Hyperbaric oxygen for neurologic indications. Action plan for multicenter trials in: stroke, traumatic brain injury, radiation encephalopathy and status migrainosus

Abstract

Introduction: There is great interest in using hyperbaric oxygen (HBO) to treat neurological disease. The exquisite sensitivity of neural tissue to hypoxia makes increased oxygenation attractive as a therapy for disease processes that induce ischemia, edema, and, more recently, apoptosis. Four things specifically exist as targets for future projects and clinical trials: (1) stroke (2) traumatic brain injury (3) radiation induced necrosis and (4) status migrainosus. Methods: Specific aims: Stroke: determine if the use of HBO in the treatment of acute ischemic stroke is effective at improving outcomes. TBI: determine whether use of HBO in the acute state after traumatic brain injury is effective at improving outcomes and reducing elevated ICP. RIN: determine whether HBO treatment of radiation necrosis of brain results in improvement of neurological function and reduction of necrosis. Migraine: determine whether use of HBO will relieve headache pain in status migrainosus. Results: Stroke: there is evidence from animal studies that focal cerebral ischemia may improve after HBO treatment. TBI: the interest in using HBO to treat TBI is based upon the premise that hypoxia, edema and apoptosis play significant roles in the pathophysiology of the disease. RIN: the evidence suggests that in cases where either the patient is not improving on medical therapies or when surgical resection is not possible, HBO should be considered as a treatment option. Migraine: there is some evidence looking at HBO as an effective treatment of acute migraine attack. Summary: Each is discussed further with proposed study design and justification for their respective parameters. As our action plan moving forward, it is our goal to investigate in each area with multidisciplinary, multi-centered, case controlled double blind crossover studies.