Hyperbaric Oxygen Therapy (HBOT) for Brain Injuries

Why HBOT for brain injuries? Why NOT HBOT for brain injuries? HBOT has been used for nearly 50 years for new and old wounds in the body regardless of the location in the body. New wounds such as "flesh eating bacteria" infections or wounds whether they are on the torso, leg, groin, or neck, gas gangrene from war wounds in the same locations, crush injuries and blast injuries from explosions regardless of location, and burns to any part of the body are all treated with HBOT. Similarly, old wounds caused by infection to any of the bones in the body, diabetic foot wounds and other long-term ulcers of the feet, and old radiation wounds in the jaw, neck, chest, abdomen, or anywhere else in the body are responsive to HBOT. In addition, "the bends" of the brain, abscesses in the brain, air that gets in blood vessels and travels to the brain (air embolism), and carbon monoxide poisoning of the brain are HBOT-treatable diagnoses. Interestingly, almost all of these are paid for by insurance, Medicare, and Medicaid.

So, if HBOT works for acute brain conditions such as "the bends of the brain", brain abscess, air embolism, and carbon monoxide poisoning of the brain, and all of the applications for old wounds listed above, why wouldn't it work for a variety of other brain injuries, new or old? The fact is, it does, and doctors and patients are just coming to this understanding. For nearly 100 years doctors have been taught and lay people have been told that there is nothing that can be done for a brain injury except the passage of time. Furthermore, we have been led to believe that after an injury brain cells are either alive and functioning, or dead and not functioning. There was supposedly no middle ground…until now. In the past 10 years it has become obvious that brain cells are more like all of the other cells in the body than they are different. And they respond to injury in the same way. They can exist for years in low blood flow states like other blood cells in the body only to be reactivated with the right stimulus such as HBOT.

Once there is the realization that all cells in the body are similar, respond similarly to injury, and similarly to HBOT it is very easy to see how brain injuries respond to HBOT. This was the thinking that Dr. Richard Neubauer applied to chronic stroke and multiple sclerosis patients in 1978 and Drs. Harch and Van Meter to divers and boxers in the late 1980s. After these examples it was an easy extension to trauma, cerebral palsy, and autism, three of the most HBOT-treatable diagnoses today.

HBOT for Traumatic Brain Injury (TBI)

The brain is similar to a large spear of broccoli. The broccoli fronds are like the outer part of the brain, the cortex or grey matter, where the brain cells exist and the spear or stalk is like the connecting tracts in the center of the brain. These tracts are also known as the white matter. Trauma causes an injury to the brain that is mechanistically identical to shaking the broccoli by its stalk. The shaking causes a mechanical disruption of the connecting tracts between brain cells. These tracts are similar to the cable that carries our cable television and broadband. Once disrupted cells can't communicate between themselves and some of the cables die back to the cells which then die. Each cable that is lost causes a loss of neurological function and thinking. In addition, each little site of disruption of cable or blood vessels is a wound in the brain that starts the inflammatory reaction. It is also associated with swelling, just like a swollen ankle or a bruise on the arm. As swelling occurs the swelling fluid compresses the small blood vessels in the area leading to low blood flow and low oxygen. Nearby cells then are further injured and live in a dormant state, or die. This is known as the "vicious cycle" of traumatic brain injury. The net result is loss of neurological function and symptoms such as headache, confusion, problems with memory, attention, concentration, sleep disturbance, irritability, etc.

How HBOT Works For Traumatic Brain Injury

HBOT has been shown to decrease swelling, repair the metabolic injury to the cell and cable, and stop the inflammation in acute brain injuries with just a few treatments in the first 72 hours after injury. It is the only drug known to break the vicious cycle. Once the vicious cycle is broken neurological function is restored and patients survive. This is what has been shown in multiple scientific studies beginning in the 1970s in Germany.

If HBOT is not used early on in traumatic injury the injury "matures" as inflammation runs its course. Since inflammation is "stereotypic" or identical regardless of where in the body it occurs the inflammatory reaction is like playing a videotape or DVD. It is the same process, the same story every time, everywhere. The net result is nearly identical chronic wounds by the time the wound is 6 months to 1 year old. At this point, the wound resembles any other wound in the body that HBOT has been shown to treat. It's just that it is in the brain. This is what Dr. Harch showed in the 1990s and beyond, and what Dr. Neubauer also showed at the same time, treating a vast range of brain injuries. Eventually, this experience in humans with chronic brain injuries was duplicated in an animal model that was published by Dr. Harch in October 2007 (Brain Research, 2007; 1174:120-9). It is the first demonstration in the history of science of improvement of chronic brain injury in animals. And, it was done using the original protocol of HBOT Dr. Harch developed in 1990. Today, variations on this protocol are being applied to chronic brain injury worldwide with reproducible results.

HBOT for Our Wounded Soldiers

The latest and most high profile application in chronic brain injury is to chronic traumatic brain injury in U.S. servicemen returning from Iraq and Afghanistan. The first serviceman to receive the healing, reparative effects of HBOT for chronic TBI was an army general who was injured by an IED in Afghanistan. For over a year he was treated at Walter Reed without success until cognitive therapy and HBOT were administered, whereupon he made a dramatic cognitive improvement. More importantly, he was now able to return to work. He is a judge in Florida. This experience and another patient of Dr. Harch's are serving as the case examples of HBOT success in chronic TBI for the military. A request is currently before congress for an appropriation of $10 million to do a formal study on chronic TBI in military veterans. Hopefully, this will come to pass in the next year.

Autism as a Brain Injury

So, what is autism? For over 60 years autism has been classified as a psychiatric disease. Wrong! Countless studies have shown abnormalities in brain structure/anatomy/biochemistry, on MRI imaging, have identified biological risk factors, genetic factors, associated medical problems that occur with autism, and demonstrated other signs of injury in the brains of autistic children. Essentially, autism is a wound of the brain, more similar than different to other wounds of the brain described above. What gives autism its peculiar characteristics is what gives a stroke, a TBI, or any other brain disorder its peculiarities: the combination of locations in the brain that are injured. In autism what has been found time and time again is injury to the frontal and especially temporal lobes of the brain. The frontal lobes control our higher functions, such as thinking, planning, organization, and social interaction while the temporal lobes control memory, sound and speech processing, and emotion. Both of these areas of the brain also control behavior. Autism is caused by injury to these areas of the brain regardless of the nature of the injury. Birth injury, i.e., low blood flow and oxygenation, viral infections, vaccine reactions, toxic heavy metals, and variety of other causes have all been implicated with brain injury that results in autism. Since the initial insult is never apparent at the time of injury, and there is delay in diagnosis, autism is not seen until the brain injury and inflammation have run their courses and it is a chronic condition.

HBOT for Autism

What about HBOT for Autism? Why not? Once autism is considered another injury of the brain why wouldn't autistic patients respond to HBOT similar to the other wounds described above? It does. As part of the application of HBOT to divers with chronic "bends of the brain" and boxers with brain injury in 1989 and 1990 Drs. Harch and colleagues applied HBOT to a variety of other chronic brain conditions. In 1996 one of the first autistic children was treated with HBOT in New Orleans and found to respond to HBOT similar to the TBI, stroke, MS, and other patients. Subsequently, a series of patients was treated over the next 12 years. Application spread to autistic children using even lower doses and similar results were obtained which have now been published. Interestingly, autistic children are exquisitively sensitive to HBOT. A variety of doses is proving to be effective. Likely, this is due to the major contribution of inflammation to autism and the effect of HBOT on inflammation. Many studies have now demonstrated that HBOT is one of the most powerful anti-inflammatory drugs. Unfortunately, the immune system has a very long memory once activated. HBOT appears to suppress the inflammatory response in autism, but does not eradicate it. The immune system is like a dying ember. It smolders for years, but can be fanned to flames with various triggers such as gluten, viral infections, heavy metals, thimerosal, etc. The key is to suppress the inflammatory response with HBOT over years while minimizing the triggers until the immune system dies back and the embers are extinguished.

Cerebral Palsy and Birth Injuries

What is cerebral palsy? It is defined as a static brain condition involving primarily motor function that occurs during childhood and results from a brain insult before, during, or shortly after birth. In essence, cerebral palsy (CP) is just another brain injury. While some cases of CP occur while the fetus is developing in the uterus the majority of cases occur in premature babies, during difficult deliveries, or shortly after birth. Of these, cerebral palsy in premies is most common and is thought to result from spontaneous bleeding at the center of the brain where the blood vessels are undeveloped and extremely fragile. This area of the brain is along the fluid system of the brain whose walls are composed of the white matter or connecting cables described above. The predominant location of bleeding is centered in the major pathways that carry motor messages from the brain to the spinal cord. Hence, movement is primarily affected. Since the bleeding is never pinpoint many other white matter tracts are also affected and account for the multiple associated abnormalities seen in a large percentage of children with CP: seizures, cognitive problems, visual problems, hearing problems, retardation, global developmental delays, etc.

These same areas of the brain are also very sensitive to injury in term infants who experience a low blood flow insult to the brain at the time of birth or soon after. Examples are prolonged times in the birth canal, low heart rate, low blood pressure, placental bleeds, infection, low blood pressure in the mother, and so on. In all of these cases where blood flow is compromised to the baby the area of the brain to see the most dramatic decreases in blood flow is the area at the center of the brain described above. This is due to peculiarities in the anatomy of the blood vessels. Once the blood flow drops in this area the white matter tracts are injured similar to bleeding. In both cases oxygen and sugar (fuel) for the brain cells is deficient and the white matter tracts die.

HBOT for Cerebral Palsy

If HBOT could be delivered at the time of the insult much of the damage could be minimized due to HBOT's effects on acute injury (see traumatic brain injury above and the effects on inflammation). Unfortunately, clinical practice has not caught up to science and so it is rare for a baby to receive HBOT at the time of a birth injury. Instead, HBOT is often delivered years later when the inflammatory "DVD" has run its course. Once again, at this stage the brain injury is a chronic wound similar to all of the other chronic wounds in the body HBOT has been shown to effectively treat. In the 1980s CP children were first treated with HBOT in Brazil. Nearly 10 years later the first child was treated in the U.S. by Dr. Harch. Since then multiple centers around the world have replicated the success of HBOT in CP. In general, the children experience improvement in their respective motor, cognitive, neurological, emotional, and behavioral deficits, depending on their specific injury. Improvements in alertness, awareness, gross motor, fine motor, spasticity, low tone, speech, cognition, balance, and oral motor function, but improvements have also been seen in vision, hearing, seizures, and autonomic function. In early 2008 the most recent study was published comparing HBOT to all other therapies in CP. Using a standard measure of motor function in children it was shown that HBOT improved children faster, to a greater degree, and permanently compared to nearly all other therapies. It is no longer a question of whether HBOT is effective for HBOT, but whether a child has access to and reimbursement for HBOT in CP.