Page 1

The Science of HBOT in TBI

Page 1 of 9

The Science of HBOT in TBI James K. Wright, Col, MC, USAF (Ret.) Hyperbaric oxygen has been used to treat brain injury caused by carbon monoxide poisoning since 19601,2. It was recognized then that hyperbaric oxygen treatment had effects causing brain healing separate from the action to remove carbon monoxide from hemoglobin molecules. Since the adoption of oxygen treatment tables by the US Navy 1967 the brain injuries of decompression sickness and arterial gas embolism since have been effectively treated by HBOT3,4. HBOT was utilized in the treatment of ischemic stroke by the US Navy in 1969. In this case it was recognized that clinical improvement was associated with HBOT three months after the stroke and only occurred after HBOT5. Late hypoxic injury to the brain has also been treated successfully with HBOT6. The lack of high quality clinical trials demonstrating the efficacy of HBOT in brain injury has been used as a reason to deny treatment in cases where HBOT might be effective7. This report is offered as a summary of scientific evidence to date (2010) demonstrating the efficacy of HBOT in brain injury. Cellular effects of HBO Neurons are exquisitely sensitive to any change in oxygen concentration, whether offered as hypoxia or any form of hyperoxia such as an oxygen enriched environment, hyperbaric air, or hyperbaric oxygen. A change in oxygen concentration results in gene transcription by the neuron, especially in stress responses, transport/neurotransmission, and signal transduction8. Thousands of affected genes have been identified9. Several studies have identified HBOT as a direct or indirect DNA signaling agent10,11. HBOT has numerous cellular mechanisms of action which are neuroprotective and assist the injured brain to heal. These include: activation of ion channels, inhibition of hypoxia inducible factor-1alpha, up-regulation of Bcl-2, inhibition of MMP-9, decreased cyclooxygenase-2 activity, decreased myeloperoxidase activity, up-regulation of superoxide dismutase and inhibition of Nogo-A (an endogenous growth-inhibitory factor)12. HBOT enhances mitochondrial recovery and reduces apoptosis in hypoxic nerve cells13,14. HBOT promotes neural stem cell activation and growth15,16, and this effect is seen in the hypoxic damaged brain17,18,19. HBOT also alleviates hypoxic induced myelin damage20. HBOT increases cellular ATP levels and cognitive recovery after concussive injury21. These findings correlate with the cellular response in humans. For example, in children with autism treated with HBOT, markers of oxidative stress were significantly lowered22. Animal studies Any change in oxygen concentration after brain injury affects a plethora of cellular mechanisms through gene regulation. Supplemental oxygen either at normobaric or hyperbaric pressures limits leukocyte aggregation and attenuates the inflammatory cytokine response to ischemic stroke through gene expression with 5,769 differentially expressed genes identified23. Hyperoxia, induced by a hyperbaric oxygen therapy significantly enhances the mobilization of endothelial progenitor cells from the bone marrow into peripheral blood, leading to enhanced wound healing24. In neonatal rats subjected to ischemic injury, HBOT enhances the migration of neural stem cells to the


The Science of HBOT in TBI

Page 2 of 9

brain cortex and differentiation into mature neurocytes25. HBOT significantly enhances learning and memory when compared to sham-treated controls26. Prior to injury, HBOT offers neuroprotection through inhibition of the p38 phosphorylation pathway regulating cellular apoptosis and inflammatory gene transcription27. After hypoxic injury, HBOT can suppress apoptosis if administered within two hours; if administered after a delay it is still effective with increasing effectiveness as the number of hyperbaric treatments increase28. After hypoxic injury HBOT increases synaptic transmission efficiency, and improves central nervous electrophysiological conduction velocity and reduces neuronal death29. Balance beam scores in rats with cerebral contusions were improved after treatment with HBO30. In a focal cortical contusion model, Harch et al demonstrated improved cerebral vascularization and cognitive function through low pressure (1.5 ATA) HBOT31. These animal results correlate well with the clinical effects detailed below. Clinical effects

While the healing effects of HBOT in the acute treatment of decompression illness have been known for decades, the condition of the injured brain after the acute phase of illness was thought to be more or less “permanent�32. However, Harch et al have demonstrated the efficacy of HBOT at 1.5 ATA (HBOT 1.5) in healing decompression sickness brain injury late after injury in the chronic phase of illness33,34,35,36. Importantly, clinically stable divers with residual brain injury from decompression sickness had a significant positive response to HBOT 1.5, even when their condition was thought to be unchangeable37. HBOT has been shown to be clinically effective in mediating the effects of brain injury38. A number of clinicians have demonstrated that HBOT 1.5, when used late after brain injury from a variety of causes (cerebral palsy, hypoxia, carbon monoxide, drowning, and stroke) is capable of promoting clinical improvement. The number of reports and cases demonstrating the repeatedly beneficial effects of HBOT 1.5, when applied late after initial brain injury, makes it seem quite unlikely that these effects are mere chance39,40,41,42,43,44,45,46,47,48,49. Stroke Since the 1960s HBOT has been used in the treatment of stroke50. HBOT 1.5 has been applied to patients with chronic stroke51, often with dramatic improvement. In acute stroke HBOT has been shown to be effective52. Conducting controlled clinical trials on acute stroke patients is difficult and studies have had to be terminated before efficacy or lack thereof could be proven53. HBOT appears to support hypoxic areas of the brain acutely after stroke and it has been used to identify patients who would benefit from surgical intervention54. There are individual case reports of the use of HBOT for stroke with success55. As with other brain injuries the provision of HBOT at pressures greater than 1.5 ATA may be harmful56. Some clinical trials of HBOT in stroke have failed to show efficacy, probably as a result of delay in receiving treatment, small sample sizes, and the use of excessive (> HBOT 1.5) chamber pressures as well as the use of pressurized air (shown to have neurologic effects) as a control57. HBOT has been used efficaciously in stroke to promote neuroprotection and recovery58. And it has dramatic results in stroke caused by air emboli59. Long term HBOT has shown promise as a treatment for ischemic stroke60. Traumatic brain injury (TBI) Recent research has demonstrated the efficacy of HBOT for traumatic brain injury, even


The Science of HBOT in TBI

Page 3 of 9

when administered years after injury. In acute severe TBI HBOT has been shown to be effective in reducing mortality61. Harch et al. demonstrated consistent SPECT brain imaging improvements (showing improved brain blood flow) in chronic TBI patients treated with HBOT 1.562,63,64,65. Since the original work of Dr. Neubauer and Harch, the efficacy of HBOT 1.5 in stable TBI has been well documented66,67. Patients with abnormal SPECT scans showing brain blood flow in TBI show consistent improvement after HBOT 1.568. To date Dr. Harch has treated more than 60 TBI patients with HBOT 1.5 showing consistent, and sometimes dramatic, clinically relevant improvements (personal communication). Using the identical HBOT 1.5 protocol in an unrelated center in Florida, Dr. Eddie Zant has achieved similar results - improvement in all of 13 military and former military TBI patients. Many patients were unable to work in their military occupations or to attend college. All those working were able to retain their military or civilian jobs and those who had dropped out of college courses were able to resume their studies after treatment (see attached spreadsheet, courtesy Dr. Eddie Zant). Table:  Dr. Eddie Zant HBOT 1.5 TBI results  Age

Sx

58 24 24

HA, CD, MD, A, D, F HA, CD, MD, A, I, D, SD, F HA, CD, MD, A, I, SD, F

# HBOT 80, 20, 20 80 40

28

HA, CD, SD, MD

40

25 25 32 33 28 27 35 40 23

HA, CD, MD, A, I, D, SD, F HA, CD, MD, I, D, SD, F HA, CD, MD, A, I, D, SD, F CD, MD HA, CD, MD, A, I, D, SD HA, I, F, I, SD, CD HA ,I, F, SD, MD, D MD, CD, MD, HA, CD, D, I

19* 40 40 40 35* 26* 15* 10* 2*

* A ADL CD D F HA I MD SD

Abbreviations treatment in progress ataxia, coordination, balance problems activities of daily living cognitive deficit depression fatigue headache irritability memory deficits sleep disturbances

Clinical outcome resumed full civilian duties retained, resumed full duties, promoted retained, resumed full duties, promoted no difficulties, improved to pre injury condn Improved, MEB recalled, resumed full duties resumed full duties, much improved performs ADL, much improved much improved improved improved, returned to school improved, resumed duties Improved, too early to assess too early to assess


The Science of HBOT in TBI

Page 4 of 9

Similarly, Dr. Harch recently reported dramatic improvement in a series of 15 patients treated with HBOT 1.5 in a clinical trial of military acquired TBI 69. Recent reports have also shown promising results for HBOT 1.5 for blast related TBI in the War on Terror70; in two airmen with pre injury neuropsychiatric testing and chronic stable TBI symptoms, HBOT 1.5 resulted in resolution of symptoms as well as a return to the pre-injury values for testing71. In a randomized controlled trial of stable severe TBI treated with HBOT 1.5 Lin et al. demonstrated improvement in the Glasgow Coma Scale72. Rockswold has demonstrated improvement in the Glasgow Coma Scale and reduced mortality in acute TBI patients undergoing HBOT with minimal risk73,74. HBOT 1.5 in this group of acute patients appears safe and does not produce oxygen toxicity75. Other individual trials also have demonstrated the efficacy of HBOT 1.5 for chronic stable TBI76. A 310 patient Chinese trial demonstrated improvement clinically, in neuropsychiatric testing, as well as in SPECT scans after HBOT 1.577. In a randomized controlled trial of 21 brain injured adults, HBOT 1.5 resulted in improved neuropsychiatric testing for the treated group78. Summary The treatment of traumatic brain injury with hyperbaric oxygen is evolving rapidly. A plethora of cellular studies demonstrate the mechanisms of favorable action of HBOT. Animal studies demonstrate the almost universal utility of HBOT for a variety of traumatic and ischemic brain injuries. Hundreds of patients have benefited from HBOT for brain injury. Controlled randomized clinical trials have demonstrated efficacy of HBOT for traumatic brain injury.

James K. Wright, MD 11 May 2010


The Science of HBOT in TBI

Page 5 of 9

                                                         1

Sluiter ME. The treatment of carbon monoxide poisoning by the administration of oxygen at high atmospheric pressure. Proc R Soc Med. 1963 Nov;56:1002-8. 2 Smith G, Sharp GR. Lancet 1960; 2: 905. 3 Duff JH, Shibata HR, Vanschaik L, Usher R, Wigmore RA, MacLean LD. Hyperbaric oxygen: a review of treatment in eighty-three patients. Can Med Assoc J. 1967 Sep 2;97(10):510-5. 4 Workman RD, Oxygen decompression following air dives for use in hyperbaric oxygen therapy. Res Rep 2-64. Rep US Navy Exp Diving Unit. 1964 Dec 15:1-10. 5 Hart GB, Thompson RE. The treatment of cerebral ischemia with hyperbaric oxygen (OHP). Stroke. 1971 May-Jun;2(3):247-50. 6 Neubauer RA, James P. Cerebral oxygenation and the recoverable brain. Neurol Res. 1998;20 Suppl 1:S33-6. 7 Paris JJ, Schreiber MD, Reardon FE. Hyperbaric oxygen therapy for a neurologically devastated child: whose decision is it? J Perinatol. 2003 Apr-May;23(3):250-3. 8 Chen Y, Nadi NS, Chavko M, Auker CR, McCarron RM. Microarray analysis of gene expression in rat cortical neurons exposed to hyperbaric air and oxygen. Neurochem Res. 2009 Jun;34(6):1047-56. Epub 2008 Nov 18. 9 Rink C, Roy S, Khan M, Ananth P, Kuppusamy P, Sen CK, Khanna S. Oxygen-sensitive outcomes and gene expression in acute ischemic stroke. J Cereb Blood Flow Metab. 2010 Feb 10. 10 Hai Y, Tian RL, Pan XW, Luan Z, Song LW. Effects of hyperbaric oxygen on brain bfgf and mRNA expression of neonatal rats after hypoxia-ischemia injury. Undersea Hyper Med 2001;28 Suppl:30. 11 Bonomo SR, Davidson JD, Yu Y, et al. Hyperbaric oxygen as a signal transducer: upregulation of platelet derived growth factor-beta receptor in the presence of HBO2 and PDGF. Undersea Hyperb Med, 1998;25(4):211-6. 12 Matchett GA, Martin RD, Zhang JH. Hyperbaric oxygen therapy and cerebral ischemia: neuroprotective mechanisms. Neurol Res. 2009 Mar;31(2):114-21. 13 Rockswold SB, Rockswold GL, Defillo A. Hyperbaric oxygen in traumatic brain injury. Neurol Res. 2007 Mar;29(2):162-72. 14 Palzur E, Zaaroor M, Vlodavsky E, Milman F, Soustiel JF. Neuroprotective effect of hyperbaric oxygen therapy in brain injury is mediated by preservation of mitochondrial membrane properties. Brain Res. 2008 Jul 24;1221:126-33. Epub 2008 May 11. 15 Wang XL, Zhao YS, Yang YJ, Xie M, Yu XH. Therapeutic window of hyperbaric oxygen therapy for hypoxic-ischemic brain damage in newborn rats. Brain Res. 2008 Jul 30;1222:87-94. Epub 2008 May 18. 16 Yang YJ, Wang XL, Yu XH, Wang X, Xie M, Liu CT. Hyperbaric oxygen induces endogenous neural stem cells to proliferate and differentiate in hypoxic-ischemic brain damage in neonatal rats. Undersea Hyperb Med. 2008 Mar-Apr;35(2):113-29. 17 Bai J, Luan Z, Zhou CL, Qu SQ, Jiang Y, Wang ZY. [Effect of hyperbaric oxygenation on the differentiation of implanted human neural stem cells into neurons in vivo] Zhongguo Dang Dai Er Ke Za Zhi. 2008 Apr;10(2):195-8. 18 Wang XL, Yang YJ, Xie M, Yu XH, Liu CT, Wang X. Proliferation of neural stem cells correlates with Wnt-3 protein in hypoxic-ischemic neonate rats after hyperbaric oxygen therapy. Neuroreport. 2007 Oct 29;18(16):1753-6. 19 Wang XL, Zhao YS, Yang YJ, Xie M, Yu XH. Therapeutic window of hyperbaric oxygen therapy for hypoxic-ischemic brain damage in newborn rats. Brain Res. 2008 Jul 30;1222:87-94. Epub 2008 May 18. 20 Yu XH, Yang YJ, Wang X, Wang QH, Xie M, Qi BX, Liu CT, Wang XL, Jia YJ, Zhong L. [Effect of hyperbaric oxygenation on neural stem cells and myelin in neonatal rats with hypoxic-ischemic brain damage] Zhongguo Dang Dai Er Ke Za Zhi. 2006 Feb;8(1):33-7.[Article in Chinese] 21 Zhou Z, Daugherty WP, Sun D, Levasseur JE, Altememi N, Hamm RJ, Rockswold GL,Bullock MR. Protection of mitochondrial function and improvement in cognitive recovery in rats treated


The Science of HBOT in TBI

Page 6 of 9

                                                                                                                                                                     with hyperbaric oxygen following lateral fluid-percussion injury. J Neurosurg. 2007 Apr;106(4):687-94. 22 Rossignol DA, Rossignol LW, James SJ, Melnyk S, Mumper E. The effects of hyperbaric oxygen therapy on oxidative stress, inflammation, and symptoms in children with autism: an open-label pilot study. BMC Pediatr. 2007 Nov 16;7:36. 23 Rink C op. cit. 24 Liu ZJ, Velazquez OC. Hyperoxia, endothelial progenitor cell mobilization, and diabetic wound healing. Antioxid Redox Signal. 2008 Nov;10(11):1869-82. 25 Wang XL, Yang YJ, Xie M, Yu XH, Wang QH. [Hyperbaric oxygen promotes the migration and differentiation of endogenous neural stem cells in neonatal rats with hypoxicischemic brain damage]. Zhongguo Dang Dai Er Ke Za Zhi. 2009 Sep;11(9):749-52. Chinese. 26 Chen J, Chen YH. [Effects of hyperbaric oxygen on synaptic ultrastructure and synaptophysin expression in hippocampus of neonatal rats with hypoxic-ischemic brain damage.]. Zhonghua Er Ke Za Zhi. 2010 Mar;48(3):199-203. Chinese. 27 Yamashita S, Hirata T, Mizukami Y, Cui YJ, Fukuda S, Ishida K, Matsumoto M, Sakabe T. Repeated preconditioning with hyperbaric oxygen induces neuroprotection against forebrain ischemia via suppression of p38 mitogen activated protein kinase. Brain Res. 2009 Dec 8;1301:171-9. Epub 2009 Sep 9. 28 Wang QH, Yang YJ, Chen CF, Yao Y, Li M. [Protective effects of delayed multiple course hyperbaric oxygen treatment against hypoxic-ischemic brain damage in neonatal rats]. Zhongguo Dang Dai Er Ke Za Zhi. 2009 Jun;11(6):464-70. Chinese. 29 Chen J, Chen YH. [Effects of hyperbaric oxygen on intrauterine hypoxic-ischemic brain damage in neonatal rats]. Zhongguo Dang Dai Er Ke Za Zhi. 2009 May;11(5):380-3. Chinese. 30 Tinianow CL, Tinianow TK, Wilcox M. Effects of hyperbaric oxygen on focal brain contusions. Biomed Sci Instrum. 2000;36:275-81. 31 Harch PG, Kriedt CL, Weisand MP, Van Meter KW, Sutherland RJ. Low pressure hyperbaric oxygen therapy (HBOT 1.5) induces cerebrovascular changes and improves cognitive function in a rat traumatic brain injury (TBI) model. Undersea Hyper Med 2001; 28 Suppl :28. 32 U.S. Navy Diving Manual, Volume 1. NAVSEA 0994-LP-001-9010, Revision 1, 1 June 1985. Sec. 2.4.6.1, p2-20. Best Publishing Co., Flagstaff, AZ; Moon RE, Gorman DF. Treatment of the Decompression Disorders, Chapter 18. In: The Physiology and Medicine of Diving, 4th Edition, eds. Bennett P, Elliott D. W. B. Saunders Company, Ltd. London, 1993. 33 Harch PG, Gottlieb SF, Van Meter KW, Staab P. SPECT brain imaging in the diagnosis and treatment of type II decompression sickness. Undersea Hyper Med, 1992;19(Suppl):42. Harch PG. Late treatment of decompression illness and use of SPECT brain imaging. In: Moon RE, Sheffield PE, editors. Treatment of decompression illness. 45th Workshop of the Undersea and Hyperbaric Medical Society. Kensington (MD) UHMS, 1995, 203-42; Barratt DM, Harch PG, Van Meter K. Decompression illness in divers: A review of the literature. Neurologist 2002; 8:186202. 34 Harch PG, Van Meter KW, Gottlieb SF, Staab P. 29. Harch PG, et al. Delayed treatment of type II DCS: the importance of HBOT 1.5 and HMPAO SPECT brain imaging in its diagnosis and treatment. Undersea Hyper Med, 1993;20(Suppl):51 35 Harch PG, Van Meter KW, Gottlieb SF, Staab P. The effect of HBOT tailing treatment on neurological residual and SPECT brain images in type II (cerebral) DCI/CAGE. Undersea and Hyper Med, 1994;21(Suppl):22-23. 36 Harch PG. Late treatment of decompression illness and use of SPECT brain imaging. In: Moon RE, Sheffield PE, editors. Treatment of decompression illness. 45th Workshop of the Undersea and Hyperbaric Medical Society. Kensington (MD) UHMS, 1995, 203-42; Barratt DM, Harch PG, Van Meter K. Decompression illness in divers: A review of the literature. Neurologist 2002; 8:186202. 37 Harch PG. Late treatment of decompression illness and use of SPECT brain imaging. In: Moon RE, Sheffield PE, editors. Treatment of decompression illness. 45th Workshop of the Undersea and Hyperbaric Medical Society. Kensington (MD) UHMS, 1995, 203-42.


The Science of HBOT in TBI

Page 7 of 9

                                                                                                                                                                     38

Shi XY, Tang ZQ, Xiong B, Bao JX, Sun D, Zhang YQ, Yao Y. Cerebral perfusion SPECT imaging for assessment of the effect of hyperbaric oxygen therapy on patients with postbrain injury neural status. Chin J Traumatol. 2003 Dec;6(6):346-9. 39 Neubauer RA. The effect of hyperbaric oxygen in prolonged coma. Possible identification of marginally functioning brain zones. Minerva Med Subaecquea ed Iperbarica, 1985;5:75. 40 Shn-rong Z. Hyperbaric oxygen therapy for coma (a report of 336 cases). In: Procedures of the XIth International Congress on Hyperbaric Medicine, eds. Li W-ren, Cramer FS. Best Publishing Co, Flagstaff, AZ, 1995. p.279-285. 41 Neubauer RA. Severe natural gas poisoning successfully treated with hyperbaric oxygen – 2 years later. Neurotoxicology and Occupational Neurology, 1990;10. 42 Eltorai I, Montroy R. Hyperbaric oxygen therapy leading to recovery of a 6-week comatose patient afflicted by anoxic encephalopathy and posttraumatic edema. J Hyperbaric Med, 1991;6: 189-198. 43 Neubauer RA. Severe natural gas poisoning successfully treated with hyperbaric oxygen – 2 years later. Neurotoxicology and Occupational Neurology, 1990;10; Harch PG, Van Meter KW, Gottlieb SF, Staab P. HMPAO SPECT brain imaging of acute CO poisoning and delayed neuropsychological sequelae (DNSS). Undersea & Hyperbaric Medicine, 1994; 21 (Suppl): 15. 44 Neubauer RA, Gottlieb SF, Miale A, Jr. Identification of hypometabolic areas in the brain using brain imaging and hyperbaric oxygen. Clin Nucl Med 1992;17(6):477-81. 45 Harch PG, Neubauer RA (1999) Hyperbaric oxygen therapy in global cerebral ischemia/ anoxia and coma. In Jain KK (ed) Textbook of Hyperbaric Medicine, 3rd Revised Edition, Chapter 18. Hogrefe & Huber Publishers, Seattle WA 1999: 319-345. 46 Neubauer RA, James P. Cerebral oxygenation and the recoverable brain. Neurol Res, 1998;20(Suppl 1): S33-S36. 47 Harch PG, Van Meter KW, Gottlieb SF, Staab P. HMPAO SPECT brain imaging and HBOT 1.5 in the diagnosis and treatment of chronic traumatic, ischemic, hypoxic and anoxic encephalopathies. Undersea and Hyperbaric Medicine, 1994;21(Suppl):30. Neubauer RA, James P. Cerebral oxygenation and the recoverable brain. Neurol Res, 1998;20(Suppl 1): S33-S36. 48 Harch PG, Van Meter KW, Gottlieb SF, Staab P. HMPAO SPECT brain imaging and HBOT 1.5 in the diagnosis and treatment of chronic traumatic, ischemic, hypoxic and anoxic encephalopathies. Undersea and Hyperbaric Medicine, 1994;21(Suppl):30. 49 Golden ZL, Neubauer R, Golden CJ, Greene L, Marsh J, Mleko A Improvement in cerebral metabolism in chronic brain injury after hyperbaric oxygen therapy. Intern. J. Neuroscience 2002;112:119-131. 50 Heyman A, Saltzman HA, Whalen RE. The use of hyperbaric oxygenation in the treatment of cerebral ischemia and infarction. Circulation. 1966 May;33(5 Suppl):II20-7. 51 Neubauer RA, End E. Hyperbaric Oxygenation as an Adjunct Therapy in Strokes Due to Thrombosis. Stroke, 1980;11(3):297-300; Jain KK. The Role of Hyperbaric Oxygenation in the Management of Stroke. In Jain KK (ed) Textbook of Hyperbaric Medicine, 2nd Edition; Hogrefe & Huber, Bern, 1996;17: 253-273. 52 Isakov IuV, Pravdenkova SV. [Respiratory and central hemodynamic responses during a session of hyperbaric oxygenation in patients with acute cerebral circulatory disorders]. Zh Nevropatol Psikhiatr Im S S Korsakova. 1981;81(8):1158-62. Russian. 53 Anderson DC, Bottini AG, Jagiella WM, Westphal B, Ford S, Rockswold GL,Loewenson RB. A pilot study of hyperbaric oxygen in the treatment of human stroke. Stroke. 1991 Sep;22(9):113742. 54 Kanno T, Nagata J, Nonomura K, Asai T, Inoue T, Nakagawa T, Mitsuyama F. New approaches in the treatment of hypertensive intracerebral hemorrhage. Stroke. 1993 Dec;24(12 Suppl):I96-100; discussion I107-8. 55 Lim J, Lim WK, Yeo TT, Sitoh YY, Low E. Management of haemorrhagic stroke with hyperbaric oxygen therapy--a case report. Singapore Med J. 2001 May;42(5):220-3. 56 Rusyniak DE, Kirk MA, May JD, Kao LW, Brizendine EJ, Welch JL, Cordell WH, Alonso RJ; Hyperbaric Oxygen in Acute Ischemic Stroke Trial Pilot Study. Hyperbaric oxygen therapy in


The Science of HBOT in TBI

Page 8 of 9

                                                                                                                                                                     acute ischemic stroke: results of the Hyperbaric Oxygen in Acute Ischemic Stroke Trial Pilot Study. Stroke. 2003 Feb;34(2):571-4. 57 Singhal AB. A review of oxygen therapy in ischemic stroke. Neurol Res. 2007 Mar;29(2):17383. Review. 58 Zhang JH, Lo T, Mychaskiw G, Colohan A. Mechanisms of hyperbaric oxygen and neuroprotection in stroke. Pathophysiology. 2005 Jul;12(1):63-77. 59 Gibson AJ, Davis FM. Hyperbaric oxygen therapy in the treatment of post cardiac surgical strokes--a case series and review of the literature. Anaesth Intensive Care. 2010 Jan;38(1):17584. Review. 60 Kidd PM. Integrated brain restoration after ischemic stroke—medical management, risk factors, nutrients, and other interventions for managing inflammation and enhancing brain plasticity. Altern Med Rev. 2009 Mar;14(1):14-35. 61 Clifton GL. Hypothermia and hyperbaric oxygen as treatment modalities for severe head injury. New Horiz. 1995 Aug;3(3):474-8. Review. 62 Harch PG, Van Meter KW, Gottlieb SF, Staab P. HMPAO SPECT brain imaging and low pressure HBOT in the diagnosis and treatment of chronic traumatic, ischemic, hypoxic and anoxic encephalopathies. Undersea and Hyperbaric Medicine, 1994;21(Suppl):30. Harch PG, Neubauer RA (1999) Hyperbaric oxygen therapy in global cerebral ischemia/ anoxia and coma. In Jain KK (ed) Textbook of Hyperbaric Medicine, 3rd Revised Edition, Chapter 18. Hogrefe & Huber Publishers, Seattle WA 1999: 319-345. 63 Harch PG, Van Meter KW, Neubauer RA, Gottlieb SF. Use of HMPAO SPECT for assessment of response to HBO in ischemic/hypoxic encephalopathies. In: Jain KK editor. Textbook of Hyperbaric Medicine, Appendix, 2nd ed, 480-491. Seattle (WA): Hogrefe &Huber Pubs., 1996. 64 Harch PG, Neubauer RA (1999) Hyperbaric oxygen therapy in global cerebral ischemia/ anoxia and coma. In Jain KK (ed) Textbook of Hyperbaric Medicine, 3rd Revised Edition, Chapter 18. Hogrefe & Huber Publishers, Seattle WA 1999: 319-345. 65 Harch PG, Neubauer RA (1999) Hyperbaric oxygen therapy in global cerebral ischemia/ anoxia and coma. In Jain KK (ed) Textbook of Hyperbaric Medicine, 3rd Revised Edition, Chapter 18. Hogrefe & Huber Publishers, Seattle WA 1999: 319-345. 66 Neubauer RA, Gottlieb SF, Pevsner NH. Hyperbaric Oxygen for Treatment of Closed Head Injury. Southern Medical Journal, 1994;87(9):933-936 67 Barrett KF, Masel BE, Harch PG, et al. Cerebral blood flow changes and cognitive improvement in chronic stable traumatic brain injuries treated with hyperbaric oxygen therapy. Neurol, April, 1998 (Suppl):A178-A179. 68 Barrett, 1998. 69 Harch PG, Andrews SR, Fogarty E, Lucarini J, Aubrey C, Staab PK, Van Meter KW. Hyperbaric Oxygen Therapy Treatment of Chronic Mild-Moderate Blast-Induced Traumatic Brain Injury/Post Concussion Syndrome with Post Traumatic Stress Disorder: Pilot Trial. Presented at 8th World Congress on Brain Injury, Washington DC, March 11, 2010 70 Harch PG, Fogarty EF, Staab PK, Van Meter K. Low pressure hyperbaric oxygen therapy and SPECT brain imaging in the treatment of blast-induced chronic traumatic brain injury (postconcussion syndrome) and post traumatic stress disorder: a case report. Cases J. 2009 Jun 9;2:6538. 71 Wright JK, Zant E, Groom K, Schlegel RE, Gilliland K. Case report: Treatment of mild traumatic brain injury with hyperbaric oxygen. Undersea Hyperb Med. 2009 Nov-Dec;36(6):391-9. 72 Lin JW, Tsai JT, Lee LM, Lin CM, Hung CC, Hung KS, Chen WY, Wei L, Ko CP, Su YK, Chiu WT. Effect of hyperbaric oxygen on patients with traumatic brain injury. Acta Neurochir Suppl. 2008;101:145-9. 73 Rockswold SB, Rockswold GL, Zaun DA, Zhang X, Cerra CE, Bergman TA, Liu J. A prospective, randomized clinical trial to compare the effect of hyperbaric to normobaric hyperoxia on cerebral metabolism, intracranial pressure, and oxygen toxicity in severe traumatic brain injury. J Neurosurg. 2010 May;112(5):1080-94. 74 Rockswold SB, Rockswold GL, Defillo A. Hyperbaric oxygen in traumatic brain injury. Neurol Res. 2007 Mar;29(2):162-72. Review.


The Science of HBOT in TBI

Page 9 of 9

                                                                                                                                                                     75

Rockswold SB, Rockswold GL, Defillo A. Hyperbaric oxygen in traumatic brain injury. Neurol Res. 2007 Mar;29(2):162-72. Review. 76 Hardy P, Johnston KM, De Beaumont L, Montgomery DL, Lecomte JM, Soucy JP, Bourbonnais D, Lassonde M. Pilot case study of the therapeutic potential of hyperbaric oxygen therapy on chronic brain injury. J Neurol Sci. 2007 Feb 15;253(1-2):94-105. Epub 2007 Jan 16. 77 Shi XY, Tang ZQ, Sun D, He XJ. Evaluation of hyperbaric oxygen treatment of neuropsychiatric disorders following traumatic brain injury. Chin Med J (Engl). 2006 Dec 5;119(23):1978-82. 78 Golden Z, Golden CJ, Neubauer RA. Improving neuropsychological function after chronic brain injury with hyperbaric oxygen. Disabil Rehabil. 2006 Nov 30;28(22):1379-86.

Science of Hyperbaric Oxygen Therapy in Traumatic Brain Injury  

Science of Hyperbaric Oxygen Therapy in Traumatic Brain Injury

Read more
Read more
Similar to
Popular now
Just for you