Accupuncture-like transcutaneous electrical nerve stimulation therapy success using a commercially available unit 8 years post-radiation for xerostomia: a case report.

Austin J Iovoli,Anurag K Singh

doi:10.1017/s1460396917000024

Abstract

BackgroundAccupuncture-like transcutaneous electrical nerve stimulation (ALTENS) therapy has been shown in prospective studies to be effective in the treatment of radiation-induced xerostomia. Those studies treated patients within 27 months from end of radiation with ALTENS delivered in the clinic using a Codetron unit. However, that unit is no longer produced and there is limited data on success of ALTENS when delivered at home.MethodsA 50-year old man with xerostomia, 8 years post-radiation for T4N1 squamous cell carcinoma of the tonsillar fossa, was given ALTENS with a currently commercially available unit from Girish Surgical. He used the unit at home, 20 minutes daily for 8 weeks.ResultsAfter 8 weeks of ALTENS therapy the patient saw a reduction in the Self-Reported University of Michigan Xerostomia-Related Quality of Life Scale from 20 to 1.ConclusionThis case report demonstrates (1) the Girish Surgical unit is effective, (2) self-administration of ALTENS in patients who cannot come to clinic regularly may be practical and (3) ALTENS can still offer durable benefit to patients even 8 years after chemoradiation therapy.

Highlights

Acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) treatment has emerged as a promising new modality to improve saliva production and related symptoms without the associated cholinergic side effects caused by sympathomimetic agents.[4,5,6,7]
Wong et al.[4] conducted a 46 patient, single institution, phase I–II trial demonstrating an Accupuncture-like transcutaneous electrical nerve stimulation (ALTENS) approach without invasive needles that improved whole saliva production and related symptoms in patients when initiated within 27 months of chemoradiation completion
A secondary analysis of this study using the RTOG-modified University of Washington Head and Neck Symptom Score to assess overall health-related quality of life demonstrated consistently lower scores, indicating better function, for patients randomised to the ALTENS arm compared with those randomised to pilocarpine.[7] the Girish Surgical TENS unit is effective, self-administration of ALTENS in patients who cannot come to clinic regularly may be practical, and ALTENS can still offer durable benefit to patients even 8 years after chemoradiation completion

Summary

Introduction

Acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) treatment has emerged as a promising new modality to improve saliva production and related symptoms without the associated cholinergic side effects caused by sympathomimetic agents.[4,5,6,7] Reports generated from single and multi-institutional studies have demonstrated benefit in patients initiating ALTENS therapy within 3–27 months of completing chemoradiation.[4,5,6,7] In addition, a previous case report found ALTENS therapy to be effective in a patient 5 years removed from completion of chemoradiation.[8] the TENS unit produced by Codetron (Buffalo, NY, USA) used to conduct these studies is no longer manufactured. The treatment protocol for these patients required them to receive therapy at a clinical centre twice weekly for 12 weeks.[4,5,6,7] A different TENS unit, produced by Girish Surgical (Mumbai, India) is available and in current production.

Results

Conclusion