"HBOT cannot help all patients with strokes, but can offer some
patients and their families hope."
What is a stroke?
Stroke/cerebrovascular accident (CVA) refers
to the loss of normal function of the brain tissue caused by impairments of
circulation within the brain. When normal circulation is obstructed due to a
clot or hemorrhage, the supply of oxygen is rapidly depleted. Without oxygen,
the neurons within the brain die. The disabilities that occur depend upon the
area of the brain that has been deprived of oxygen-enriched blood. The common
symptoms of a stroke may be that of numbness or weakness of the face, arm, or
leg, spasticity or rigidity of the limbs, double vision and imbalance. In
addition, a stroke may cause a loss of the ability to speak, comprehend and
swallow. There may even be associated mental difficulties, including memory loss
and distinct personality changes.
There are several
reasons for the cessation of blood circulation to part of the brain. The first
is ischemia, or lack of blood flow, which is caused by narrowing or blockage of
an artery. Ischemic thrombotic strokes may result from arteriosclerosis or
cholesterol plaques. A second cause for a stroke is the development of emboli.
These are blood clots that sometimes arise from the carotid artery or heart and
travel from these distant places to deep vessels within the brain, thus causing
disruption of normal blood flow.
A third and final cause of stroke is a cerebral hemorrhage. This entails
the rupture of a vessel, thus causing massive bleeding into the brain tissue,
destroying the tissue in and around the site of the hemorrhage. In addition,
there is damage to the brain by the pressure exerted by this blood clot on the
preserved brain tissue as well.
Infrequently, a patient may be given a
warning of an impending stroke. This is classified as a transient ischemic
attack (TIA). A TIA is a "mini-stroke" which presents itself as a transient
episode of numbness or weakness of the face, arm or leg, which may be associated
with inability to speak, or slurring of speech. Once again, the symptoms that
present are directly related to the area of the brain in which the circulation
has been compromised. It is estimated that approximately one-third of patients
who experience
a TIA will suffer an incapacitating stroke within 5 years with
a 15% chance of a stroke occurring within 2 years after the TIA.
When a patient develops a stroke, there is a central region of brain tissue,
which dies. It is not possible to rejuvenate this localized area of brain
tissue. However, there is an area between this damaged tissue and the unaffected
brain which is referred to as the pnumbra. This pnumbra is a very important area
as it contains "dormant", "idling" or resting brain cells that are alive but
unable to function due to the lack of blood and oxygen needed for normal cell
metabolism. If these cells were to be "awakened", with the restoration of
adequate blood flow, improvement in function would occur.
There is a belief
that the brain has plasticity in that there is some ability of the brain to
reorganize itself after a trauma. At times one part of the brain can assume the
function of another part of the brain by switching functions.
An
acute stroke occurs in several phases. The first phase is called the ischemic
cascade. This phase, which lasts several minutes up to 6 hours, requires
immediate medical attention. It has been termed a "brain attack." After the
ischemic cascade, the brain goes through a period of reorganization, which can
last approximately 1 week. Following reorganization, the brain enters a more
stable phase, which can last, from approximately 1 week up to 3 months. It is
felt by some clinicians that this period of time is not amenable to HBOT.
It is generally
considered among neurologists that patients can achieve 95% of their ultimate
magnitude of improvement by 6 months with an additional 5% occurring between 6
months to 1 year. There are many treatments that have been found helpful in the
recovery from devastating strokes. These include medications to reduce limb
spasms, injections with preparations such as Eotox to reduce spasticity as well
as various medications to reduce the chances of recurrent ischemic events such
as aspirin, Plavix, Aggrenox, Ticlid or even Coumadin.
How does HBOT help the brain recover?
As stated earlier,
the most important factor in determining the patient's ability to recover from a
stroke is the size of the infarct, the location of the infarct as well as the
size of the pnumbra (the region that surrounds the area of infarct). Following
an acute brain infarction, there is a moderate amount of swelling which causes
additional pressure upon the viable brain structures. HBOT has been found to
reduce this swelling and enable oxygen- enriched blood to enter the
dormant/idling brain cells.
Hyperbaric oxygen therapy increases the
concentration of oxygen within the body to 1,500 to 2,000 times the
~concentration one has on room air. This allows the oxygen to diffuse into all
the body fluids, including blood, plasma, lymph and cerebrospinal fluid (the
fluid that bathes the brain and spinal cord). There is also increased oxygen
perfusion to the brain tissue itself as well as muscle and bone.
Just as a
non-healing diabetic wound slowly and gradually heals with hyperbaric oxygen
therapy by stimulating capillary growth, the brain too is healed by the growth
of new capillaries into the area of the pnumbra. These new capillaries bring
nutrients, including oxygen, and carry away the bi-products of cell
metabolism.
Physical therapy has been found to complement the effects of
hyperbaric oxygen therapy. When an orthopedist removes a cast from a fractured
arm he frequently finds it necessary to refer the patient for physical therapy
to restore the strength and movement of the joint that has been immobile for an
extended period of time. Similarly, a patient who has had a stroke requires
physical therapy after a certain number of treatments of hyperbaric oxygen
therapy to restore strength and mobility as well as stability in limbs that have
not been used for a period of time.
There was a study
with 122 patients having ischemic strokes who were treated with hyperbaric
oxygen therapy. Of the 122 patients, 79 were treated from 5 months to 10 years
after the initial stroke (this is well beyond the time in which normal
spontaneous improvement would be expected). Prior to entry into this study, many
of these patients had received physical therapy; occupational therapy and
various other modalities yet still had significant impairments. These patients
underwent HBOT treatments at 1.5 to 2.0 atmospheres absolute, for a period of 60
to 90 minutes. Seventy-nine patients (65%) reported improvement in their quality
of life. It should be noted that the HBOT patients spend less time in the
hospital (an average of 177 days compared with 287 days for conventionally
treated patients) .It should be noted that all the HBOT patients were able to go
home while a large number of the other patients had to enter a rehabilitation
facility.
One should never lose sight of
potential improvement that HBOT can render. If you can take a patient who lives
a bed-to-wheelchair existence and enable them to walk with a walker or take a
patient who ambulates with a walker and allow them to walk with either a cane or
unassisted, their life has changed greatly. If you have a patient who cannot
communicate and with hyperbaric oxygen therapy restore the ability to speak or
take a man who has slurred speech and allow him to return to gainful employment
you have given him back dignity, self-worth and at times financial stability. I
have seen these frequently with the use of hyperbaric oxygen
therapy.
Severe, intractable
and recurrent headaches can be incapacitating. These headaches are frequently
described as pounding, throbbing headaches associated with nausea and vomiting
with a tendency for bright lights, noises or noxious fumes to intensify the
headache. Frequently migraine headaches are accompanied by visual obscurations,
including loss of peripheral vision, seeing flashing lights or "wavy lines."
Some patients even experience numbness or weakness of an arm or leg and speech
difficulty during an episode. Migraine headaches are vascular headaches that are
caused by dilation of the blood vessels within the brain, causing the
aforementioned discomfort. It has been very well established that oxygen therapy
can abort a headache within only a few minutes simply by reducing the dilatation
of the blood vessel.
Head injuries, like stroke, deprive certain areas of the brain of
oxygen. The size and location of the brain trauma as well as the potential for
reversibility of damage within the penumbra (dormant brain tissue surrounding
the central core of dead brain tissue) is what dictates the patient's potential
for recovery.
Traumatic brain
injury causes micro hemorrhages with associated swelling of brain tissue. As
the skull is a fixed, hard, bony structure, which cannot expand with increased
pressure within the brain, the delicate structures within the brain become more
compressed, thus inhibiting blood flow, thus causing more ischemic damage.
This swelling may
take upwards to 9 to 12 months to
resolve, during which time the delicate structures within the brain remain
compressed, thus limiting normal blood flow to the damaged tissues. HBOT reduces
the swelling within the brain and enhances new blood vessel growth
(angiogenesis). This process of forming
new capillaries extends from the surrounding healthy brain tissue into the area
of the ischemic penumbra.
With the improvement in brain circulation and
reduction of edema, HBOT enables the patient to have return of cognitive
function with reduction in headaches, imbalance and ringing of the ears
REFLEX
SYMPATHETIC DYSTROPHY
Reflex sympathetic dystrophy is a disorder, which occurs following
trauma to a nerve of the arm or leg. Researchers now believe that these symptoms
occur because the nerves send a mixed signal to the brain. In effect, these
inappropriate signals short circuit and interfere with the normal blood flow and
sensory signals, thus generating symptoms of a reflex sympathetic dystrophy
which includes severe burning pain, extreme sensitivity to even light touch,
swelling, excessive sweating and change in bone and skin tissue.
Treatment
modalities for this painful disorder have included various medications, physical
therapy, sympathetic nerve blocks, placement of spinal cord stimulators, as well
as the use of a morphine pump. Unfortunately these therapies have rarely offered
the patient any significant long-term improvement. A study of 15 patients (11
men and 4 women) was performed using hyperbaric oxygen therapy as the sole means
of treatment after failure to improve by other modalities. The clinical
diagnosis was based upon the presence of pain, tenderness, swelling, vasomotor
instability, joint stiffness lasting long after a trauma. Radiographic
studies confirmed bone demineralization and osteoporosis commonly seen
in patients with RSD. After the first week of HBOT, a marked reduction in pain
and tenderness in the extremity was observed in 9 out of the 15 patients with
discrete clinical improvement being recorded in 3 cases. Reduction of swelling
and restoration of movement in the affected extremity progressed during the
course of HBO therapy. At the completion of the first cycle of HBO therapy,
complete recovery, i.e. the absence of pain and the restoration of normal joint
movement, was noted in 4 of the 15 patients. Marked clinical improvement, i.e.
occasional tenderness with minimal swelling occurring solely at night with
almost normal movement of the affected joints, was noted in 5 out of the 15
cases. Moderate clinical improvement, i.e. reduction of pain and swelling with
partial restoration of movement, was noted in 4 of the 15 patients. In 2 of the
15 patients there was reduction in swelling with some persistent pain. An
additional 10 sessions of HBO was given to 4 cases in which there was a partial
relapse of symptoms, only to afford the patient complete recovery. This
demonstrates the significant oxygen therapy in the treatment of effectiveness of
hyperbaric reflex sympathetic dystrophy.
CEREBRAL PALSY
Definition
This disability is a
condition resulting from chronic brain damage, and emerges in different forms,
ranging from severe to nearly normal. It does not necessarily disable
intellectually; even those who are unable to walk, speak, or control their
movement may have perfectly normal intelligence.
Spastic cerebral palsy, extreme stiffness or
tightness in the muscles, is accompanied by weakness in the affected limb.
Athetosis, uncontrolled writhing movements affecting the hands, face and tongue,
impairs the patient's ability to speak or use I his/her hands. Dystonia, extreme
stiffness and floppiness, is exhibited by spasms in the muscles of the
shoulders, neck and trunk. Ataxia, unsteady, shaky movements, including balance,
is the least common type of cerebral palsy.
HBOT can improve
some cerebral palsy symptoms, but the degree differs from patient to patient.
Improvements include cognitive ability, vision, hearing and speech. Brain
injuries, including head trauma or stroke can result in long-term improvement.
HBOT cannot be considered a cure, but should be supplemented with other
therapies.
There are a number
of factors that can cause CP, some of which are premature separation of the
placenta in utero, the umbilical cord wrapped around the neck, stroke, traumatic
birth, prematurity, low birth weight and postpartum infection. These disorders cause a deficiency of oxygen
at or around the time of birth-either in the later months of pregnancy, at
delivery, or during infancy. During
early childhood, oxygen deprivation through choking, poisoning, near-drowning,
head injury, or infection can also cause brain damage that may result in
cerebral palsy.
The post-polio
syndrome is a condition that may develop years after the acute episode of
Poliomyelitis. The symptoms are muscle
weakness and stiffness with associated pain.
HBOT can provide significant relief of the symptoms but like M.S.
periodic HBOT is required to maintain improvement achieved with the initial
course of 20 to 40 treatments. Dr.
William Fife reported this use of HBOT.
A number of
different drugs are used in MS therapy, including interferons and various
steroids. These drugs not only cause a
wide variety of side effects, but can be very expensive as well. HBOT is the only treatment that offers the MS
patient relief of symptoms with no serious side effects. Unlike most of the other therapies, it is the
only drug-like treatment that has been shown to work on a continuing basis. IN addition HBOT has been the therapy used on
the largest number of patients for the longest period of time, which means that
it is the therapy with the longest period of follow-up results.
The Gottlieb-Neubauer theory, proposing that
MS is caused by luck of oxygen, has been supported by research showing that
HBOT, which overcomes a lack of oxygen, is an effective treatment method. HBOT is not a cure of MS. For best results, HBOT treatment of MS should
be started as early as possible following diagnosis. As with most illness, MS becomes more
difficult to control as the disease continues.
The average series of treatments consists of twenty sessions. Treatment should continue as long as the
patient shows progress. Once stable,
periodic boost treatments and at times a mini series of HBOT are usually needed
to maintain improvements.
Lyme disease is a
tick-borne illness with a wide array of symptoms. Cases have been reported throughout the
country but the disease is most prevalent in the Northeast and upper
Midwest . The
first sign of Lyme disease is a usually painless skin rash called erythema
migrans at or near the site of the bite. If not promptly and properly treated
with antibiotics, Lyme disease can produce the following conditions: CNS
problems, including inflammation of the membranes covering the brain and spinal
cord (meningitis) or of the brain itself (encephalitis). Some patients may develop confusion, memory
loss, and emotional difficulties. Heart problems, including inflammation of the heart (myocarditis)
and heart block, an abnormal slowing of the heartbeat. Joint problems, usually
arthritis of the larger joints such as the knee or ankle. Various other problems, including fever,
fatigue, headache and muscle pain.
Dr. William Fife
and Dr. Donald Freeman at Texas
A&M University
reported the use of HBOT for Lyme disease in humans. In their study, 40 patients were treated with
HBOT at a pressure of 2.36 atmospheres absolute once or twice a day, five day of
week, for from one to four weeks. Some
patients continued antibiotic therapy while taking HBOT. Others did not.
In response to
treatment, all of the patients developed a sudden, passing fever called
Jarisch-Herxheimer reaction. This
reaction also often appears during aggressive antibiotic therapy for Lyme
disease. SPECT brain scans can show the
encephalopahty of Lyme disease and demonstrate the improvement, which occur in
almost all patients with HBOT.
Every year,
thousands of children suffer brain damage as the result of near drowning,
choking, near hanging, near-electrocution, cardiac arrest, cyanide and carbon
monoxide poisoning, and lightening strikes.
These incidents deprive areas of the brain of vital new change oxygen,
causing an anoxic ischemic encephalopathy (AIE), which in severe cases can
result in coma. Swelling cuts off the
brain’s blood supply, leading to the accumulation of toxic levels of cell wastes
which further aggravates the swelling.
HBOT can, at times, break this vicious cycle by constricting the brain’s
blood vessels, while delivering more healing oxygen deep within the tissue to
repair AIE damage.
HYPERBARIC OXYGEN IMPROVES PERIPHERAL NERVE
REGENERATION
Several studies have documented the
effectiveness of hyperbaric oxygen in models of acute and delayed crush injury.
Intermittent exposure to hyperbaric hyperoxia serves to interrupt the injury
cycle of edema, ischemia and tissue necrosis (1), as well as
hemorrhagic hypotension (2), which in turn leads to former edema and
ischemia. Tissue ischemia is countered by the ability of hyperbaric doses of
oxygen to elevate tissue oxygen tensions (3). Furthermore, edema is
reduced, secondary to hyperoxia-induced arteriolar vasoconstriction
(4), leading to improved tissue viability, thereby reducing necrosis
(1). Hyperbaric oxygen has also been studied in models of peripheral nerve
injury (5). Researchers from the US Air Force School Aerospace
Medicine and Louisiana State University
recently sought to
determine what, if any, morphologic changes are associated with hyperbaric
oxygen treated peripheral nerve injury (6). Their model involved a
crushed sciatic nerve in the rabbit.
Exposure to hyperbaric oxygen across the
range of current clinical dose schedules was compared to untreated, and pressure
(hyperbaric air) controls. A pathologist blinded as to group documented the
extent of nerve regeneration via morphologic analysis of electron
micrographs. All of the animals exposed
to hyperbaric doses of oxygen were reported to demonstrate advanced stages of a
healed nerve, in contrast to both control groups. As this research was limited to a
determination of regeneration of morphology, the exact effects of hyperbaric
oxygen were not known. The authors speculate, however, that there may be several
suggesting increased myelination, decreased edema, reduced internal collagen and
improvements in neurofilamentous material density. They conclude that this study
provides additional evidence of a link between tissue oxygen levels and the
health of peripheral nerves.
...
all animals exposed to hyperbaric oxygen "demonstrated
characteristics expected of in the advanced stages of a healed
nerve"
