Frequency Modulated Neural Stimulation (FREMS) in Symptomatic Diabetic Neuropathy
Condition: Diabetic Neuropathy, Painful
MeSH terms: Peripheral Nervous System Diseases; Diabetic Neuropathies
Study type: Interventional
Phase: Phase 4

Summary: 
      Aim of this study is to evaluate safety and efficacy of transcutaneous frequency modulated
      electromagnetic neural stimulation (FREMS) to treat symptomatic peripheral neuropathy in
      patients with diabetes mellitus.
    

Detailed description: 
      Diabetic neuropathy is a common and potentially disabling complication of patients with type
      1 or type 2 diabetes due to the damage of peripheral nerves caused by chronic hyperglycemia.
      The most common clinical signs and symptoms of diabetic neuropathy include numbness,
      diminished sensation and painful symptoms, such as burning, pins and needles, intolerable
      pain and hyperaesthesia of the lower extremities.

      Different classes of drugs, such as analgesics, antidepressants and anti-epileptics are
      variably efficacious in pain relief, but are unfortunately unable to revert the natural
      history of the disease.

      A wide range of electrotherapies have been proposed for the non-pharmacological treatment of
      diabetic neuropathy. The rationale of using electric or magnetic stimulation is the potential
      enhancement of microcirculation and endoneural blood flow, possibly counteracting the nerve
      ischemic damage, together with other yet poorly understood mechanisms, such as masking pain
      by interfering with pain gate control.

      A number of studies have reported the efficacy of different electrotherapies, such as
      transcutaneous electrical nerve stimulation (TENS), pulsed-dose electrical stimulation,
      peripheral nerve, nerve root, spinal cord, deep brain and epidural motor cortex stimulations,
      pulsed (electro-)magnetic fields and static magnetic fields, high-frequency external muscle
      stimulation, high-tone external muscle stimulation and external muscle stimulation. However,
      of all these electrotherapies, only TENS is currently recommended as a treatment for painful
      diabetic neuropathy by the American Academy of Neurology.

      Recently, a novel transcutaneous frequency-modulated electromagnetic neural stimulation (also
      named as Frequency Rhythmic Electrical Modulation System, FREMS), has been developed. FREMS
      consists of a sequence of modulated electrical stimuli that varies automatically in terms of
      pulse frequency, duration and voltage amplitude. FREMS was tested in a pilot randomized,
      cross-over study, and reduced diabetic neuropathy pain and ameliorated the sensory tactile
      and vibration perception threshold and motor nerve conduction velocity compared to a sham
      treatment.

      The aim of this study was to test the efficacy and safety of FREMS in a multicentre,
      randomized, double-blind, placebo-controlled study enrolling a large population with
      symptomatic diabetic polyneuropathy, with repeated treatment sessions and a post-treatment
      follow-up of adequate length.
    

Intervention name(s): Frequency Modulated Neural Stimulation (FREMS) (Aptiva); sham treatment (Aptiva)
Intervention type(s): Device; Device
Intervention description(s): FREMS consisted of sequences of biphasic (negative and positive), asymmetric and electrically balanced pulses, composed of: 1) an active phase of high negative voltage spike (variable, max -300 V) and extra short duration (variable, 10-100 μsec, mostly ~40 μsec); followed by: 2) a recharging phase of low voltage and long duration (0.9 - 999 msec); pulse frequency was variable, ranging 1 to 1,000 Hz, mainly in the low range 1-50 Hz. Three cycles of 10 consecutive (one a day for 5 days/week) applications to both lower limbs were delivered.; The sham treatment consisted of no electrical pulses delivered by the same device used to deliver the FREMS treatment and with the same treatment procedure and schedule.
Other intervention name(s): Aptiva device (Lorenz Biotech, Medolla, Italy); Aptiva device (Lorenz Biotech, Medolla, Italy)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Diabetic Neuropathy, Painful