Concussion, Post Concussion Syndrome, & mTBI

The importance of proper healing from Mild Traumatic Brain Injuries (mTBIs), such as concussions, has been historically undervalued(1). Recent years have brought an increased focus towards mTBIs in New Zealand, especially towards their potential long-term consequences(2).

 

Acute symptoms such as slow response time, irritability, and low energy may resolve on their own, but sometimes they can persist and evolve into long-lasting cognitive, behavioral, and communicative disabilities(2). When these symptoms remain present 3 months post-injury, the individual is considered to have “Post-Concussion Syndrome” or “PCS”(3).

HBOT has repeatedly been shown to improve many PCS symptoms, even years after initial injury(4-7).

Specific categories of improvement include memory, depression, anxiety, post-traumatic stress disorder (PTSD) ratings, sleep quality, and overall quality of life(4-6).

These positive findings are typically achieved after completing 40 HBOT treatments, most commonly at a pressure of 1.5-2.0 atmospheres(4-6).

Research suggests that these improvements are due to improved tissue oxygenation, cellular metabolism, and mitochondrial function as well as a well-regulated inflammatory response. These effects are a direct result of HBOT(8).

Lastly, the benefits of HBOT for mTBI are likely most significant when administered soon after initial injury, although studies have found that improvements can still occur many years after the causative event (7).

  • Decreased Inflammation

    Hyperbaric oxygen therapy reduces systemic inflammation by increasing anti-inflammatory gene expression and decreasing proinflammatory genes.

  • New Blood Vessel Formation

    Hyperbaric oxygen therapy stimulates the formation of new blood vessels, healing injured tissues that were unable to get nutrients and oxygen.

  • Increased Stem Cell Activity

    Hyperbaric oxygen therapy mobilizes stem progenitor cells (SPCs) from the bone marrow, creating the opportunity for tissue regeneration.

 

Videos from the experts

 
 

  1. Mann, Aneetinder, et al. “Concussion Diagnosis and Management: Knowledge and Attitudes of Family Medicine Residents.” Canadian Family Physician, vol. 63, no. 6, The College of Family Physicians of Canada, June 2017, pp. 460–66.

  2. Silverberg, Noah D., et al. “Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines.” Archives of Physical Medicine and Rehabilitation, vol. 101, no. 2, Feb. 2020, pp. 382–93. ScienceDirect, doi:10.1016/j.apmr.2019.10.179.

  3. Ryan, Laurie M., and Deborah L. Warden. “Post Concussion Syndrome.” International Review of Psychiatry (Abingdon, England), vol. 15, no. 4, Nov. 2003, pp. 310–16. PubMed, doi:10.1080/09540260310001606692.

  4. Harch, Paul G., et al. “Hyperbaric Oxygen Therapy for Mild Traumatic Brain Injury Persistent Postconcussion Syndrome: A Randomized Controlled Trial.” Medical Gas Research, vol. 10, no. 1, Mar. 2020, pp. 8–20. PubMed, doi:10.4103/2045-9912.279978.

  5. Mozayeni, B. Robert, et al. “The National Brain Injury Rescue and Rehabilitation Study – a Multicenter Observational Study of Hyperbaric Oxygen for Mild Traumatic Brain Injury with Post-Concussive Symptoms.” Medical Gas Research, vol. 9, no. 1, Mar. 2019, pp. 1–12. PubMed, doi:10.4103/2045-9912.254636.

  6. Weaver, Lindell K., et al. “Hyperbaric Oxygen for Post-Concussive Symptoms in United States Military Service Members: A Randomized Clinical Trial.” Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc, vol. 45, no. 2, Apr. 2018, pp. 129–56.

  7. Boussi-Gross, Rahav, et al. “Hyperbaric Oxygen Therapy Can Improve Post Concussion Syndrome Years after Mild Traumatic Brain Injury – Randomized Prospective Trial.” PLoS ONE, vol. 8, no. 11, Nov. 2013. PubMed Central, doi:10.1371/journal.pone.0079995.

  8. Efrati, Shai, and Eshel Ben-Jacob. “Reflections on the Neurotherapeutic Effects of Hyperbaric Oxygen.” Expert Review of Neurotherapeutics, vol. 14, no. 3, Mar. 2014, pp. 233–36. PubMed, doi:10.1586/14737175.2014.884928

  9. Boussi-Gross R, Golan H, Fishlev G, et al. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury – randomized prospective trial. PLoS One. 2013;8(11):e79995. Published 2013 Nov 15. doi:10.1371/journal.pone.0079995 

  10. Uri Balla, Merav Catalogna, Eran Kozer, Adi Oren-Amit, Amir Hadanny, Shai Efrati.
    Persistent post-concussive syndrome in children after mild traumatic brain injury is prevalent and vastly underdiagnosed.
    Scientific Reports volume 12, Article number: 4364 (2022).

  11. Tal S, Hadanny A, Sasson E, et al. Hyperbaric oxygen therapy can induce angiogenesis and regeneration of nerve fibers in traumatic brain injury patients. Front Hum Neurosci. 2017;11:508. Published 2017 Oct 19. doi:10.3389/fnhum.2017.00508

  12. Meng XE, Zhang Y, Li N, et al. Hyperbaric oxygen alleviates secondary brain injury after trauma through inhibition of tlr4/nf-κb signaling pathway. Med Sci Monit. 2016;22:284–288. Published 2016 Jan 26. doi:10.12659/msm.894148

  13. Reflections on the Neurotherapeutic Effects of Hyperbaric Oxygen Efrati, S. and E. Ben-Jacob. Expert Rev Neurother 14, no. 3 (Mar 2014): 233-6.

  14. Vlodavsky, E. Palzur, M. Feinsod, et al. Evaluation of the apoptosis-related proteins of the BCL-2 family in the traumatic penumbra area of the rat model of cerebral contusion, treated by hyperbaric oxygen therapy: a quantitative immunohistochemical study. Acta Neuropathol., 110 (2) (2005), pp. 120-126

  15. Dong Y, Hu XH, Wu T, et al. Effect of hyperbaric oxygenation therapy on post-concussion syndrome [published correction appears in Exp Ther Med. 2018 Dec;16(6):4918]. Exp Ther Med. 2018;16(3):2193–2202. doi:10.3892/etm.2018.6463

  16. Tal, S., A. Hadanny, E. Sasson, G. Suzin, and S. Efrati.
    "Hyperbaric Oxygen Therapy Can Induce Angiogenesis and Regeneration of Nerve Fibers in Traumatic Brain Injury Patients." Front Hum Neurosci 11 (2017): 508.

  17. Tsutsumi I, Tsujimoto Y, Takahashi S, et al. Hyperbaric oxygen therapy for persistent post‐concussion syndrome following mild traumatic brain injury. Cochrane Database Syst Rev. 2017;2017(7):CD012727. Published 2017 Jul 16. doi:10.1002/14651858.CD012727

  18. Eve DJ, Steele MR, Sanberg PR, et al. Hyperbaric oxygen therapy as a potential treatment for post-traumatic stress disorder associated with traumatic brain injury.  Neuropsychiatr Dis Treat. 2016;12:2689–2705. Published 2016 Oct 20. doi:10.2147/NDT.S110126

  19. Tal, S., A. Hadanny, N. Berkovitz, E. Sasson, E. Ben-Jacob, and S. Efrati.
    "Hyperbaric Oxygen May Induce Angiogenesis in Patients Suffering from Prolonged Post-Concussion Syndrome Due to Traumatic Brain Injury." Restor Neurol Neurosci 33, no. 6 (2015): 943-51.

  20. Hadanny, A., H. Golan, G. Fishlev, Y. Bechor, O. Volkov, G. Suzin, E. Ben-Jacob, and S. Efrati.
    "Hyperbaric Oxygen Can Induce Neuroplasticity and Improve Cognitive Functions of Patients Suffering from Anoxic Brain Damage." Restor Neurol Neurosci 33, no. 4 (2015): 471-86.

  21. Hadanny, A. and S. Efrati."Treatment of Persistent Post-Concussion Syndrome Due to Mild Traumatic Brain Injury: Current Status and Future Directions." Expert Rev Neurother 16, no. 8 (Aug 2016): 875-87.

  22. Hadanny, A., S. Abbott, G. Suzin, Y. Bechor, and S. Efrati. "Effect of Hyperbaric Oxygen Therapy on Chronic Neurocognitive Deficits of Post-Traumatic Brain Injury Patients: Retrospective Analysis." BMJ Open 8, no. 9 (Sep 28 2018): e023387.