PT  - JOURNAL ARTICLE
AU  - Figueroa, Xavier A.
AU  - Wright, James K.
TI  - Hyperbaric oxygen
AID  - 10.1212/WNL.0000000000003146
DP  - 2016 Sep 27
TA  - Neurology
PG  - 1400--1406
VI  - 87
IP  - 13
4099  - http://n.neurology.org/content/87/13/1400.short
4100  - http://n.neurology.org/content/87/13/1400.full
SO  - Neurology2016 Sep 27; 87
AB  - 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.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