A Phase I Study of Low-Pressure Hyperbaric Oxygen Therapy for Blast-Induced Post-Concussion Syndrome and Post-Traumatic Stress Disorder
Paul G. Harch, Susan R. Andrews, Edward F. Fogarty, Daniel Amen, John C. Pezzullo, Juliette Lucarini, Claire Aubrey, Derek V. Taylor, Paul K. Staab, and Keith W. Van Meter
Journal of Neurotrauma, Volume: 29 Issue 1: January 9, 2012
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.
Copyright©2012 Mary Ann Liebert, Inc. publishers
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SPECT IMAGES
Patient History: 45 year old male soldier who was continuously symptomatic since loss of consciousness of less than one minute from a mortar attack 15 months before imaging. Diagnosed with persistent post-concussion syndrome and post-traumatic stress disorder after misdiagnosis of conversion disorder. Blast was from the left side of the patient’s head/body. Patient enrolled in LSU IRB #7051 and underwent SPECT brain imaging with Neurolite and cognitive testing pre and post 40 HBOTs. He experienced symptomatic, physical, cognitive and quality of life improvement as well as reduction in anxiety and depression. PTSD score did not change. All of the following imaging was performed under identical conditions and doses of radiopharmaceutical. Expert processing and three-dimensional thresholding was performed by Phillip J. Tranchina.
Figure 1
Transverse SPECT brain slices, Pre-HBOT (left) vs. Post 1 HBOT (right). Standard CT orientation with each slice viewed from the patient’s feet: Patient’s right is on viewer’s left, front of patient is top of image. Color map is from highest brain blood flow to lowest: yellow, orange, purple, blue, black. Note heterogeneity to Pre-HBOT images with marked reduction in flow to the left temporal and cerebellar lobes. After 1 HBOT there is a generalized improvement in brain blood flow, particularly to the left temporal and cerebellar lobes.
Figure 2
Transverse SPECT brain slices, Pre-HBOT (left) vs. Post 40 HBOTs (right). Note marked improvement in heterogeneity (now homogeneous) and generalized symmetry of the two sides of the brain, especially the temporal and cerebellar lobes, after 40 HBOTs.
Figure 3
Three dimensional surface reconstruction of the Pre-HBOT SPECT scan. Viewer is looking at the patient face-on with the patient’s right on the viewer’s left. Note the bilateral orbital frontal defects, right temporal lobe defect, reduction in flow to the left temporal lobe and cerebellum, and irregular surface of the brain, consistent with the transverse slices.
Figure 4
Three dimensional surface reconstruction of the Post 1 HBOT SPECT scan. Note generalized improvement in the appearance of the brain, consistent with the appearance of the slices in Figure 1.
Figure 5
Three dimensional surface reconstruction of the Post-40 HBOTs SPECT scan. Note marked improvement of the brain scan, consistent with the slices in Figure 2. There remains a mild reduction in left temporal and cerebellar blood flow.
