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There's quite a bit of attention currently on the effects of repetitive concussion, which can lead to post-concussive syndrome and Chronic Traumatic Encephalopathy (CTE). CTE is most often linked with football and other contact sports, and occurs when the brain repeatedly sustains mild to moderate concussive impact, leading to accumulative micro-damage.

Behavior changes, like irritability, aggression, and difficulty with focus, are the most common symptoms. For a detailed look at this condition, check out the eye-opening book, "When Brains Collide," by Michael Lewis.

Conventional medical treatment options are somewhat limited, and may include medication management and rehabilitation. This column takes a look at a novel treatment that shows promise: Hyperbaric Oxygen Therapy, or HBOT.

Brief background

Hyperbaric therapy works with pressure as a medical tool (hyper for increased and baric for atmospheric pressure). In chemistry, Henry's Law tells us that the amount of a gas (oxygen) dissolved into a fluid (blood) increases with pressure. By ramping up atmospheric pressure to varying levels, hyperbaric chambers increase oxygen supply and delivery to body tissues.

Treatment involves physically going inside a pressurized chamber for an hour or so, with repeat sessions for a certain number of days. At sea level, around 0.3 mL of oxygen will dissolve into 100 mL of serum. At 1.3 atmospheres, HBOT increases oxygen by a factor of 7 times, hyper-oxygenating body tissues.

By pulsing tissue oxygenation, HBOT activates various healing pathways - promoting stem cell activation in bone marrow, lowering inflammation, enhancing blood vessel growth, and improving immune health. Steel-sided chambers create higher pressures for enhanced wound healing, acute anemia recovery, and the benz, or decompression sickness.

Soft-sided, chambers create lower pressures ranging from 1.3 to 1.5 atmospheres, and show promise for treating mild traumatic brain injury mTBI in emerging research. Currently, HBOT treatment for head injury is considered an off-label by the FDA.

A look at the evidence

With brain injury, there is essentially a bruise inside the cranium, leading to swelling that causes symptoms like confusion, vomiting, and light sensitivity. Pathological changes from CTE and mTBI can be detected using SPECT neuroimaging. SPECT is a unique type of imaging that assesses changes in blood flow, and creates a 3D brain map, and is used to monitor changes with HBOT treatment. Treatments with lower pressure chambers is associated with positive outcomes, including enhanced healing time and improved long-term symptoms.

In research, the typical HBOT protocol is 40 hours at 1.5 atmospheres over one month - which is compared to baseline.

In 2012, researchers at the University of Louisiana School of Medicine embarked on a study of 16 military personnel diagnosed with post-concussion syndrome. Dr. Paul Harch, a leader in hyperbaric medicine, pioneered this project. All 16 subjects completed a series of tests and SPECT scans before starting. After one month, there was marked improvement in concussive symptoms, cognitive tests, and self-reported quality of life.

SPECT imaging discovered increases in healthy cerebral blood flow for most participants. A larger scale study at Tel Aviv University in 2013 tracked 56 patients with mTBI. Scientists used a similar approach to monitor changes, including physical exam and SPECT imaging. In this study, participants underwent 40 sessions spread over two months, and experienced brain healing and repair along with improvements on SPECT imaging as well.

Safety

Common side effects with HBOT include ear pain and reversible lung spasm. At low pressures (between 1.3 and 1.5 atmospheres) HBOT is safe with appropriate medical screening prior to use. Before a session, a provider should screen for allergies, sinusitis, hypertension, and respiratory illness.

A simple exam and set of vitals help uncover any conditions that will make it difficult to clear the ears. At low pressures, hyperbaric medicine is safe for children, under qualified medical supervision.

Neuroplasticity: the brain's ability to heal!

Emerging research into neuroplasticity reveals the brain's ability to change continuously throughout the lifespan. Neural pathways and synapses shift and heal based on behavior, environment, and neural processes, allowing the brain to recover function over time.

With more serious injury, developing a holistic treatment plan with your care team is the way to go, which may include advanced therapies like hyperbaric oxygen. Further research into post-concussive syndrome & HBOT is needed. For now, there is promising evidence pointing to a therapeutic use.