Hyperbaric Oxygen & Neurological Disease

Hyperbaric Therapy has a wealth of data for uses in Neurology

Background: 

The most important metabolic effects of Hyperbaric Oxygen are on the Brain and Central Nervous System. 

The brain has unusually high resting energy requirements, which can only be met by oxidative breakdown of substrate. Cerebral metabolism is closely tied to blood flow. The brain, although it makes up only 2 % of the body weight, consumes 20 % of the oxygen taken in.

Furthermore, the brain cannot store oxygen and therefore cannot tolerate being without Oxygen for more than 3 minutes as neurons have a poor capacity to self recover or regenerate after periods without oxygen. 

Energy by glycolysis (i.e anerobic production of lactate) is not adequate to maintain normal brain function. Glycolysis uses NAD+ and produces two molecules of NADH and 2 ATP from each molecule of glucose versus 38 ATP via normal oxidative phosphorylation. 

Under aerobic conditions, pyruvate is metabolized with NAD+ to produce NADH which is oxidized through mitochondrial electron transfer hence the  synergy between intravenous NAD+ and Hyperbaric Oxygen. 

Hyperbaric Effects in Neurology

According to Jain 2017, numerous mechanisms are related to the effects of Hyperbaric Oxygen in neurological disorders:

• Relief of hypoxia

• Improvement of microcirculation (via angiogenesis)

• Relief of cerebral edema (by vasoconstrictive effect)

• Preservation of damaged tissue (rendered inactive by ischemia/hypoxia). 

• Improvement of cerebral metabolism

• Alleviating oxidative stress & inflammation

• Increasing mitochondrial function

• Stem Cell Mobilization 

In terms of inflammation, Hyperbaric Therapy can enhance anti-inflammatory IL-10 levels in the serum and brain tissues. In animal models, Hyperbaric Oxygen has been shown to increase the expression of Sirt1, Nrf2, and superoxide dismutase (SOD) for modulating inflammation and promoting longevity.

Cognitive Function

Hypoxia has been considered a causal factor in the decline of intellectual function in the elderly

Vascular dementia is the second most common type of dementia in the world after Alzheimer’s disease accounting for about 20% of cases of all dementia.

The main risk factors include hypertension, obesity, diabetes, hyperlipidemia, metabolic syndromes, smoking, hyperhomocysteinemia and genetic disposition. 

A 2012 Cochrane review (Xiao et al) assessed the effect of Hyperbarix Oxygen for Vascular Dementia. They failed to provide sufficient clinical evidence because only one randomized controlled trial involving 64 patients was included in their systematic review. 

A meta-analysis by You 2019 looked at twenty-five randomized clinical trials involving 1,954 patients and looked at Hyperbaric Treatment along with nootropic medications. The results indicated that additional HBOT strikingly improved the Mini-Mental State Examination and activities of daily living. The authors concluded "the present meta-analysis suggested that HBOT can be recommended as an effective and safe complementary therapy for the treatment of VD."

For instance, Xu 2019 looked at 158 patients with Vascular Dementia which were randomly divided into control group and Hyperbaric groups.

Hyperbaric Oxygen was given 5 days per week, 60 min for each session at 2.0 ATA for 12 weeks. After treatment, compared with the control group, the MMSE scores were significantly increased. 

The authors concluded "HBO therapy can improve cognitive function in patients with VD, and its mechanism may be related to elevated serum Humanin levels." Serum Humanin levels in the HBOT group were significantly increased and were positively correlated with MMSE scores. Multiple studies have shown that Humanin is closely related to the pathogenesis of cognitive impairment. 

In Naturopathic medicine many cognitive enhancers or "nootropics" exist. Some of our Naturopathic Doctors' favorites include Huperzine from Chinese club moss Huperzia serrata, which acts as a cholinesterase inhibitor. 

Xing 2014 looked at eight Alzheimer's trials with 733 participants and two Vascular Dementia trials with 92 participants. The results showed that Huperzine improve the minimental state examination and activities of daily living scale as well as significant improvement of cognitive function measured by memory quotient in patients with AD. The mechanism of Huperzine is not vascular. Our Naturopaths will often use Vinpocetine if a more robust vascular effect is needed for our Edmonton patients. 

Alzheimer's

Not much easily accessible data exists for Hyperbaric treatment and Alzheimer's. However data exists that suggests Hyperbaric treatment can amyloid burden and tau phosphorylation - part of the pathological processes underlying Alzheimer's. Harch 2018 discusses a case report of a 58-year-old female was diagnosed with Alzheimer's dementia which was rapidly progressive in the 8 months prior to initiation of hyperbaric oxygen therapy - she received 40 treatments in total. 

The patient received 1.15 ATA treatments once per day, 5 days per week.

After 21 Hyperbaric treatments the patient reported increased energy, activity, mood, and perform activities of daily living, and work crossword puzzles.

After 40 Hyperbaric treatments, she reported increased memory, concentration, sleep, conversation, appetite, ability to use the computer, more good days (5/7) than bad days, resolved anxiety, and decreased disorientation and frustration. 

PET scans showed up to a 38% increase in brain metabolism, including typical Alzheimer brain areas.

Dr. Dale Bredesen has published some excellent literature on Functional and Naturopathic medicine approaches to Alzheimer's termed "ReCODE" – reversal of cognitive decline – a protocol that has reversed symptoms in patients with mild cognitive impairment and Alzheimer’s disease. Easy assessments such as a1c, crp, fasting blood glucose and insulin and homocysteine and serum zinc are basics of the protocol which are simple labs we run at our Naturopath clinic in Edmonton. 

Looking at chronic infections, intermittant fasting, ketosis and heavy metal load are also easy part of Dr. Bredesen's approach that our Naturopaths frequently run at our Edmonton office. 

Parkinson's 

Neretin (1989) looked at Hyperbaric Therapy for the treatment of 64 patients suffering from Parkinsonism. Hyperkinesia, bradykinesia, and muscle rigidity, can develop with brain lesions of varied etiology. 

29 men and 35 women ranging in age from 37 to 78 years. Hyperbaric Oxygen was given daily for 8-12 treatments between 1.3 and 2.0 atm for 40-60 minutes. The Hyperbaric Treatment was combined with the taking of nootropic medications and preparations for improving microcirculation.

One or two sessions of HBO permitted the achievement of an improvement in general state of feeling in all patients.  Perceptible shifts in neurological status were identified, as a rule, in the middle of the course of treatment (4th to 6th session). 

Beneficial effects were seen 55/64 patients (86%).  Good treatment results were noted in 18 patients. The therapeutic effect was considered satisfactory in 26 patients. 

The authors found results were better in vascular parkinsonism, in patients under 65 years, with a disease between 1 and 5 years.

The rigidity regressed to a greater degree, whereas with trembling Hyperbaric treatment was less potent.

A case report from Xu 2018 was regarding a 45-year-old male Parkinson's patient with severe depression and anxiety that refused to be treated with mood modifying therapies.  The patient initially presented 1.5 years prior with resting tremor and bradykinesia. Three months prior to initiating Hyperbaric Therapy, the Parkinson's symptoms progressively intensified and he began to present psychiatric symptoms associated with PD.  

2 sessions of 40 minute HBOT was used, separated by a 10 minute break at 2.0 ATA. After 4 days of hyperbaric oxygen treatment, the patient had significantly improved sleeping quality. Treatment was used for 30 days and mood significantly improved following treatment. Additionally, the resting tremor and bradykinesia improved significantly.

The authors suggested that the results may be because hyperbaric oxygen treatment reduces oxidative stress and inflammation, which are known factors in the pathogenesis of Parkinson's. 

Intravenous Glutathione Therapy is a favorite of our Naturopathic Doctors for Parkinson's at our Edmonton clinic. A study by  Perlmutter 2009 looked at 11 Parkinson's patients receiving an extremely conservative 1400mg of IV Glutathione Therapy with a mild symptomatic benefit. This is in stark contrast to Sechi 1996 who reported a 42% decline in Parkinson's disability with frequent IV Glutathione treatment for 30 days. The authors also found that this robust therapeutic effect lasted for 2 to 4 months.

Hyperbaric Oxygen and Neurological Disease

MS

Numerous studies exist examining the impact of Hyperbaric Treatment on MS. We've chosen to point out two longer term studies demonstrating positive effect. 

Oriani et al (1990) looked at 44 MS patients and compared Hyperbaric Oxygen at 2.5 ATA  against compressed air (90 minute treatments for 1 month before initiating maintenance treatments for a 1 year period. 

In the Hyperbaric group, 64% reported benefits, 10% reported no change and 10% declined. However, only 5% in the Hyperbaric air group reported effect.

Only after 6 months were any changes noted, which implies other studies may have been too short. Of the 64% of responders, over 50% of them experienced a 2 point EDSS score drop which can indicate massive changes in functionality.

With regards to disease course Pallota (1986) studied 22 RRMS patients for 8 years with an initial Hyperbaric treatment course of 20 treatments, with half treated (11/22) treated with two HBO treatments every 3 weeks thereafter (which is a reasonable course that a patient can actually realistically carry out over a long period of time if sufficiently motivated).

The relapse frequency decreased dramatically in the 11/22 patients over the 8 year period. 

MS is certainly an area our Naturopathic doctors are experienced with at our Edmonton clinic. Our Naturopaths screen for food sensitivities, assess gut health, chronic infections, toxicities and use IV Glutathione, IV Myers and are exploring IV NAD for benefit in our Edmonton MS patients.  

For our entire discussion on Hyperbaric medicine and MS visit our MS Section. 

Stroke 

A tremendous amount of data exists on potential positive effects of Hyperbaric Therapy for Chronic stroke sequela. Two controlled studies are presented in greater detail below: 

Neubauer and End (1980) used Hyperbaric Therapy for both acute and the chronic stroke at pressures of 1.5–2 ATA up to 60 minutes twice daily. Of the 122 patient studied, 79 of which were chronic stroke with treatment commencing between 5 months to 9 years after the initial insult. The authors reported that 65% of the chronic stroke patients reported an improvement in their quality of life.

Efrati et al.(2013), studied 74 chronic stroke patients commencing Hyperbaric treatment for 60 days  (5 weekly sessions for 90 minutes at 2 ATA for a total of 40 treatments). Treatment began between 6 and 36 months after the intial insult. The authors found that Hyperbaric therapy led to significant neurological improvements in this chronic stroke population.

Both studies suggest that the neuroplasticity and partial restoration of brain function can still be activated long after the initial insults in chronic stroke patients. 

For our entire discussion on Hyperbaric medicine and stroke visit our Stroke section. 

Citicholine is Naturopath favorite at our clinic for both MS and Stroke.  Alvarez-Sabín 2013 gave citicoline (1 g/day) for 12 months vs. no citicoline in patients selected 6 weeks after suffering a stroke. 

199 patients underwent evaluation at 1 year. Citicoline-treated patients showed better outcome in attention-executive functions and temporal orientation at 6 month. Moreover, citicoline group showed a better functional outcome and ultimately deemed effective in improving poststroke cognitive decline. In our Naturopaths' experience Citicholine is well tolerated. 

TBI

Anti-inflammatory, hyperoxygenating and neovascular Hyperbaric effects make it an attractive option for use in chronic TBI. 

Harch et al. 2012, looked at Hyperbaric therapy in 16 war veterans with traumatic brain injury as well as Post-Concussion Syndrome and PTSD. Hyperbaric Therapy was 40 sessions at 1.5 ATA for 60 minutes in 30 days. 

80% of the subjects reported an improvement in the majority of their symptoms in areas such as: headache, sleep, short term memory and cognition as well as PTSD symptoms. 

For our entire discussion on Hyperbaric medicine and TBI visit our TBI Section

IV Glutathione with supportive nutrients (B-Vitamins, Selenium, Magnesium and Zinc) are some of our Naturopaths' favorites for augmenting TBI symptoms. We've seen some of our Edmonton TBI patients respond rapidly and dramatically to IV Glutathione.  

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