthopaedicSurgery,NipponMedicalSchool,Tokyo,Japan.

Ultrastructuralstudyofhyaluronicacidbeforeandaftertheuseofapulsedelectromagneticfield,

electrorydesis,inthetreatmentofwrinkles.

BACKGROUND.Treatmentofwrinkleshasbecomeanincreasingproblemfordermatologists.Hyaluronicacidisa

componentofthefamilyofglycosaminoglycans(GAGS,substancesknownfortheirpropertyofretainingwater),

thatsignificantlydecreaseswithagingandinwrinkles.Anewtechniquethatusesaspecificpulsed

electromagneticfield,electrorydesis,hasbeenintroducedinthetreatmentofwrinklesassociatedwithaging.The

treatmentisbasedonthereportedinvitroeffectsofspecificelectromagneticfieldsonfibroblastcultures(e.g.,an

increaseinDNAsynthesisandintheproductionofcollagenandpresumablyalsoofGAGS).METHODS.Theinvivo

effectsoftheelectromagneticfieldonagedskin(3subjectsaged50,56and60years),withparticularfocusonthe

ultrastructuralmodificationsandGAGSamountbeforeandafterthetreatment,wereevaluatedbyelectron

microscope.RESULTS.Theultrastructuralstudy(tissuestainedwithalcianblue)showedaftertreatmenta

significantincrease(p


16/27

factorinbothbonemodelingandremodelingprocesses.Delineationofthefieldparametersmosteffectivein

retainingorpromotingbonemasswillacceleratethedevelopmentofelectricityasauniqueandsitespecific

prophylaxisforosteopenia.Becausefieldsofthesefrequenciesandintensitiesareindigenoustobonetissue,it

furthersuggeststhatsuchexogenoustreatmentcanpromotebonequantityandqualitywithminimalriskor

consequence.

RubinC.Et.al.Dep.Orthopaedics,StateUniversityofNewYorkJBoneMinerRes

Pulsedmagneticfieldsimproveosteoblastactivityduringtherepairofanexperimentalosseousdefect.

Theinfluenceofpulsedlowfrequencyelectromagneticfields(PEMFs)onboneformationwasinvestigatedin

studiesofthehealingprocessoftranscorticalholes,boredatthediaphysealregionofmetacarpalbonesofsix

adulthorses,exposedfor30daystoPEMFs(28Gpeakamplitude,1.3msrisetime,and75Hzrepetitionrate).A

pairofHelmholtzcoils,continuouslypoweredbyapulsegenerator,wasappliedfor30daystotheleftmetacarpal

bone,throughwhichtwoholes,ofequaldiameteranddepth,hadbeenboredatthediaphysealregion.Twoequal

holes,boredatthesamelevelintherightmetacarpalandsurroundedbyaninactivepairofHelmholtzcoils,were

usedascontrols.Allhorsesweregivenanintravenousinjectionof2530mg/kgoftetracyclinechlorideonthe

15thandagainonthe25thdayaftertheoperationandwerekilled5dayslater.Thehistomorphometricanalysis

indicatedthatboththeamountofboneformedduring30daysandthemineralappositionrateduring10days

(deducedfromtheintervalbetweenthetwotetracyclinelabels)weresignificantlygreater(p


17/27

bydisusetreatedwithinactivecoils.Exposuretothepulsedelectricalfieldspreventedthisosteopeniaand

stimulateda10percentmeanincreaseinthebonearea.Theosteogenicinfluenceofthesinusoidalelectrical

fieldswasstronglydependentonthefrequency;the150,seventyfive,andfifteenhertzsinusoidalfields,

respectively,generateda3percent,+5percent,and+20percentmeanchangeinthebonearea.Theseresults

suggestatissuesensitivitythatisspecifictoverylowfrequencysinusoidalelectricalfieldsandtheyimplythatthe

inducedelectricalfieldsneednothavecomplexwaveformstobeosteogenic.Sincethefrequencyandintensity

rangeofthesinusoidalfieldsproducingthegreatestosteogenicresponsearesimilartothelevelsproduced

intrinsicallyby

normal

functional

activity,

these

results

support

the

hypothesis

that

electricity

plays

arole

in

the

retentionofthenormalremodelingbalancewithinmaturebone.

McLeodK.et.al.Dep.Orthopaedics,SchoolofMedicine,StateUniversityofNewYork,:JBoneJointSurgAm

Treatmentofununitedtibialfractures:acomparisonofsurgeryandpulsedelectromagneticfields(PEMF).

Theuseofpulsedelectromagneticfields(PEMF)isgainingacceptanceforthetreatmentofununitedfractures.

Theresultsof44articlespublishedintheEnglishlanguageliteraturehavebeencompiledtoassessthe

effectivenessofPEMFvssurgicaltherapy.Forununitedtibialfractures,81%ofreportedcaseshealedwithPEMF

vs82%withsurgery.Aftermultiplefailedsurgeries,thesuccessrateofPEMFisreportedtobegreaterthanwith

surgery;thisdiscrepancyincreaseswithadditionalnumbersofpriorsurgeries.Ininfectednonunions,theresults

ofsurgicaltreatmentdecreasedby21%andwerelessthantheresultsutilizingPEMF(69%vs81%).Inopen

fractures,surgicalhealingexceededPEMF(89%vs78%),whereasinclosedinjuriesPEMFcaseshealedmore

frequently(85%vs79%).Ingeneral,PEMFtreatmentofununitedfractureshasprovedtobemoresuccessfulthan

noninvasivetraditionalmanagementandatleastaseffectiveassurgicaltherapies.Giventhecostsandpotential

dangersofsurgery,PEMFshouldbeconsideredaneffectivealternative.Experiencesupportsitsroleasa

successfulmethodoftreatmentforununitedfracturesofthetibia.

GosslingH.Et.al.Dep.OrthopedicSurgery,UniversityofConnecticutOrthopedics

Longtermpulsedelectromagneticfield(PEMF)resultsincongenitalpseudarthrosis.

Ninetyone

patients

with

congenital

pseudarthrosis

of

the

tibia

have

been

treated

with

pulsed

electromagnetic

fields(PEMFs)since1973andallexcept4followedtopuberty.Lesionswerestratifiedbyroentgenographic

appearance.TypeIandtypeIIhadgapslessthan5mminwidth.TypeIIIwereatrophic,spindled,andhadgapsin

excessof5mm.OverallsuccessintypeIandIIlesionswas43of60(72%).Ofthose28patientsseenbefore

operativerepairhadbeenattempted,7of8typeIlesionshealed(88%),whereas16of20typeIIlesionshealed

(80%)onPEMFsandimmobilizationalone.Only19%(6of31)typeIIIlesionsunited,onlyoneofwhichdidnot

requiresurgery.Sixteenof91limbs(18%)wereultimatelyamputed,mostbeforetreatmentprincipleswerefully

definedin1980.Fourteenofthese16patients(88%)hadtypeIIIlesions.Refractureoccurredin22patients,most

astheresultofsignificanttrauma,intheabsenceofexternalbracesupport.Twelveofthe19refractures,

retreatedwithPEMFsandcasts,healedonthisregime.EpisodicuseofPEMFsprovedeffectiveincontrolling

stressfracturesinseveralpatientsuntiltheyreachedpuberty.PEMFs,whichareassociatedwithnoknownrisk,

appearto

be

an

effective,

conservative

adjunct

in

the

management

of

this

therapeutically

challenging,

congenital

lesions.

BassettC.et.al.BioelectricResearchCenter,Riverdale,NewYorkCalcifTissueInt

Protectionagainstfocalcerebralischemiafollowingexposuretoapulsedelectromagneticfield.

Thereisevidencethatelectromagneticstimulationmayacceleratethehealingoftissuedamagefollowing

ischemia..ExposuretopulsedelectromagneticfieldattenuatedcorticalischemiaedemaonMRIatthemost

anteriorcoronallevelby65%(P


18/27

damageinthissamecorticalareaby69%(P


19/27

scaledforwholebodyuse,mayhaveclinicalapplicationinthepreventionandtreatmentofosteoporosis.

TabrahF.et.al.UniversityofHawaiiSchoolofMedicine,Honolulu.

Effectofpulsedmagneticfieldsonhumanumbilicalendothelialveincells

Thelongtermgoalofthisprogramwastoexaminetheefficacyofelectromagneticfieldsasanadjuncttherapyto

facilitatewound

repair.

The

experiments

reported

here

were

directed

to

the

question

of

whether

pulsed

electromagneticfields(PEMF)couldfacilitateendothelialcellmigrationfollowinginductionofawound.These

studieswerebasedonareportthatweakPEMFfacilitatedcellmigrationinawoundedconfluentmonolayer

cultureofhumanumbilicalveincells.Experimentsreportedinthispaperwereanattempttoreproduceand

extendtheseobservations.Ourdatasupporttheoriginalobservations.Further,weexaminedseveralhypotheses

inanattempttoclarifythemechanismofinteractionbetweentheappliedelectromagneticfieldsandcells.The

datadonotsupportthehypothesisthatPEMFisactinginamannersimilartoendothelialcellgrowthfactor,a

normalcomponentofthegrowthmedium,orthatPEMFappliedatthetimeofcelltransferenhanceDNA

replication.WehavefoundthatPEMFismoreeffectiveinacceleratingmigrationiftheyinduceanelectricfield

thatisperpendicularratherthanparalleltothesidesofthewound.

Goodman,E.et.alJ.BiomedicalRes.Inst.,Univ.Wisconsin,WI,USA

Effectsofpulsedmagneticfieldsinthetherapyofosteoporosisinducedbyovariectomyintherat.

Thispaperpresentspreliminaryresultsontheeffectsofpulsedelectromagneticfields(EMF)inthetherapyof

postmenopausalosteoporosisinducedbyovariectomyinfemaleratsagedtenmonths.Inparticular,theeffects

oftheintensityofpulsedEMFappliedatconstantfrequencyhasbeenstudied.Magneticfieldspulsedat50Hz

wereusedhavingapositivesinusoidalwaveformwithamaximumintensityof30and70Gauss.Treatment

lastingonehourperdayfor4monthsshowedthatthepulsedEMFwith30Gaussofmaximumintensityareable

toslowdownthebonemassloss,keepingitwithinsome10%;withpulsedEMFwith70Gaussofmaximum

intensity,instead,nosignificantbonemasslosswasobserved.

Zati,A.et.al.InstituteOrthopaedicRizzoli,UniversityofBologna.

Possibletherapeuticapplicationsofpulsedmagneticfields

Magnetotherapyisarelativelynew,nowadayshowever,relativelywidespreadmethodinseveralmedical

disciplines.Themechanismproperofthefavorableactionofthepulsedmagneticfieldonthelivingorganismis

notquiteclearsofar,clinicalinvestigationsrevealed,however,afavorableantiinflammatory,angioedematous

andanalgesictherapeuticeffect.Theauthorssoughtanoptimalfrequencyofthepulsedmagneticfieldwith

regardtothecharacterofthedisease.Theyfocusedattentionaboveallontreatmentofacuteandchronic

inflammatoryconditionsofthelocomotorapparatus,ischaemiaofthebloodvesselsofthelowerextremities,

dyspepticsyndrome,lactationmastitisandotherdiseases.Onetherapeuticcyclelasted20minutes,themean

numberofcyclesvariedbetween5.8and7.7.Aregressionofcomplaintswasrecordedasaruleafter23

sessions.The

optimal

frequency

of

the

pulsed

magnetic

field

seems

to

be

avalue

between

10.0

and

25.0

Hz.

It

is

usefulinparticularinsevereconditionstorepeatthetherapeuticcycleafter23months.Theadvantageofthis

therapeuticmethodistheminimalnumberofcontraindications.

Navratil,L.et.al. CzechRepublic

TheCanadianexperiencewithpulsedmagneticfieldsinthetreatmentofununitedtibialfractures

Aclinicalsurveyof56patientswasconductedatfourdifferentcentersinCanadatoevaluatetheeffectof

extremelylowfrequencypulsedmagneticfields(PMF)onununitedfracturesofthetibia.Alltenpatientswith


20/27

delayedunionand84%ofthe44patientswithnonunionhealed.Onecasewithatraumaticpseudarthrosisand

onewithacongenitalpseudarthrosisfailedtorespondtotreatment.Theseresultscomparefavorablytothose

reportedbyothersusingasystemwithdifferentpulsecharacteristics.Prolongedimmobilizationisnecessaryand

posesproblemsofrehabilitation.Nonunionswithagapbetweenthetibialfragmentsandpseudarthrosesare

bettertreatedwithbonegraftingandinternalfixationpriortoelectricalstimulation.

Haas,W.et.al.J.ofClin.Orthop.

Pulsedmagnetic

field

therapy

for

tibial

non

union.

Interim

results

of

adouble

blind

trial.

Englishpatientswithtibialfractureswhichhadremainedununitedforatleast52weekswererandomlyallocated

toeitheractiveordummypulsedmagneticfieldstimulatorsandtreatedinfulllegplastersfor24weekswitha

nonweightbearingconservativeregimen,asisusualwithsuchtechniques.Fracturesin5ofthe9patientswith

workingmachinesunitedandfracturesin5ofthe7patientswithdummymachinesalsounited.Theseearly

resultsofthisdoubleblindtrialarecompatiblewithadifferenceinsuccessrateat24weeksonactivetreatment

of+33%to61%(95%confidencelimits)comparedwiththesuccessrateonthedummystimulators.Thehigh

proportionoffracturesunitinginthecontrolgroupsuggeststhatconservativemanagementofnonunionis

effectiveandthismayexplainmuchofthesuccessattributedtopulsedmagneticfieldtherapy.

Barker,A.et.alLancet

PulsedMagneticFieldTherapyForInsomnia:ADoubleBlind,PlaceboControlledStudy

This4weekdoubleblind,placebocontrolledstudyassessedtheefficacyofimpulsemagneticfieldtherapyfor

insomnia.Onehundredonepatientswererandomlyassignedtoeitheractivetreatment(n=50)orplacebo(n=

51)andallocatedtooneofthreediagnosticgroups:(1)sleeplatency;(2)interruptedsleep;or(3)nightmares.

Efficacyendpointswereintensityofsleeplatency,frequencyofinterruptions,sleepinessafterrising,daytime

sleepiness,difficultywithconcentration,anddaytimeheadaches.Intheactivetreatmentgroup,thevaluesofall

criteriaweresignificantlyloweratstudyend(P


21/27

Comparativestudyofbonegrowthbypulsedelectromagneticfields.

Pulsedelectromagneticfieldshavebeenwidelyusedfortreatmentofnonunitedfracturesandcongenital

pseudarthrosis.Severalelectricalstimulationsystemssuchasaircoredandironcoredcoilsandsolenoidshave

beenusedtheworldoverandclaimedtobeeffective.Electricalparameterssuchaspulseshape,magnitudeand

frequencydifferwidely,andtheexactbonehealingmechanismisstillnotclearlyunderstood.Thestudyattempts

toanalytically

investigate

the

effectiveness

of

various

parameters

and

suggests

an

optimal

stimulation

waveform.

MathematicalanalysisofelectricfieldsinsidethebonetogetherwithFourieranalysisofinducedvoltage

waveformsproducedbycommonlyusedelectricalstimulationwaveformshasbeenperformed.Ahypothesis

basedonassigningdifferentweightingstodifferentfrequenciesforosteogenicresponsehasbeenproposed.

Usingthishypothesisastonishinglysimilareffectivevaluesofelectricfieldshavebeenfoundindifferentsystems.

Itisshownthateffectiveelectricfieldratherthanpeakelectricfieldisthemainparameterresponsiblefor

osteogenesis.Theresultsareinagreementwithexperimentalfindingsmadeonhumanbeingsbydifferent

investigators.

GuptaT.et.al.Dep.ElectricalEngineering,HarcourtButlerTechnologicalInstitute,Kanpur,India.MedBiolEng

Comput

LongtermfollowupoffracturenonunionstreatedwithPEMF.

Onehundredthirtynineestablishedfracturenonunionsweretreatedusingapulsedelectromagneticfield

(PEMF)devicethatalsorecordedpatientusage.Patientswhousedthedevicelessthananaverageofthreehours

adayhadasuccessrateof35.7%(5/14),whilethosewhousedthedeviceinexcessofthreehoursdailyhadan

80%successrate(108/135).Thedifferenceinthesuccessratewasstatisticallysignificantatplessthan.05.

Treatmentsuccesswasunaffectedbylongversusshortbone,openversusclosedfractures,nonunionofnineto

12monthsdurationcomparedtoonetotenyears,ageofpatient(whetherlessthanorgreaterthanage60),

gender,recalcitrantversusfirsttimetreatment,infectedversusnoninfectednonunions,fracturegapsupto1cm,

orweightbearingversusnonweightbearing.Ninetysevenfracturesin90patients

(90%followup)whoaveragedmorethanthreehoursofPEMFtreatmentdailyandwereoriginallyclassifiedas

healedwere

reevaluated

clinically

and

radiographically

at

four

years

following

treatment

(range:

3.6

5.4

years;

mean:4.1years).Eightynine(92%)maintainedasolidunion.ThesuccessrateofPEMFtreatmentfornonunion

repairdemonstratednostatisticallysignificantchangeoverlongtermfollowup.

GarlandD.Et.al.UniversityofSouthernCaliforniaSchoolofMedicine,LosAngeles,California.ContempOrthop

Augmentationofbonerepairbypulsedelfmagneticfields.

Tibialosteotomiesinratswereexposedfor2,3,5and8weekstoapulsedextremelylowfrequencymagnetic

field.Theshapeofthepulsewasadoublehalfwave(50Hz,70G).Therateofbonehealingwasevaluatedbylight

andelectronmicroscopy.Anincreaseofbonehealingwasfoundinratstreatedwithmagneticfieldspersisting

throughoutthe

tested

time.

The

accelerated

healing

process

produced

asequence

of

morphological

appearances

identicaltothoseofanormalfracturecallusbeingtheenhancementofosteogenesisproducedbyanacceleration

ofpreliminaryossification.

OttaniV.et.al.IstitutodiAnatomiaUmanaNormale,Bologna,Italy.AnatAnz

Thedevelopmentandapplicationofpulsedelectromagneticfields(PEMFs)forununitedfracturesand

arthrodeses.

Thisarticledealswiththerationalandpracticaluseofsurgicallynoninvasivepulsedelectromagneticfields


22/27

(PEMFs)intreatingununitedfractures,failedarthrodeses,andcongenitalpseudarthroses(infantilenonunions).

Themethodishighlyeffective(morethan90percentsuccess)inadultpatientswhenusedinconjunctionwith

goodmanagementtechniquesthatarefoundedonbiomechanicalprinciples.Whenunionfailstooccurwith

PEMFsaloneafterapproximatelyfourmonths,theirproperuseinconjunctionwithfreshbonegraftsinsuresa

maximumfailurerateof1to1.5percent.Unionoccursbecausetheweakelectriccurrentsinducedintissuesby

thetimevaryingfieldseffectcalcificationofthefibrocartilageinthefracturegap,therebysettingthestageforthe

finalphasesoffracturehealingbyendochondralossification.Theefficacy,safety,andsimplicityofthemethod

hasprompted

its

use

by

the

majority

of

orthopedic

surgeons

in

this

country.

In

patients

with

delayed

union

three

tofourmonthspostfracture,PEMFsappeartobemoresuccessfulandhealing,generally,ismorerapidthanin

patientsmanagedbyotherconservativemethods.Formorechallengingproblemssuchasactivelyinfected

nonunions,multiplesurgicalfailures,longstanding(forexample,morethantwoyearspostfracture)atrophic

lesions,failedkneearthrodesesafterremovalofinfectedprostheses,andcongenitalpseudarthroses,successcan

beexpectedinalargemajorityofpatientsinwhomPEMFsareused.Finally,aslaboratorystudieshaveexpanded

knowledgeofthemechanismsofPEMFaction,itisclearthatdifferentpulsesaffectdifferentbiologicprocessesin

differentways.Selectionoftheproperpulseforagivenpathologicentityhasbeguntobegovernedbyrational

processessimilar,incertainrespects,tothoseappliedtopharmacologicagents.

BassettCAClinPlastSurg&OrthopClinNorthAm

PulsedelectromagneticfieldstimulationofMG63osteoblastlikecellsaffectsdifferentiationandlocalfactor

production.

Pulsedelectromagneticfieldstimulationhasbeenusedtopromotethehealingofchronicnonunionsand

fractureswithdelayedhealing,butrelativelylittleisknownaboutitseffectsonosteogeniccellsorthe

mechanismsinvolved.Thepurposeofthisstudywastoexaminetheresponseofosteoblastlikecellstoapulsed

electromagneticfieldsignalusedclinicallyandtodetermineifthesignalmodulatestheproductionofautocrine

factorsassociatedwithdifferentiation.ConfluentculturesofMG63humanosteoblastlikecellswereplaced

betweenHelmholtzcoilsandexposedtoapulsedelectromagneticsignalconsistingofaburstof20pulses

repeatingat15Hzfor8hoursperdayfor1,2,or4days.Controlswereculturedunderidenticalconditions,butno

signalwasapplied.Treatedandcontrolcultureswerealternatedbetweentwocomparableincubatorsand,

therefore,between

active

coils;

measurement

of

the

temperature

of

the

incubators

and

the

culture

medium

indicatedthatapplicationofthesignaldidnotgenerateheatabovethelevelfoundinthecontrolincubatoror

culturemedium.Thepulsedelectromagneticsignalcausedareductionincellproliferationonthebasisofcell

numberand[3H]thymidineincorporation.Cellularalkalinephosphatasespecificactivityincreasedinthecultures

exposedtothesignal,withmaximumeffectsatday1.Incontrast,enzymeactivityinthecelllayerlysates,which

includedalkalinephosphataseenrichedextracellularmatrixvesicles,continuedtoincreasewiththetimeof

exposuretothesignal.After1and2daysofexposure,collagensynthesisandosteocalcinproductionweregreater

thaninthecontrolcultures.ProstaglandinE2inthetreatedcultureswassignificantlyreducedat1and2days,

whereastransforminggrowthfactorbeta1wasincreased;at4daysoftreatment,however,thelevelsofboth

localfactorsweresimilartothoseinthecontrols.Theresultsindicateenhanceddifferentiationastheneteffect

ofpulsedelectromagneticfieldsonosteoblasts,asevidencedbydecreasedproliferationandincreasedalkaline

phosphatasespecific

activity,

osteocalcin

synthesis,

and

collagen

production.

Pulsed

electromagnetic

field

stimulationappearstopromotetheproductionofmatrixvesiclesonthebasisofhigherlevelsofalkaline

phosphataseat4daysinthecelllayersthanintheisolatedcells,commensuratewithosteogenicdifferentiationin

responsetotransforminggrowthfactorbeta1.Theresultsindicatethatosteoblastsaresensitivetopulsed

electromagneticfieldstimulation,whichalterscellactivitythroughchangesinlocalfactorproduction.

LohmannC.et.al.Dep.Orthopaedics,UniversityTexasHealthScienceCenter,SanAntonioJOrthopRes

Pulsedelectromagneticfieldsaffecttheintracellularcalciumconcentrationsinhumanastrocytomacells.

Experimentsassessedwhetherlongtermexposureto50Hzpulsedelectromagneticfieldswithapeakmagnetic


23/27

fieldof3mTcanalterthedynamicsofintracellularcalciuminhumanastrocytomaU373MGcells.Pretreatment

ofcellswith1.2&mgr;MsubstancePsignificantlyincreasedthe[Ca(2+)](i).Thesameeffectwasalsoobserved

when[Ca(2+)](i)wasevaluatedinthepresenceof20mMcaffeine.Afterexposuretoelectromagneticfieldsthe

basal[Ca(2+)](i)levelsincreasedsignificantlyfrom143+/ 46nMto278+/ 125nM.Theincreasewasalso

evidentaftercaffeineaddition,butincellstreatedwithsubstancePandsubstanceP+caffeineweobserveda

[Ca(2+)](i)decreaseafterexposure.Whenwesubstitutedcalciumfreemediumfornormalmediumimmediately

beforethe[Ca(2+)](i)measurements,the[Ca(2+)](i)wassimilartothatmeasuredinthepresenceofCa(2+).Inthis

case,after

EMFs

exposure

of

cells

treated

with

substance

P,

the

[Ca(2+)](i),

measured

without

and

with

addition

ofcaffeine,declinedfrom824+/ 425to38+/ 13nMandfrom1369+/ 700to11+/ 4nM,respectively,

indicatingthatelectromagneticfieldsacteitheronintracellularCa(2+)storesorontheplasmamembrane.

Moreovertheelectromagneticfieldsthataffected[Ca(2+)](i)didnotcausecellproliferationorcelldeathandthe

proliferationindexesremainedunchangedafterexposure.

PessinaG.et.al.Inst.ofGeneralPhysiologyandNutritionalScience,UniversityofSiena,Italy.

Bioelectromagnetics

Pulsedelectromagneticfieldspromoteboneformationarounddentalimplantsinsertedintothefemurof

rabbits.

Thepresentstudyexaminedtheeffectofapplyingapulsedelectromagneticfield(PEMF)onboneformation

aroundaroughsurfaceddentalimplant.AdentalimplantwasinsertedintothefemurofJapanesewhiterabbits

bilaterally.APEMFwithapulsewidthof25microsecondsandapulsefrequencyof100Hzwasapplied.PEMF

stimulationwasappliedfor4hor8hperday,atamagneticintensityof0.2mT,0.3mTor0.8mT.Theanimals

weresacrificed1,2or4weeksafterimplantation.Afterstainingtheresinsectionswith2%basicfuchsinand0.1%

methyleneblue,newlyformedbonearoundtheimplantontissuesectionswasevaluatedbycomputerimage

analysis.ThebonecontactratiosofthePEMFtreatedfemursweresignificantlylargerthanthoseofthecontrol

groups.Boththebonecontactratioandbonearearatioofthe0.2mT and0.3mTtreatedfemurswere

significantlylargerthantherespectivevalueofthe0.8mTtreatedfemurs(P


24/27

RichardA.Silver,M.D.TucsonOrthopaedic&FractureSurgeryAssociates,Ltd.,Tucson,AZ.

Therapeuticeffectsofalternatingcurrentpulsedelectromagneticfieldsinmultiplesclerosis.

Multiplesclerosisisthethirdmostcommoncauseofseveredisabilityinpatientsbetweentheagesof15and50

years.Thecauseofthediseaseanditspathogenesisremainunknown.Thelast20yearshaveseenonlymeager

advancesinthedevelopmentofeffectivetreatmentsforthedisease.Nospecifictreatmentmodalitycancurethe

diseaseor

alter

its

long

term

course

and

eventual

outcome.

Moreover,

there

are

no

agents

or

treatments

that

will

restorepremorbidneuronalfunction.Ahostofbiologicalphenomenaassociatedwiththediseaseinvolving

interactionsamonggenetic,environmental,immunologic,andhormonalfactors,cannotbeexplainedonthebasis

ofdemyelinationaloneandthereforerequirerefocusingattentiononalternativeexplanations,oneofwhich

implicatesthepinealglandaspivotal.Thepinealglandfunctionsasamagnetoreceptororgan.Thisbiological

propertyoftheglandprovidedtheimpetusforthedevelopmentofanovelandhighlyeffectivetherapeutic

modality,whichinvolvestranscranialapplicationsofalternatingcurrent(AC)pulsedelectromagneticfieldsflux

density.Thisreviewsummarizesrecentclinicalworkontheeffectsoftranscraniallyappliedpulsed

electromagneticfieldsforthesymptomatictreatmentofthedisease.

SandykR.Dep.ofNeuroscience,InstituteforBiomedicalEngineeringandRehabServicesofTouroCollege,Dix

Hills,NewYork.

Doubleblindstudyofpulsingmagneticfieldeffectsonmultiplesclerosis.

Weperformedadoubleblindstudytomeasuretheclinicalandsubclinicaleffectsofanalternativemedicine

electromagneticdeviceondiseaseactivityinmultiplesclerosis(MS).TheMSpatientswereexposedtoamagnetic

pulsingdevicewherethefrequencyofthemagneticpulsewasinthe413Hzrange.Atotalof30MSpatients

worethedeviceonpreselectedsitesbetween10and24hoursadayfor2months.Halfofthepatients(15)

randomlyreceivedadevicethatwasmagneticallyinactiveandtheotherhalfreceivedanactivedevice.EachMS

patientreceivedasetofteststoevaluateMSdiseasestatusbeforeandafterwearingthedevice.Thetests

included(1)aclinicalrating(Kurtzke,EDSS),(2)patientreportedperformancescales,and(3)quantitativeelectro

encephalography(QEEG)duringalanguagetask.Althoughtherewasnosignificantchangebetweenpretreatment

andpost

treatment

in

the

EDSS

scale,

there

was

asignificant

improvement

in

the

performance

scale

(PS)

combinedratingforbladdercontrol,cognitivefunction,fatiguelevel,mobility,spasticity,andvision(activegroup

3.83+/ 1.08,p


25/27

components.Alloftheseeffectsareimportantfordiseasepathologyandclinicalsymptomsinmultiplesclerosis

(MS).EEGwasmeasuredinthisstudyinordertotestourhypothesisthatthepulsingmagneticdeviceaffectsthe

brainelectricalactivity,andthatthismaybeamechanismfortheeffectwehaveobservedonpatientreported

symptoms.TheEEGdatareportedpreviouslyweremeasuredonlyduringrestingandlanguageconditions.The

purposeofthecurrentstudywastomeasuretheeffectoftheelectromagneticdeviceonEEGactivityduringand

afterphoticstimulationwithflashinglights.Afterphoticstimulation,therewasastatisticallysignificantincrease

inalphaEEGmagnitudethatwasgreaterintheactivegroupcomparedtotheplacebogroupinelectrode

positionsP3,

T5,

and

O1

(analysis

of

variance

p


26/27

ScientificArticlesandAbstracts

FurtherReferences:

The treatment of chronic benign pain by means of low frequency pulsating magnetic fields F.Paccagnella et al University of Padova. Bio-electrochemistry and Bio-energetics

Therapeutic effects of pulsed magnetic fields on joint diseases: E.R. Sanseverino et al University ofBologna. Panminerva med

The effect of pulsed electromagnetic fields in the treatment of osteoarthritis of the knee and cervicalspine. Report of randomized, double blind, placebo controlled trials: D.H. Trock et al Yale university

school of medicine. Journal of Rheumatology

Beschleunigung der Osteoinduktion durch elektromagnetische Wechselfelder: G. Aldinger et al

Orthopedic university clinic Tuebingen. Osteologie

Effects of extremely low frequency electromagnetic field on collagen type I mRNA expression and

extracellular matrix synthesis of human osteoblastic cells: K. Heerneier et al Institute for molecularvirology Neuherberg, Germany. Bio-electromagnetics

Long term follow-up of fracture nonunions treated with PEMFs: D.E. Garland. Contemporaryorthopaedics

The differentiation of normal and transformed human fibroblasts in vitro is influenced byelectromagnetic fields: H.P. Rodemann et al University Hohenheim, Germany. Experimental cell research

A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields forinterbody lumbar fusions: V. Mooney, University of California. Spine

The effect of pulsing electromagnetic fields on bone metabolism in experimental disuse osteoporosis:R.L. Cruess et al Mc. Gill University, Canada. Clinical Orthopaedics and related research

Lecture at the 2nd International Congress for Magneto Medicine Rome, Italy. Sansaverino Dr. E Riva,

Biomedical Implications of Pulsing Electromagnetic Fields. Bassett C. A., Prof. Orthopedic Surgery,Columbia University, New York.

Influence of Magnetic Fields on Calcium Salts Crystal Formation: An explanation of the pulsedmagnetic field technique for bone healing. Madronero A. BES Journal

The Possible Role of Pulsating Magnetic Fields in the Reduction of Pain, Warnke U. ElsevierBiomedical Press, Pain Therapy

Pulsed Electromagnetic Field Therapy of Persistent Rotator Cuff Tendinitis, Binder A. et.al. Dep.Rheumatology, Addenbrookes Hospital. Lancet

Effect of Low Intensity Electromagnetic Fields on Diabetic Retinopathy. Lau B., School of Medicine,Lomo Linda, USA.

Pulsing Electromagnetic Field Therapy of Multiple Sclerosis, Guseo A., Dep. of Neurology,Szekesfeheruar, Hungary. J. of Bioelectricity

Technology Evaluation: Pulsing electromagnetic Fields and Fracture Management. An Analysis ofClinical Efficacy and Safety (1988). Parsippany, NJ: Aaron RK,

The conservative treatment of osteonecrosis of the femoral head. A comparison of core decompression

and pulsing electromagnetic fields. Lennox D. Et.al. Clin Orthop. Classification of disease: Osteoarthritis. Altman R. Semin. Arthritis Rheum.

The use of pulsing electromagnetic fields to treat full thickness skin defects in the rabbit model. AndinoR. et.al. Proceedings Annual Meeting of the Bioelectrical Repair and Growth Society

Beneficial effects of electromagnetic fields. Bassett C. J Cell Biochem.

Rhythmic variations in pain perception in osteoarthritis of the knee. Bellamy N. et.al. J Rheumatol.

Pulsed electromagnetic field therapy of persistent rotator cuff tendinitis. Binder A. Et.al. Lancet.

The effect of pulsing electromagnetic fields on bone metabolism in experimental disuse osteoporosis.Cruess R. et.al. Clin Orthop.


27/27

Detection of osteoarthritis (OA) of the knee using magnetic resonance imaging, needle and standardarthroscopy with histologic correlation. Dedrick D. et al. Arthritis Rheum.

Augmentation of mucosal adaptation following small-bowel resection by electromagnetic fieldstimulation in rats. Dindar H. et.al. J. Exp Clin Med.

An examination of direct current fields for the treatment of spinal cord injury. G, Hurlbert R. et.al.Proceedings World Congress for Electricity and Magnetism in Biology and Medicine.

In vitro effects of 50 Hz magnetic fields on oxidatively damaged rabbit red blood cells. Fiorani M. et.al.Bioelectromagnetics.

Treatment of headache by pulsating electromagnetic field: A preliminary report. Giczi J. et.al. JBioelectricity

Pulsed electromagnetic fields in experimental cutaneous wound healing in rats. Patino O. et.al. J BurnCare Rehabil.

Prospects on clinical applications of electrical stimulation for nerve regeneration. Sisken B. et.al. J. CellBiochem.

Intrastructural study of hyaluronic acid before and after the use of a pulsed electromagnetic field,electrorydesis, in the treatment of wrinkles. Teofoli P. et.al. Int. J Dermatol.

Osteoarthritis of the knee. A prospective double-blind placebo controlled study using very low

frequency electromagnetic induction therapy in the treatment of patients with inflammatory and non-inflammatory arthritis. Trock et.al.

Osteoarthritis of the cervical spine. A prospective double-blind placebo controlled study using very lowfrequency electromagnetic induction therapy in the treatment of patients with inflammatory and non-

inflammatory arthritis. Trock et.al.

The conservative treatment of osteonecrosis of the femoral head. A comparison of core decompressionand pulsing electromagnetic fields. Aaron R. et.al. Clin Orthop.

The use of pulsing electromagnetic fields to treat full thickness skin defects in the rabbit model. AndinoR. et.al. Proceedings Meeting of the Bioelectrical Repair and Growth Society.

The effect of pulsing electromagnetic fields on bone metabolism in experimental disuse osteoporosis.Cruess R. et.al. Clin Orthop.

Pulsed magnetic and electromagnetic fields in experimental Achilles tendonitis in the rat: a prospectiverandomized study. Lee E. et.al. Arch Phys Me Rehabil.

Pulsed electromagnetic fields in experimental cutaneous wound healing in rats. Patino O. et.al. J BurnCare Rehabil.

Stimulation of experimental endochondral ossification by low-energy pulsing electromagnetic fields.Aaron R. et.al. J Bone Min Res.

Scientific Articles Abstracts

Documents

Transcript of Scientific Articles Abstracts