Functional MRI (fMRI) Evaluation of Hyperbaric Oxygen Therapy (HBOT) Efficacy in Chronic Cerebral Stroke: A Small Retrospective Consecutive Case Series

Abstract

Topics: Functional Magnetic Resonance Imaging (fMRI) evaluation of HyberBaric Oxygen Therapy (HBOT) effects on chronic cerebral stroke Patients (Pts). Introduction: Our aim was to evaluate with fMRI, in a 3 Tesla system, the functional effects of HBOT on the Central Nervous System (CNS) in four Pts with established ischaemic and haemorrhagic cerebral strokes (2 Pts each). To our knowledge, no author used fMRI technique for this purpose, till now. Methods: All four Pts underwent a fMRI study before and after 40 HBOT sessions, with a time window of a few days. They carried out two language (text listening, silent word-verb generation) and two motor (hand and foot movements) tasks (30 s On-Off block paradigms). Results: After HBOT, all Pts reported a clinical improvement, mostly concerning language fluency and motor paresis. fMRI analysis demonstrated an increase in both the extent and the statistical significance of most of the examined eloquent areas. Conclusions: These changes were consistent with the clinical improvement in all Pts, suggesting a possible role of fMRI in revealing neuronal functional correlates of neuronal plasticity and HBOT-related neoangiogenesis. Although only four Pts were examined, fMRI proved to be a sensitive, non-invasive and reliable modality for monitoring neuronal functional changes before and after HBOT.

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“…Although animal studies have shown the inhibitory effect of HBOT on inflammation and apoptosis after cerebral ischemia [259,260], clinical trials on humans have not shown any significant benefit. Anyway, it has been indicated that HBOT can improve some neuropsychological and inflammatory outcomes, especially in stroke patients, within the first few hours [261,262]. Furthermore, studies on animals have shown that HBOT is associated with reduced blood-brain barrier breakdown, reduced cerebral edema, improved cerebral oxygenation, decreased intracranial pressure, reduced oxidative burden, reduced metabolic derangement, and increased neural regeneration [260,261,263].…”

The Role of Hyperbaric Oxygen Therapy in the Treatment of Surgical Site Infections: A Narrative Review

“…Furthermore, these studies have shown that HBOT is associated with reduced blood-brain barrier breakdown, reduced cerebral edema, improved cerebral oxygenation, decreased intracranial pressure, reduced oxidative burden, reduced metabolic derangement, and increased neural regeneration [41,42,45]. Clinical trials on humans have not shown any significant benefit, although it is indicated that HBOT can improve some neuropsychological and inflammatory outcomes, especially in stroke patients, within the first few hours [42,46]. Moreover, there is evidence suggesting that HBOT is not only safe for cancer patients, but might also have tumor-inhibitory effects in certain cancer subtypes and can also be used in the treatment of complications after radiotherapy [33,47].…”

The application and perspective of hyperbaric oxygen therapy in acute ischemic stroke: From the bench to a starter?

“…Compared to the traditional clinical function score and the infarct size, functional MRI (fMRI), quantitative electroencephalogram (qEEG), and other responses to neurological function indicators can be used (47). In the study by Cevolani et al, fMRI was first used to evaluate HBOT functional effects on the central nervous system (CNS) of patients with strokes, suggesting a possible role of fMRI in revealing functional neuronal correlates of neuronal plasticity and HBOT-related neoangiogenesis (48).…”