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Hyperbaric Oxygen Therapy
Post Traumatic Stress Disorder,
Traumatic Brain Injury (TBI), Stroke, and Concussion
Post-traumatic stress disorder (PTSD) is a psychological condition that is triggered by a past event that was experienced or witnessed, which may cause flashbacks, nightmares, severe anxiety, or uncontrollable thoughts about that event. These issues can cause problems in social situations, at work, and in relationships, and they can interfere with your ability to carry out your usual daily tasks.
PTSD can also cause physical damage to the brain tissue, which may include atrophy or altered/reduced activity and stimulation.
Traumatic Brain Injury (TBI) is a brain dysfunction caused by an outside force, usually a violent blow to the head. Traumatic brain injury often occurs as a result of a severe sports injury or car accident. Immediate or delayed symptoms may include confusion, blurry vision, and concentration difficulty.
A concussion occurs from a mild blow to the head, either with or without loss of consciousness, and can lead to temporary cognitive symptoms. Symptoms may include headache, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness, and excessive fatigue.
HBOT provides increased oxygen to the blood which helps heal damaged brain tissue, reduces inflammation, promotes the growth of new tissue and blood vessels, and improves general blood flow and oxygen delivery to the body.
Studies on PTSD, TBI, Stroke, & Concussion and HBOT
Doenyas-Barak K, Catalogna M, Kutz I, Levi G, Hadanny A, Tal S, Daphna-Tekoha S, Sasson E, Shechter Y, Efrati S. Hyperbaric oxygen therapy improves symptoms, brain's microstructure and functionality in veterans with treatment-resistant post-traumatic stress disorder: A prospective, randomized, controlled trial. PLoS One. 2022 Feb 22;17(2):e0264161. doi: 10.1371/journal.pone.0264161. PMID: 35192645; PMCID: PMC8863239.
Introduction:
Post-traumatic stress disorder (PTSD) is characterized by changes in both brain activity and microstructural integrity. Cumulative evidence demonstrates that hyperbaric oxygen therapy (HBOT) induces neuroplasticity and case-series studies indicate its potentially positive effects on PTSD. The aim of the study was to evaluate HBOT’s effect in veterans with treatment-resistant PTSD.
Results:
Thirty-five veterans were randomized to HBOT (N = 18) or control (n = 17) and 29 completed the protocol. Following HBOT, there was a significant improvement in CAPS-V scores and no change in the control (F = 30.57, P<0.0001, Net effect size = 1.64). Significant improvements were also demonstrated in BSI and BDI scores (F = 5.72, P = 0.024 Net effect size = 0.89, and F = 7.65, P = 0.01, Net effect size = 1.03). Improved brain activity was seen in fMRI in the left dorsolateral prefrontal, middle temporal gyri, both thalami, left hippocampus, and left insula. The DTI showed significant increases in fractional anisotropy in the fronto-limbic white-matter, genu of the corpus callosum, and fornix.
Conclusions:
HBOT improved symptoms, brain microstructure, and functionality in veterans with treatment-resistant PTSD.
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​Tal S, Hadanny A, Sasson E, Suzin G, Efrati S. Hyperbaric Oxygen Therapy Can Induce Angiogenesis and Regeneration of Nerve Fibers in Traumatic Brain Injury Patients. Front Hum Neurosci. 2017 Oct 19;11:508. doi: 10.3389/fnhum.2017.00508. PMID: 29097988; PMCID: PMC5654341.
Background:
Recent clinical studies in stroke and traumatic brain injury (TBI) victims suffering chronic neurological injury present evidence that hyperbaric oxygen therapy (HBOT) can induce neuroplasticity.
Results:
HBOT was initiated 6 months to 27 years (10.3 ± 3.2 years) from injury. After HBOT, DTI analysis showed significantly increased fractional anisotropy values and decreased mean diffusivity in both white and gray matter structures. In addition, the cerebral blood flow and volume were increased significantly. Clinically, HBOT induced significant improvement in the memory, executive functions, information processing speed and global cognitive scores.
Conclusions:
The mechanisms by which HBOT induces brain neuroplasticity can be demonstrated by highly sensitive MRI techniques of DSC and DTI. HBOT can induce cerebral angiogenesis and improve both white and gray microstructures indicating regeneration of nerve fibers. The micro structural changes correlate with the neurocognitive improvements.
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Hyperbaric oxygen therapy: A new look on treating stroke and traumatic brain injury
Gonzales-Portillo B, Lippert T, Nguyen H, Lee JY, Borlongan CV. Hyperbaric oxygen therapy: A new look on treating stroke and traumatic brain injury. Brain Circ. 2019 Sep 30;5(3):101-105. doi: 10.4103/bc.bc_31_19. PMID: 31620655; PMCID: PMC6785945.
Abstract
Although hyperbaric oxygen therapy (HBOT) is common as a treatment for injuries, this study aimed to research the ability of HBOT in preconditioning to diminish any potential damage. The hypothesis stated that HBOT preconditioning alleviated the death of cells in primary rat neuronal cells (PRNCs) by transferring mitochondria from astrocytes. In this experiment, PRNCs were given an HBOT treatment before a tumor necrosis factor-alpha or lipopolysaccharide injury which resembled cell death associated with stroke and traumatic brain injury (TBI). After being examined, the study found more cell viability in the PRNCs that had received HBOT precondition and a mitochondrial transfer. The mitochondrial transfer was visualized by a series of images showing the transfer after the HBOT treatment. This study demonstrated the ability of HBOT preconditioning as a treatment for inflammation in stroke and TBI, with the transfer of mitochondria from astrocytes to PRNCs reducing cell death. Along with the discussion of the study, this review also focuses on different stroke treatments in comparison with HBOT.
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B. Robert Mozayeni1,*, William Duncan2, Eddie Zant3, Tommy L. Love4, Robert L. Beckman1, Kenneth P. Stoller5 1 Foundation for the Study of Inflammatory Disease, Bethesda, MD, USA
2 Patriot Clinics, Oklahoma City, OK, USA
3 Hyperbaric Medicine Inc. of Florida, Destin, FL, USA
4 Concentra Medical Center, Salt Lake City, UT, USA
5 Hyperbaric Oxygen Therapy San Francisco, American College of Hyperbaric Medicine, San Francisco, CA, USA
Abstract: The National Brain Injury Rescue and Rehabilitation Project was established as a preliminary study to test the safety and practicality of multi-center hyperbaric oxygen administration for the post-concussive symptoms of chronic mild traumatic brain injury as a precursor to a pivotal, independent, multi-center, controlled clinical trial. This report presents the results for 32 subjects who completed a preliminary trial of hyperbaric oxygen several years before the passage of the 21st Century Cures Act. This study anticipated the Act and its reassessment of clinical research. Subjects received 40–82 one-hour treatments at 1.5 atmospheres absolute 100% oxygen. Outcome measures included repeated self-assessment measures and automated neurocognitive tests. The subjects demonstrated improvement in 21 of 25 neurocognitive test measures observed. The objective neurocognitive test components showed improvement in 13 of 17 measures. Earlier administration of hyperbaric oxygen post injury, younger age at the time of injury and hyperbaric oxygen administration, military status, and increased number of hyperbaric oxygen administrations were characteristics associated with improved outcomes. There were no adverse events. Hyperbaric oxygen was found to be safe, inexpensive and worthy of clinical application in the 21st Century model of facile data collection provided by recent research regulatory shifts in medicine. The study was approved by the ethics review committee of the Western Institutional Review Board
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Paul G. Harch*
Hyperbaric Medicine Unit, Section of Emergency Medicine, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
Background: Mild traumatic brain injury results in over 15% of patients progressing to Persistent Postconcussion Syndrome, a condition with significant consequences and limited treatment options. Hyperbaric oxygen therapy has been applied to Persistent Postconcussion Syndrome with conflicting results based on its historical understanding/definition as a disease-specific therapy. This is a systematic review of the evidence for hyperbaric oxygen therapy (HBOT) in Persistent Postconcussion Syndrome using a dose-analysis that is based on the scientific definition of hyperbaric oxygen therapy as a dual-component drug composed of increased barometric pressure and hyperoxia.
Methods: In this review, PubMed, CINAHL, and the Cochrane Systematic Review Database were searched from August 8–22, 2021 for all adult clinical studies published in English on hyperbaric oxygen therapy in mild traumatic brain injury Persistent Postconcussion Syndrome (symptoms present at least 3 months). Randomized trials and studies with symptomatic and/or cognitive outcomes were selected for final analysis. Randomized trials included those with no-treatment control groups or control groups defined by either the historical or scientific definition. Studies were analyzed according to the dose of oxygen and barometric pressure and classified as Levels 1–5 based on significant immediate post-treatment symptoms or cognitive outcomes compared to control groups. Levels of evidence classifications were made according to the Centre for Evidence-Based Medicine and a practice recommendation according to the American Society of Plastic Surgeons. Methodologic quality and bias were assessed according to the PEDro Scale.
Results: Eleven studies were included: six randomized trials, one case-controlled study, one case series, and three case reports. Whether analyzed by oxygen, pressure, or composite oxygen and pressure dose of hyperbaric therapy statistically significant symptomatic and cognitive improvements or cognitive improvements alone were achieved for patients treated with 40 HBOTS at 1.5 atmospheres absolute (ATA) (four randomized trials). Symptoms were also improved with 30 treatments at 1.3 ATA air (one study), positive and negative results were obtained at 1.2 ATA air (one positive and one negative study), and negative results in one study at 2.4 ATA oxygen. All studies involved
Conclusion: In multiple randomized and randomized controlled studies HBOT at 1.5 ATA oxygen demonstrated statistically significant symptomatic and cognitive or cognitive improvements alone in patients with mild traumatic brain injury Persistent Postconcussion Syndrome. Positive and negative results occurred at lower and higher doses of oxygen and pressure. Increased pressure within a narrow range appears to be the more important effect than increased oxygen which is effective over a broad range. Improvements were greater when patients had comorbid Post Traumatic Stress Disorder. Despite small sample sizes, the 1.5 ATA HBOT studies meet the Centre for Evidence-Based Medicine Level 1 criteria and an American Society of Plastic Surgeons Class A Recommendation for HBOT treatment of mild traumatic brain injury persistent postconcussion syndrome.
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