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Hyperbaric Oxygen Therapy Improves Behavioral Function in Children with Post-concussion Syndrome, Study Finds

​Cognitive and behavioral function in children with post-concussion syndrome improved after they underwent hyperbaric oxygen therapy[EF1] , according to findings of a controlled trial published online Sept. 23 in Scientific Reports.

The randomized, double-blind trial conducted from Dec. 1, 2017, to Nov. 1, 2021, at Shamir Medical Center in Be'er Ya'akov, Israel, included 25 children aged 8 to 15. The participants had experienced mild‑moderate traumatic brain injury (TBI) six months to 10 years prior to the study.

“Persistent post‑concussion syndrome (PPCS) is a common and significant morbidity among children following [TBI] and the evidence for effective PPCS treatments remains limited," explained lead author Amir Hadanny, MD, PhD, of the Sagol Center for Hyperbaric Medicine and Research at Shamir (Assaf Harofeh) Medical Center, Zerifin, and the Sackler School of Medicine at Tel-Aviv University, and colleagues. “Recent studies have shown the beneficial effects of hyperbaric oxygen therapy … in PPCS adult patients."

The researchers noted that more than 90 percent of TBI cases in children under 16 years are mild. Most of these children recover completely very quickly, but approximately 10 percent to 30 percent experience PPCS for a month or even years, they wrote.

“PPCS has a significant effect on a child's quality of life, school performance, family function, and activities," researchers said. “A recent survey confirmed that PPCS is underdiagnosed as over 25 percent of the children coming to the [emergency department] due to [mild TBI] will suffer from PPCS."

The treatment for concussion in children typically includes rest and a gradual return to activities, including school, with aerobic exercise known to speed up recovery in the month following the injury, according to the study. Evidence for effective PPCS treatments, however, is limited and often includes physical and neurocognitive therapies, researchers said. Adults with chronic TBI and PPCS, however, have benefited from hyberbaric oxygen therapy even years after an injury, as its “combined action of hyperoxia and hyperbaric pressure" results in “significant improvements in tissue oxygenation, while targeting both oxygen and pressure sensitive genes," the study noted.

Preclinical models and clinical studies in TBI survivors have demonstrated the effect of hyperbaric oxygen “through several mechanisms including anti-inflammatory, mitochondrial function restoration, increased perfusion via angiogenesis and induction of proliferation and migration of stem cells," researchers said.

From six months to 10 years prior to the study, the participants with mild TBI had lost consciousness for up to 30 minutes, experienced post-traumatic amnesia for up to 24 hours, and had a Glasgow Coma Scale (GCS) grade of 13 to 15. Those with moderate TBI scored between nine and 12 on the GCS, had CT abnormalities, and had other unspecified criteria. Before participating in the study, the participants had experienced at least two PPCS symptoms for at least three months but did not have any cognitive or behavioral function changes for at least one month.

The researchers randomized the participants into either the hyperbaric oxygen or sham-control group. They then questioned the children about what they thought of the treatment they received after the first session, and they asked again one to three weeks after the last of 60 daily sessions. Researchers found that those who underwent hyperbaric oxygen therapy had significant improvements in their general cognitive score (d = 0.598, p = 0.01), memory (d = 0.480, p = 0.02), executive function (d = 0.739, p = 0.003), PPCS symptoms including emotional score (p = 0.04, d = – 0.676), behavioral symptoms including hyperactivity (d = 0.244, p = 0.03), global executive composite score (d = 0.528, p = 0.001), planning/organizing score (d = 1.09, p = 0.007)."

“Clinical outcomes correlated with significant improvements in brain MRI microstructural changes in the insula, supramarginal, lingual, inferior frontal and fusiform gyri," researchers said. “The study suggests that HBOT [hyperbaric oxygen therapy] improves both cognitive and behavioral function, PPCS symptoms, and quality of life in pediatric PPCS patients at the chronic stage, even years after injury. Additional data is needed to optimize the protocol and to characterize the children who can benefit the most."​

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