Effective Stepwise Anti-inflammatory Treatment for Markedly Disabling Neuropsychiatric Comorbidities: A Case Report

Abstract

Background: This is the first case report of a stepped novel anti-inflammatory treatment plan for a complicated, markedly disabling neuropsychiatric condition with multiple comorbidities. The treatment consisted of 1) hyperbaric oxygen therapy, 2) combination therapy of infused ketamine applied concurrent with transcranial magnetic stimulation, 3) administration of perispinal etanercept, and finally 4) non-invasive transnasal Sphenopalatine Ganglion block. Methods and findings: The patient was a 34-year-old Caucasian unemployed female who presented with lifelong symptoms of a regulatory disorder of childhood, epilepsy, reflex sympathetic dystrophy, and multiple concussions that ultimately led to marked disability in activities of daily living. Following the sequential treatment, the patient showed marked clinical improvement and progressed from major incapacitation to an independent life, resuming school and taking a parttime job. Indeed, successive improvements occurred after hyperbaric oxygen therapy in the realms of distress tolerance, resilience, and social interaction and then continued after downward titration of oral medications (which required the use of the ketamine/transcranial magnetic stimulation treatment), and further improved after administration of perispinal etanercept. Finally, a Sphenopalatine Ganglion block provided migraine relief. Single-photon emission computer tomography imaging was done before the beginning of treatment, one month later (after hyperbaric oxygen therapy), and at the conclusion of the perispinal etanercept injections. Results from both follow-up SPECT scans validated the clinical impression by showing substantial and additive blood flow increases in previously deficient brain areas. Conclusions: We provide evidence of successful treatment of a disabling neuropsychiatric condition via the sequential application of a novel anti-inflammatory treatment plan including four procedures, all known for their anti-inflammatory effects. The use of functional imaging provided a useful biomarker for the efficacy of this sequential treatment.