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Med Gas Res. 2017 Oct 17;7(3):156-174. doi: 10.4103/2045-9912.215745. eCollection 2017 Jul-Sep.

Case control study: hyperbaric oxygen treatment of mild traumatic brain injury persistent post-concussion syndrome and post-traumatic stress disorder.

Author information

1
Louisiana State University School of Medicine, New Orleans, LA, USA.
2
University of North Dakota School of Medicine, Bismarck, ND, USA.

Abstract

Mild traumatic brain injury (TBI) persistent post-concussion syndrome (PPCS) and post-traumatic stress disorder (PTSD) are epidemic in United States Iraq and Afghanistan War veterans. Treatment of the combined diagnoses is limited. The aim of this study is to assess safety, feasibility, and effectiveness of hyperbaric oxygen treatments (HBOT) for mild TBI PPCS and PTSD. Thirty military subjects aged 18-65 with PPCS with or without PTSD and from one or more blast-induced mild-moderate traumatic brain injuries that were a minimum of 1 year old and occurred after 9/11/2001 were studied. The measures included symptom lists, physical exam, neuropsychological and psychological testing on 29 subjects (1 dropout) and SPECT brain imaging pre and post HBOT. Comparison was made using SPECT imaging on 29 matched Controls. Side effects (30 subjects) experienced due to the HBOT: reversible middle ear barotrauma (n = 6), transient deterioration in symptoms (n = 7), reversible bronchospasm (n = 1), and increased anxiety (n = 2; not related to confinement); unrelated to HBOT: ureterolithiasis (n = 1), chest pain (n = 2). Significant improvement (29 subjects) was seen in neurological exam, symptoms, intelligence quotient, memory, measures of attention, dominant hand motor speed and dexterity, quality of life, general anxiety, PTSD, depression (including reduction in suicidal ideation), and reduced psychoactive medication usage. At 6-month follow-up subjects reported further symptomatic improvement. Compared to Controls the subjects' SPECT was significantly abnormal, significantly improved after 1 and 40 treatments, and became statistically indistinguishable from Controls in 75% of abnormal areas. HBOT was found to be safe and significantly effective for veterans with mild to moderate TBI PPCS with PTSD in all four outcome domains: clinical medicine, neuropsychology, psychology, and SPECT imaging. Veterans also experienced a significant reduction in suicidal ideation and reduction in psychoactive medication use.

KEYWORDS:

brain injury treatment; cognitive assessment; combat veterans; hyperbaric oxygen; persistent post concussion syndrome; post traumatic stress disorder; single photon emission computed tomography; traumatic brain injury

Conflict of interest statement

Conflicts of interest Dr. Harch owns a small hyperbaric medicine consulting company. He derives income from the treatment facility that is the primary location of his medical practice. He is on the board of directors of the International Hyperbaric Medical Association, a non-profit professional organization, and derives no income from this organization. Dr. Fogarty is president of the International Hyperbaric Medical Foundation (IHMF), a non-profit corporation that promotes education, research, and teaching in hyperbaric medicine. He also owns a holding company for a mobile hyperbaric clinic. Dr. Andrews has no competing financial interests. Juliette Lucarini, is co-owner of the hyperbaric consulting company with Paul G. Harch, M.D. Dr. Van Meter owns a hyperbaric equipment leasing company and contracts with hospitals to provide hyperbaric medicine physician staffing. Dr. Van Meter also owns the treatment facility. Partial presentation of a small subset of data at HBOT 2014 (The 9th International Symposium on Hyperbaric Oxygenation: Roadmap for the Future). Presented two slides on P values for the cognitive and quality of life outcomes for the first 24 subjects, compared to the first 15 subjects, in a lecture on review of the science and literature of HBOT in persistent post-concussion syndrome. None of the imaging, demographics, and content of the tables in this manuscript were presented at that meeting.

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