RESUMEN
Traumatic brain injury (TBI) may cause persistent cognitive dysfunction. A pilot clinical study was performed to determine if hyperbaric oxygen (HBO2) treatment improves cognitive performance. It was hypothesized that stem cells, mobilized by HBO2 treatment, are recruited to repair damaged neuronal tissue. This hypothesis was tested by measuring the relative abundance of stem cells in peripheral blood and cognitive performance during this clinical trial. The subject population consisted of 28 subjects with persistent cognitive impairment caused by mild to moderate TBI suffered during military deployment to Iraq or Afghanistan. Fluorescence-activated cell sorting (FACS) analysis was performed for stem cell markers in peripheral blood and correlated with variables resulting from standard tests of cognitive performance and post-traumatic stress disorder: ImPACT, BrainCheckers and PCL-M test results. HBO2 treatment correlated with stem cell mobilization as well as increased cognitive performance. Together these results support the hypothesis that stem cell mobilization may be required for cognitive improvement in this population.
Asunto(s)
Lesiones Traumáticas del Encéfalo/terapia , Movimiento Celular/fisiología , Trastornos del Conocimiento/terapia , Cognición/fisiología , Oxigenoterapia Hiperbárica , Personal Militar , Células-Madre Neurales/fisiología , Antígeno AC133 , Campaña Afgana 2001- , Antígenos CD34 , Lesiones Traumáticas del Encéfalo/sangre , Lesiones Traumáticas del Encéfalo/complicaciones , Trastornos del Conocimiento/sangre , Trastornos del Conocimiento/etiología , Método Doble Ciego , Citometría de Flujo , Humanos , Guerra de Irak 2003-2011 , Nestina/análisis , Proyectos Piloto , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: Determine changes in cognition and post-traumatic stress disorder (PTSD) symptoms in subjects with traumatic brain injury (TBI) exposed to 2.4 atmospheres absolute (atm abs) breathing 100% oxygen vs. sham (1.3 atm-abs air). METHODS: Fifty randomized subjects completed a total of 30 exposures. A concussion history was taken, then baseline, post-series, and six-week follow-up immediate post-concussion assessment and cognitive testing, Brain-checkers and PTSD Checklist for Military (PCL-M) tests were administered. RESULTS: No statistically significant differences between groups were noted, but both groups improved. Subgroups analyses, based on concussion history and individual test components, showed improvement in the treatment group vs. the sham. These subgroups included the number of concussive events, time from event to consent, loss of consciousness, visual memory, processing, go--no go, and simple reaction time. CONCLUSION: There was no statistically significant difference between a sham and 2.4 atm abs hyperbaric oxygen (HBO2) in cognitive scores from ImPACT and Brain-checkers or composite scores in the PCL-M; however both groups showed improvement. Subgroups with favorable response to treatment are identified. Future studies evaluating HBO2 should consider concussion histories or focus on validating subgroup response to determine HBO2 as a potential adjunctive treatment for persistent symptoms following TBI.