HYPERBARIC OXYGEN THERAPY FOR TBI

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Hyperbaric Oxygen Therapy: A Controversial but Promising Treatment for Traumatic Brain Injury

Though not FDA-approved for TBI, hyperbaric oxygen therapy (HBOT) is increasingly used off-label to treat brain injuries by slowing cell death and promoting healing. While past skepticism surrounds claims of its efficacy in chronic TBI, recent advances in study design and placebo controls are paving the way for more reliable research and potential acceptance of HBOT as a treatment option.

BY NAOMI KHAN

Hyperbaric oxygen therapy (HBOT) is defined as the use of oxygen at higher than atmospheric pressure for the treatment of underlying disease processes and the diseases they produce. Modern HBOT in which 100% O2 is breathed in a pressurized chamber dates back to the 1930s when it was first used for the treatment of decompression illness in divers. There are currently 13 FDA-approved uses for HBOT.

Though TBI treatment is not an FDA-approved use for HBOT, many physicians have used it as an “off-label” treatment with notable results. Though not yet scientifically proven, it has been said that HBOT can dramatically and permanently improve symptoms of chronic TBI months or even many years after trauma. This assertion is generally met with skepticism within the medical establishment because it is widely accepted that any post-concussion symptoms persisting more than 6 months after a head injury is due to permanent brain damage that cannot be repaired. Therefore, treatment has been limited to symptom management and rehabilitative services, and any claim suggesting that fundamental healing is possible is not considered mainstream.

Researchers started investigating HBOT as a TBI treatment in the 1960s because of its ability to slow cell death, suppress inflammation, and boost cell and blood vessel growth. Most of the research was conducted on animals until recently because of the ethical issues involved in experimenting on humans with acute, severe brain injury.

One of the biggest issues complicating research of HBOT in brain injury is the ability to conduct randomized, double-blind, placebo-controlled studies. Brain injury varies widely from person to person, making it difficult to find TBI patients to study who have similar injury severity and affected regions.

Finding an objective way to measure the effects of HBOT is also an obstacle with several published studies failing to use a placebo. However, recently researchers have devised and used a placebo for HBOT in their studies, usually by increasing the air pressure without changing the oxygen content of the air being delivered. It’s imperfect (since air pressure increases while oxygen stays the same), but it does improve the reliability of results and possibly paves the way for HBOT as an acknowledged treatment for TBI.