Hyperbaric oxygen therapy promotes late neuroplasticity in post-stroke patients

Hyperbaric oxygen therapy promotes late neuroplasticity in post-stroke patients - Randomized, Prospective Study.

Efrati S, Fishlev G, Bechor Y, Volkov O, Bergan J, Kliakhandler K, Kamiager I, Gal N, Friedman M, Ben-Jacob E, Golan H. The Institute of Hyperbaric Medicine, Assaf Harofeh Medical Center, Zerifin, Israel; Research and Development Department, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Summary:

Recovery from stroke correlates with non-active (stunned) brain regions that can persist for years. The present study investigated whether increasing dissolved oxygen by hyperbaric oxygen therapy (HBOT) can activate neuroplasticity in patients with chronic neurological deficits due to stroke.

Methods and Results:

In a prospective, randomized, controlled trial, 74 patients (15 were excluded) were enrolled. All participants had suffered a stroke 6-36 months prior to the study and had at least one motor dysfunction. Patients were randomly assigned to “treated” or “cross” groups. Brain activity was assessed by SPECT imaging, neurological functions were evaluated by NIHSS, ADL, and quality of life. Patients in the treated group were evaluated twice: at baseline and after 40 HBOT sessions. Patients in the cross group were evaluated three times: at baseline, after a 2-month control period without treatment, and after a subsequent 2-month HBOT treatment. HBOT protocol: Two months, 40 sessions (5 days/week), 90 minutes each session, 100% oxygen at 2 ATA. The results show that the neurological functions and quality of life of all patients in both groups were significantly improved after the HBOT sessions. However, no improvement was observed during the control period of the cross group. The results of the SPECT imaging correlated well with the clinical improvement.

Conclusions:

The results show that HBOT can lead to significant neurological improvements even in late stage post-stroke patients. The observed clinical improvements suggest that neuroplasticity can be activated long after stroke in regions where there is a SPECT/CT mismatch (anatomy/physiology) of the brain.

Study registration: ClinicalTrials.gov NCT00715897

PLoS