0653

Hyperbaric Oxygen Therapy Treatment of Chronic Mild-Moderate Blast-Induced Traumatic Brain Injury/Post Concussion Syndrome with Post Traumatic Stress Disorder: Pilot Trial

Paul G. Harch ¹, Susan R. Andrews¹, Edward Fogarty², Juliette Lucarini¹, Claire Aubrey¹, Paul K. Staab¹, Keith W. Van Meter^1
1Louisiana State University School of Medicine, United States, ²University of North Dakota School of Medicine, United States

Objectives

Mild-moderate blast-induced traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) affect 11-28% and 13-17%, respectively, of U.S. combat troops returning from Iraq and Afghanistan. Protracted treatment for PTSD exists, but there is no effective treatment for the post-concussion syndrome (PCS) of mild-moderate TBI nor the combined diagnoses of PCS and PTSD. Based on previous case experience with PCS and an animal model we investigated the effect of hyperbaric oxygen therapy (HBOT 1.5) on symptoms, cognition, and SPECT brain blood flow in military veterans with blast-induced TBI/PCS with/without PTSD.

Method

Fifteen symptomatic U.S. military veterans with blast-induced PCS(2) or PCS/PTSD(13), diagnosed by military and/or civilian neuropsychologists and neurologists, who were average: 29.7y (21-45), 2.6y (1.24-4.75) post injury, 1 minute (13 subjects; 2 subjects 4.5 & 9h) loss of consciousness, with 3 blast TBI’s (1-8) completed the study. All subjects completed cognitive testing, symptom and quality of life questionnaires, and affective measures pre and immediately post a course of forty bid, 5d/week, 1.5ATA/60 minute hyperbaric oxygen therapy treatments (HBOT). Subjects underwent SPECT brain blood flow imaging (Picker Prism 3000, 25mCi Ethyl Cysteinate Dimer) pre and post a single HBOT and post 40 HBOT’s. SPECT was analyzed with Osirix software; relative standard deviation of the mean on a histogram analysis of counts in left centrum semiovale region of interest was taken pre/post Rx. Paired Student t test and Wilcoxon Signed-Ranks test (non-normally distributed data) were used for all cognitive/questionnaires.

Results

All subjects reported symptomatic improvement in the 35 day study period. Pre, post, difference, confidence interval, and p values for cognitive tests and questionnaires were: FSIQ: 95.8+/-8.4; 110.6+/-10.3, 14.8+/-7.4, 10.7-18.9, <0.001; Wechsler Memory Scale (WMS) IV delayed memory: 97.7+/-13.3, 106.9+/-15.4, 9.2+/-14.3, 1.3-17.1, =0.026; WMS Working Memory: 97.0+/-13.6, 106.9+/-13.1, 9.9+/-10.3, 4.1-15.6, =0.003(np); Stroop Color/Word: 84.3+/-12.2, 95.3+/-12.8, 11.1+/-9.2, 6.0-16.2, <0.001; TOVA variability: 64.4+/-28.7, 75.3+/-24.6, 10.9+/-20.2, -0.2-22.1, =0.045(np); Rivermead Post Concussion Symptom Questionnaire: 39.7+/-6.0, 24.1+/-12.6, -15.6+/-12.8, -22.7-(-8.5), =0.002(np); PTSD Checklist Military: 67.4+/-10.5, 47.1+/-16.0, -20.3+/-18.2, -30.4-(-10.2), <0.001; Modified Perceived Quality of Life: 81+/-37, 114+/-36, 33+/-36, 13-53, =0.003; Personal Health Questionnaire 9-Depression Index: 16.6+/-4.9, 8.2+/-4.7, -8.4+/-7.4, -12.5-(-4.3), <0.001; GAD-7 Anxiety Rating: 12.7+/-5.8, 7.9+/-5.3, -4.8+/-5.8, -8.0-(-1.6), =0.007; Percent Back to Normal: [Cognitive: 49.6+/-17.6, 67.0+/-19.4, 17.4+/-17, 7.5-27.2, =0.002], [Physical: 46.8+/-23.0, 66.3+/-18.6, 19.5+/-16, 10.3-28.7, <0.001], [Emotional: 32.5+/-20.6, 61.3+/-19.8, 28.8+/-20.9, 16.7-40.9, <0.001]. SPECT analysis on the first 5 subjects showed a reduction in the standard deviation of the mean on counts in the left centrum which corresponded to a pattern shift from heterogeneity (abnormal) to homogeneity (more normal).

Conclusions

A thirty day course of forty 1.5 ATA HBOT’s demonstrated significant symptomatic, cognitive, and affective improvements in 15 U.S. military veterans with chronic blast-induced post-concussion syndrome and post-traumatic stress disorder. These findings were reinforced by quantitative and qualitative SPECT improvements.