Is Hyperbaric Oxygen the Answer for Concussion Treatment in Kids?

Hyperbaric oxygen therapy may help resolve symptoms of concussion in children years after they have suffered a brain injury, researchers in Israel have found.

As many as 1 in 4 children who have a mild traumatic brain injuries experience symptoms that last up to a year or more after an event ― a condition known as post-concussion syndrome. Lingering symptoms can include headaches, dizziness, fatigue, memory loss, attention deficit, and blurred vision.

Previous studies have suggested that hyperbaric oxygen therapy ― exposure to pure oxygen at pressures above normal atmospheric levels ― could be an effective treatment for traumatic brain injury in adults. The new findings, published in Scientific Reports, adds to some trials that have shown benefits of the therapy for children with post-concussion syndrome.

Researchers at the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center and their colleagues enrolled 25 children and adolescents aged 8 to 15 years in the randomized, controlled trial. All of the participants had persistent post-concussion syndrome after experiencing a traumatic brain injury 6 to 10 years before enrolling in the trial.

The researchers assessed 17 of the participants’ baseline cognitive and behavioral function scores (eight children who were younger than 10 were deemed too young to undergo baseline testing). The researchers then randomly assigned 15 participants to receive daily sessions of hyperbaric oxygen therapy for 2 months, and 10 to a sham treatment ― a placebo design the researchers called novel.

“We have accomplished many incredible firsts in this study, including a unique sham protocol which is the first of its kind in hyperbaric medicine,” Amir Hadanny, MD, chief researcher at the Sagol Center and lead author of the study, said in a written statement. “The protocol enables true masking and blinding of patients without any active treatment.”

Patients who underwent hyperbaric oxygen therapy experienced as much as a 12% improvement from baseline in their scores on tests of memory, cognition, and motor skills, compared to those who received sham treatment. Among the participants who received sham treatment, symptoms improved by 2%.

MRI scans of eight patients in the therapy group and eight in the sham group showed that among the patients who underwent hyperbaric oxygen therapy, brain tissue density was increased, which the researchers correlated with gains in cognition and motor skills.

Images of the brains after surgery suggest improvement in brain signaling and growth of new cells, according to Mohammed Elamir, MD, lead physician at AVIV Clinics, in The Villages, Florida. who was not involved in the study. (Hadanny also is affiliated with AVIV.)

“This [study] replicates what we already know is possible to do in the brain as a result of concussion and traumatic brain injury in adults, just applied to children,” Elamir told Medscape Medical News.

Dr Elizabeth Pieroth

But Elizabeth M. Pieroth, PsyD, ABPP, MPH, director of the concussion program at Midwest Orthopaedics at Rush University Medical Center in Chicago, said the findings do not provide enough evidence to recommend hyperbaric oxygen treatment for post-concussion syndrome.

“There are so many confounding variables here. It’s hard to say that hyperbaric oxygen treatment was the cause of the improvement,” Pieroth said.

Pieroth said the researchers tried to capture a broad variety of conditions by including a small group of young patients whose symptoms ranged from mild to moderate in severity. The study did not provide information as to what caused each participant’s post-concussion syndrome or whether they had previously undergone other treatments for their symptoms.

Six to 10 years “is very far out from the event,” she said. “Maybe those kids didn’t have the right [initial] treatment based on what caused their injury.”

The most common side effects reported from patients in both arms of the study were mild ear pain and inflamed ear tubes.

Elamir said the finding adds to the growing evidence on the benefits of hyperbaric oxygen therapy to help treat traumatic brain injury and prevent further physical, psychological, and cognitive deterioration.

“The sooner we act, the more difference we can make at an earlier point,” he said.

Pieroth disagreed, saying that hyperbaric oxygen therapy is not a primary treatment or replacement for the standard of care for children and adults with post-concussion syndrome ― time and tailored management of patients’ symptoms.

The number of therapy sessions the researchers used in the study to possibly achieve their outcome ― daily hourlong sessions conducted five times per week for 60 days ― is not possible for many children.

“That’s so unrealistic in clinical use,” said Pieroth, who noted that in Chicago, the cost of the “unproven” therapy would be roughly $8000.

“I have always said to people, ‘I want [hyperbaric oxygen therapy] to work;’ I really desperately want my patients to feel better,” Pieroth added. “I would scream it from the rooftop if it works, but the data doesn’t support it. This article just doesn’t change my opinion.”

Elamir and Pieroth reported no relevant financial relationships. Hadanny works for AVIV Scientific LTD.

Sci Rep. Published September 23, 2022. Full text

Lara Salahi is a journalist living in Boston.

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