Safety
Enobio
There are no special safety considerations for Enobio. However, for safety reasons, neither Enobio nor StarStim will operate while charging. In order to charge your NECBOX device, plug it via the USB port to a computer or power supply, and make sure the power switch of the NECBOX is in OFF position. If it is in the ON position, the device will not charge.
StarStim
Please note: tCS therapy should be supervised by a trained medical doctor. Modalities other than tDCS (tACS, tRNS) are for research purposes only.
There are no studies in the literature describing the effects of direct current treatments on pregnant women, or children below 18 years, or patients with pacemakers, intracranial electrodes, implanted defibrillators, or any other prosthesis. Before applying StarStim, make sure that pacemakers, intracranial electrodes, defibrillators, or any other prosthesis are not implanted in the patient. Otherwise, the application of DC currents could be unsafe.
For safety, StarStim is limited in the following ways. It will not operate if the contact impedance is above 20 kOhm. It can only provide potential differences across electrode of 30 V to deliver a maximum, at any electrode of (+ or -) 2 mA of current.
Based on abundant literature, the guideline for clinical use is to keep average current densities in electrodes below 2 mA/35 cm2= 0.06 mA/cm2. Such stimulation current densities are far from the threshold for tissue damage (14.3 mA/cm2) recently indicated for tDCS in an animal model. Typical applications times are of 20 min or less.
Current densities above 0.06 mA/cm2 (but always well below 14.3 mA/cm^2) are for advanced clinical or research purposes only.
Stimulation session durations beyond 40 minutes are for research purposes only.
In addition, electrode positions above cranial foramina and fissures should be avoided because these could increase beyond safety limits the effective current density.
StarStim can only be used with specifically designed Neuroelectrics electrodes.
With sponge electrodes, the use of sodium chloride solution, the regular replacement of the sponge, and the careful inspection of the condition of the skin under the electrode before and after tDCS is recommended. Observed Adverse Effects include: skin itching, tingling, headache, burning sensation and discomfort. In rare cases, skin lesions have been observed. If skin lesions are observed, the treatment must be suspended and the equipment revised.
StarStim components must never be opened or damaged. Before using check that StarStim components, including electrodes, are undamaged and clean.
Safety Guide
The following chart is provided to guide operators, providing safety zones for different electrode current densities. Note this is an updated chart from the 2012 version. The only change is the removal of the "Uncharted Territory" zone. During the last year several groups have been working with our Pi electrodes using up to 2 mA of currents, and no ill effects have been reported.
It illustrates the MAX average current density that can be used for mainstream clinical applications, advanced clinical applications, research as a function of electrode size.
Please note: the proposed limits are not based on available negative evidence (i.e., findings of Adverse Effects with higher current densities). Rather, it is a conservative statement based on the limited experience with current densities above 2 mA/35 cm2).
