HBOT and Chronic Traumatic Brain Injury - Hyperbaric Oxygen Therapy
HBOT and Chronic Traumatic Brain Injury
Traumatic brain injury is characterized by mechanical forces which disrupt brain tissue in addition to all of the destructive inflammatory and ischemic/hypoxic processes of other brain injuries. In 1989 Drs. Van Meter and Gottlieb first evaluated the effect of low-pressure HBOT in chronic traumatic brain injury through the Dementia Pugulistica Study of the JoEllen Smith Institutional Review Board. The project subsequently came under Dr. Harch's direction after the treatment of and discovery made in the above mentioned two divers. In 1992 a third boxer evaluated under this IRB referred a young lady with a severe head injury incurred in a motor vehicle accident 5 years before. Her treatment and improvement were presented at the 1994 UHMS meeting (3) and published in the Second Edition of the Textbook of Hyperbaric Medicine by K.K. Jain, 1996 (28). Dr. Harch then solicited the Moody Foundation of Texas for bi-institutional funding for a randomized prospective controlled study on the effect of HBOT in chronic traumatic brain injury to be performed at Louisiana State University School of Medicine, New Orleans with Dr. Harch as the principal investigator and the University of Texas Medical Branch, Galveston. Dr. Harch was requested to and subsequently directed the study gratis and employ his protocol while the Moody Foundation only funded the UTMB arm. This study and its protocol became the template for all of the subsequent UTMB/Moody Foundation head injury/HBOT studies. The original study was presented at the 1998 UHMS and American Academy of Neurology Meetings (30). Below is the case of a self-inflicted gunshot wound to the brain treated by Dr. Harch in 1994 and her illustrative/dramatic SPECT brain imaging. These images were reviewed by an international expert in SPECT brain imaging.
The patient is a 29 year old female who presented five and one half years after gunshot wound to the brain that left her with functional quadriplegia, severe spasticity, autonomic disturbance, and mild cognitive impairment. The patient underwent SPECT brain imaging before and after a single (Figures 1 and 2) and 80 (Figure 3) low-pressure HBOT's which showed a significant improvement in the patchy heterogenous pattern and overall brain blood flow that paralleled improvements in speech, motor, autonomic function, and spasticity. Figures 4, 5, and 6 are three dimensional surface reconstructions of Figures 1, 2, and 3, looking at the patient's brain from her right frontal view, the entry point of the bullet; the path of the bullet from right temple to left posterior is clearly visible.
3. Harch PG, et al. 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.
28. Harch PG, et al. Use of HMPAO SPECT for assessment of response to HBO in ischemic/hypoxic encephalopathies. Appendix, Textbook of Hyperbaric Medicine, 2nd Edition, 480-491. K.K. Jain, editor. Hogrefe and Huber Pubs., Seattle, 1996.
30. 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.