 Strokes
(cerebrovascular accidents) are a leading cause of neurologic disability
in the western hemisphere; fortunately, hyperbaric oxygen therapy can aid in convalescences. Stroke happens to be the third most frequent
cause of death in the United States
and is a major cause of disability among Americans. The cost of treating stroke in the United States is more than 30 billion dollars a year, only a fraction of which goes to hyperbaric oxygen therapy. One-third of those
who suffer a stroke do not survive the episode with another one-third
left to reside in nursing homes. One-third of these patients do indeed
improve over time, but they are left with disabilities that prohibit
them from resuming their prior lifestyle. Utilizing hyperbaric medicine procedures, doctors could potentially change these percentages. The cost of treating stroke in
the United States
is more than 30 billion dollars a year. HBOT therapy 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 (this why hyperbaric oxygen therapy is so effective, it can increase oxygen concentration with in body tissue and fluids, thereby offsetting the lack of circulation, while promoting regeneration). 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 with hyperbaric oxygen therapy or any other treatment currently known. 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. Hyperbaric oxygen therapy greatly increases oxygen concentration in the body, effectively bathing the dormant region with oxygen rich blood. 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 therapy or hyperbaric medicine procedures.
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 therapy help the brain
recover?
As
stated earlier, the most important factor in determining the patient's
ability to recover from a stroke, utilizing Hyperbaric oxygen therapy or any other treatment, 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 from HBOT 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 the HBOT 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.
MIGRAINE HEADACHES
Severe,
intractable and recurrent headaches can be incapacitating, fortunately, hyperbaric oxygen therapy can provide some relief. 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 HBOT therapy can
abort a headache within only a few minutes simply by reducing the
dilatation of the blood vessel.
TRAUMATIC
BRAIN INJURY
Head
injuries, like stroke, deprive certain areas of the brain of oxygen. These are areas that can potentially benefit from hyperbaric 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. The increased barometric pressure during hyperbaric medicine procedures has been shown to offset this compression.
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, induced by hyperbaric oxygen, 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 therapy 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.
Non hyperbaric oxygen 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 therapy, 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 HBOT therapy. At the completion of the first cycle of HBOT 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 after HBOT, 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 after HBOT, 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 HBOT 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 effectiveness of hyperbaric oxygen therapy in the treatment of reflex sympathetic dystrophy.
For a more in-depth explanation of the benefits of
Hyperbaric Oxygen Therapy for Reflex Sympathetic Dystrophy go to
RSD Therapy.
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 that hyperbaric oxygen helps differs from patient to patient. Improvements from hyperbaric oxygen therapy 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. Given the increased oxygen concentration hyperbaric oxygen treatment induces in body tissue and fluids, it is well suited as an effective therapy, subjectively.
Post-Polio
Syndrome
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.
MULTIPLE SCLEROSIS
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, hyperbaric oxygen therapy 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
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 hyperbaric oxygen 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.
NEAR
DROWNING
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; hyperbaric oxygen can potentially reverse some of this damage.
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.
Hyperbaric medicine procedures 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 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 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 from hyperbaric oxygen treatment and the health of peripheral nerves.
...
all animals exposed to hyperbaric oxygen
"demonstrated characteristics expected of in the advanced stages of
a healed nerve"
Of the estimated 20 million people in the United States with
diabetes, 3 million struggle with DPN—and even patients with
pre-diabetes and impaired glucose (blood sugar) tolerance may
have symptoms. The older the person is, the longer he or she has
had diabetes, and the less-controlled the disease, the greater
chance of feeling pain because of damaged nerves.
Fifty percent of patients with long-standing diabetes
have numbness, burning, electrical sensations, stabbing, or
shooting pain in their feet or legs—and it’s usually worse at
night. While the pain is uncomfortable, the lack of sensation
can have even worse consequences. If a person’s shoes fit
improperly, are too tight, have rough spots inside, or rub when
the person walks, the blisters, abrasions or cuts may not be
felt. Because circulation is not as good as it is for people
without diabetes, these wounds can become infected and very
difficult to heal.
Hyperbaric Oxygen Therapy is a very effective treatment for
diabetic neuropathy. By driving oxygen deep into tissues, it
reduces cell death and pain symptoms. Hyperbaric oxygen also
stimulates the growth of new blood vessels, enabling the body to
increase effective oxygen and nutrient delivery.
If there is tissue damage and a
wound that resists healing, many insurance companies will cover
Hyperbaric Oxygen Therapy. For more information go to
Diabetic
Neuropathy Therapy.
Introduction
: Indications for HBOT Therapy :
Meet Dr. Spiegel & Staff
Treatment of Neurological Disorders :
Other Uses of HBOT
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