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Abstract
Objective: First, to demonstrate that B-level evidence exists for the use of hyperbaric oxygen therapy (HBOT) as an effective treatment in mild to moderate traumatic brain injury/persistent postconcussion syndrome (mTBI/PPCS). Second, to alert readers and researchers that currently used pressurized air controls (≥21% O2, >1.0 ATA) are therapeutically active and cannot be utilized as sham controls without further validation.
Method: Review of published, peer-reviewed articles of HBOT prospective and controlled clinical trials of mTBI/PPCS symptoms.
Results: Published results demonstrate that HBOT is effective in the treatment of mTBI/PPCS symptoms. Doses of oxygen that are applied at ≥21% O2 and at pressures of >1.0 ATA produce improvements from baseline measures. Some of the recently published clinical trials are mischaracterized as sham-controlled clinical trials (i.e., sham = 21% O2/1.2–1.3 ATA), but are best characterized as dose-varying (variation in oxygen concentration, pressure applied, or both) clinical trials.
Conclusions: Hyperbaric oxygen and hyperbaric air have demonstrated therapeutic effects on mTBI/PPCS symptoms and can alleviate posttraumatic stress disorder symptoms secondary to a brain injury in 5 out of 5 peer-reviewed clinical trials. The current use of pressurized air (1.2–1.3 ATA) as a placebo or sham in clinical trials biases the results due to biological activity that favors healing.
GLOSSARY
- DoD=
- Department of Defense;
- HBA=
- hyperbaric air;
- HBO=
- hyperbaric oxygen;
- HBOT=
- hyperbaric oxygen therapy;
- mTBI=
- mild traumatic brain injury;
- PPCS=
- persistent postconcussion syndrome;
- PTSD=
- posttraumatic stress disorder;
- TBI=
- traumatic brain injury;
- VA=
- Veterans Administration
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received November 4, 2015.
- Accepted in final form May 9, 2016.
- © 2016 American Academy of Neurology
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Letters: Rapid online correspondence
- Author response to Drs. Hampson and Holm
- Hyperbaric oxygen for mild traumatic brain injury
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