Hyperbaric Oxygen Therapy and Stroke

What does the research say? 

Background: 

An ischemic stroke occurs when there is a block to an artery to the brain (thrombus or embolus), blocking or reducing the blood flow to the brain and consequently the transport of oxygen and glucose which are of course crucial for brain function with subsequent  neurological dysfunction that lasts longer than 24 h. 

For completeness, hemorrhagic strokes usually are due to hypertension or rupture of an aneurysm. About 85% of strokes are ischemic and 15% are hemorrhagic.

Stroke accounts for 10 % of deaths in all industrialized countries and is the most common cause of
disability worldwide. 

Risk factors for stroke include hypertension, diabetes, atrial fibrillation, hyperlipidemia, cigarette smoking, heavy alcohol consumption, and obesity. 

Hyperbaric Treatment Edmonton

Acute stroke management: 

 All patients with acute ischemic stroke should be treated on an emergency basis within 1 h of occurrence. Use of thrombolytics and even surgery to restore normal cerebral blood flow. Cerebral protection against the effects of cerebral ischemia Hyperbaric oxygen can be used acutely in a hospital setting but is not an official Health Canada recognized indication. HBOT has been studied in acute stroke because of it's edema reducing and oxygen enhancing effects in addition to stem cell mobilization. Unfortunately studies in acute stroke have yielded conflicting results with some patients showing clear benefit in some studies and negligible benefit in others. 

 Chronic stroke management: 

In contrast to the amazing acute efforts done in a hospital setting for management of acute stroke, little is done comparatively for the patients in the chronic stroke stage. Many stroke patients have been discharged and don't often receive regular physical therapy or even worse Naturopathic care.  Furthermore, physicians are typically not interested in chronic stroke patients as the neurological deficits are considered somewhat fixed due to irreversible brain damage. 

Select Review of Clinical Hyperbaric Studies in Stroke: 

The total number of cases reported using Hyperbaric Therapy in stroke in the literature is well over 1000 with an extremely encouraging rate of improvement is 40–100 % which is much higher than the expected natural rate of recovery (particularly because many cases were chronic with stable, non improving neurological deficits) (See Jain 2017). 

The data in the above chart is extremely encouraging for use of Hyperbaric therapy in Chronic stroke patients. The following looks into three controlled studied in chronic stroke patients in greater detail: 

Neubauer and End (1980) used Hyperbaric Oxygen Treatment in 122 patients with ischemic strokes in both the acute and the chronic stages. HBOT was given at 1.5–2 ATA which are the standard pressure ranges for brain injury, treatments were up to 1 hour twice daily. Of 79 patients chronic stroke patients who received Hyperbaric treatment, 5 months to 9 years after the stroke, 65% reported an improvement in the quality of life.

Efrati et al.(2013), in a randomized, controlled trial done at The Institute of Hyperbaric Medicine in Israel using Hyperbaric Oxygen in 74 patients who suffered a stroke 6– 36 months prior to the study, HBOT led to significant neurological improvements.  HBOT protocol was two months of 40 sessions (5 days/week), 90 minutes each, 100% oxygen at 2 ATA. This study suggests that the neuroplasticity of the central nervous system can still be activated long after damage onset in chronic stroke patients. 

The Klausenbach Study by Jain carried out between 1987 and 1989 in Germany, looked at fifty chronic stroke (anywhere from 3 weeks to 5 years post incident) patients with hemiparesis (half body weakness) or hemiplegia. Daily Hyperbaric oxygen was given for 45 min at 1.5 ATA for 6 weeks. Physical therapy was routinely given in the chamber during the HBO session. All of the 50 patients in this series showed positive improvement.  The most striking finding was the prolonged reduction of spasticity under HBO conditions with physical therapy. 

 At 1-year follow-up, patients continued to maintain the improvement noted at the time of discharge. 

There of course have been some trials that have not shown substantial benefit in acute stroke in particular, and the data for acute stroke seems to be mostly mixed and inconclusive. The failure of some clinical trials of HBO in stroke is suggested to be attributed to factors such as delayed time to therapy, small sample size, and the use of chamber pressures that are too high as pressures of 2.0 ATA or lower was used in the majority of >2000 stroke patients that have been treated in published studies.  

Use of Hyperbaric treatment in late stroke is based on  premise that affected parts of the brain are dysfunctional but not dead and that one can "activate" brain tissue around the area of the stroke. 

Pressure of 1.5 ATA is suggested as optimal for recovery of injury from stroke from Jain 2017. 

Naturopathic Medicine and Stroke: 

In observational studies, higher potassium intake was associated with a lower incidence of stroke and lower stroke-related mortality.

Patients with strokes have been reported to have low levels of magnesium not only in the blood but in the the cerebrospinal fluid that bathes the brain which can promotes spasm of brain blood vessels (a factor in the progression of ischemic stroke). 

Numerous observational studies have found that an elevated plasma homocysteine concentration is a strong and independent risk factor for stroke. Hyperhomocysteinemia (possbily from B6, B12 and Folic Acid deficiency are contributors. 

In prospective studies, low vitamin C intake or low plasma vitamin C concentrations were associated with an increased risk of stroke and stroke mortality.

Vitamin C, Magnesium and B6, methyl-B12 and methylated Folic Acid are key nutrients our Naturopathic doctors include in IV Therapy treatments for cardiovascular health for our Edmonton patients. 

Our Naturopathic doctors can certainly help our Edmonton patients assess underlying risk factors to stroke if you are looking for stroke prevention through nutritional analysis and advanced lipid panels that include various inflammatory parameters and diet and lifestyle analysis. 

IV Therapy

Our general approach would be to provide nourishment to the brain both orally and intravenously. IV Phospholipids, IV Glutathione and IV B-Vitamins with Glutathione support nutrients (Zinc, Selenium, Vitamin C) would be key treatments to be done 1-3 times weekly pre or post hyperbaric treatment. The Klausenbach study is an example of how important it is to integrate regular physical therapy among Hyperbaric treatment and we believe IV therapy is not an exception and must have regular physical therapy integrated as well. 

Concluding thoughts: 

Overall, the data in chronic stroke appears extremely encouraging with publications on hundred of patients with substantial change after Hyperbaric Oxygen Therapy treatment. Whereas acute stroke is not definitively benefited by HBOT. We believe based on this data Hyperbaric oxygen can be of extreme benefit in chronic stroke. Synergy is thought to exist between Hyperbaric Oxygen and aggressive nutritional interventions such as IV Therapy which our Naturopaths also focus on at our Edmonton office.