Hyperbaric Oxygen Therapy Can Improve Post Concussion Syndrome Years after Mild Traumatic Brain Injury – Randomized Prospective Trial

AbstractBackground: Traumatic brain injury (TBI) is the leading cause of death and disability in the US. Approximately 70-90% of theTBI cases are classified as mild, and up to 25% of them will not recover and suffer chronic neurocognitive impairments. Themain pathology in these cases involves diffuse brain injuries, which are hard to detect by anatomical imaging yet noticeablein metabolic imaging. The current study tested the effectiveness of Hyperbaric Oxygen Therapy (HBOT) in improving brainfunction and quality of life in mTBI patients suffering chronic neurocognitive impairments.Methods and Findings: The trial population included 56 mTBI patients 1–5 years after injury with prolonged post concussion syndrome (PCS). The HBOT effect was evaluated by means of prospective, randomized, crossover controlled trial:the patients were randomly assigned to treated or crossover groups. Patients in the treated group were evaluated atbaseline and following 40 HBOT sessions; patients in the crossover group were evaluated three times: at baseline, followinga 2-month control period of no treatment, and following subsequent 2-months of 40 HBOT sessions. The HBOT protocolincluded 40 treatment sessions (5 days/week), 60 minutes each, with 100% oxygen at 1.5 ATA. ‘‘Mindstreams’’ was used forcognitive evaluations, quality of life (QOL) was evaluated by the EQ-5D, and changes in brain activity were assessed bySPECT imaging. Significant improvements were demonstrated in cognitive function and QOL in both groups followingHBOT but no significant improvement was observed following the control period. SPECT imaging revealed elevated brainactivity in good agreement with the cognitive improvements.Conclusions: HBOT can induce neuroplasticity leading to repair of chronically impaired brain functions and improvedquality of life in mTBI patients with prolonged PCS at late chronic stage.