A Phase I study of low pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and posttraumatic stress disorder.

ABSTRACT:

Objective: This is a preliminary report on the safety and efficacy of 1.5 ATA HBOT in military subjects with chronic blast-induced mild-moderate traumatic brain injury (TBI)/post-concussion syndrome (PCS) and post-traumatic stress disorder (PTSD).

Methods: 16 military subjects received forty 1.5 ATA/60 minute HBOTs in 30 days. Symptoms, physical and neurological exams, SPECT brain imaging, neuropsychological and psychological testing were completed before and within one week after treatment.

Results: 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=.001), WMS IV Delayed Memory (p<.026), WMS-IV Working Memory (p=.003), Stroop Test (p=.001), TOVA Impulsivity (p=.041), TOVA Variability (p<.045), Grooved Pegboard (p=.028), PCS symptoms (Rivermead PCSQ: p=.0002), PTSD symptoms (PCL-M: p<.001), Depression (PHQ-9: p<.001), Anxiety (GAD-7: p<.007), quality of life (MPQoL: p<.003), and self-report of percent of normal (p<.001),SPECT coefficient of variation in all white matter and some gray matter ROI’s after the first HBOT, and in half of white matter ROIs after 40 HBOT’s, and SPECT statistical parametric mapping analysis (diffuse improvements in regional cerebral blood flow).

Conclusion(s): Forty 1.5 ATA HBOTs 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 changes/normalization of SPECT. Further study of the efficacy and safety of 1.5 ATA HBOT is underway in a larger group of subjects.