A Phase I Study of Low-Pressure Hyperbaric Oxygen Therapy for Blast-Induced Post-Concussion Syndrome and Post-Traumatic Stress Disorder

Abstract

This is a preliminary report on the safety and efficacy of 1.5 ATA hyperbaric oxygen therapy (HBOT) in military subjects with chronic blast-induced mild to moderate traumatic brain injury (TBI)/post-concussion syndrome (PCS) and post-traumatic stress disorder (PTSD). Sixteen military subjects received 40 1.5 ATA/60 min HBOT sessions in 30 days. Symptoms, physical and neurological exams, SPECT brain imaging, and neuropsychological and psychological testing were completed before and within 1 week after treatment. Subjects experienced reversible middle ear barotrauma (5), transient deterioration in symptoms (4), and reversible bronchospasm (1); one subject withdrew. Post-treatment testing demonstrated significant improvement in: symptoms, neurological exam, full-scale IQ (+14.8 points; p<0.001), WMS IV Delayed Memory (p=0.026), WMS-IV Working Memory (p=0.003), Stroop Test (p<0.001), TOVA Impulsivity (p=0.041), TOVA Variability (p=0.045), Grooved Pegboard (p=0.028), PCS symptoms (Rivermead PCSQ: p=0.0002), PTSD symptoms (PCL-M: p<0.001), depression (PHQ-9: p<0.001), anxiety (GAD-7: p=0.007), quality of life (MPQoL: p=0.003), and self-report of percent of normal (p<0.001), SPECT coefficient of variation in all white matter and some gray matter ROIs after the first HBOT, and in half of white matter ROIs after 40 HBOT sessions, and SPECT statistical parametric mapping analysis (diffuse improvements in regional cerebral blood flow after 1 and 40 HBOT sessions). Forty 1.5 ATA HBOT sessions in 1 month was safe in a military cohort with chronic blast-induced PCS and PTSD. Significant improvements occurred in symptoms, abnormal physical exam findings, cognitive testing, and quality-of-life measurements, with concomitant significant improvements in SPECT.

A prospective, randomized Phase II clinical trial to evaluate the effect of combined hyperbaric and normobaric hyperoxia on cerebral metabolism, intracranial pressure, oxygen toxicity, and clinical outcome in severe traumatic brain injury

“…There have been investigations of HBO 2 therapy for blast-induced postconcussion syndrome and posttraumatic stress disorder. 22 The patients experienced their injuries at least 12 months prior to HBO 2 treatment. The preliminary report by Harch et al 22 suggests that HBO 2 should be studied in a larger catchment of patients.…”

“…22 The patients experienced their injuries at least 12 months prior to HBO 2 treatment. The preliminary report by Harch et al 22 suggests that HBO 2 should be studied in a larger catchment of patients. The mechanism of action of HBO 2 in this setting has not been clearly delineated.…”

Sport-related structural brain injury associated with arachnoid cysts: a systematic review and quantitative analysis

“…PCS is a well-studied entity across many populations after general trauma, military blast injury, and SRC. 25,39,67,69 Tator et al 69 comprehensively described the phenotype of PCS across 138 athletes, where most patients were younger than 30 years with an average of 7.6 symptoms for a median of 6 months. As both populations have symptom duration of weeks to months, differentiating between a recovering PCS patient with no structural injury versus one with an AC associated SDH or hygroma becomes challenging.…”

Traumatic Brain Injury Among North Carolina’s Veterans

“…However, recent scientific studies published in the Journal of Neurotrauma [14] and by the Sackler School of Medicine of Tel Aviv University [15] report that TBI subjects with posttable 2.…”