Chamber of Hopes For Brain Repair
Chamber of Hopes For Brain Repair
Chamber of Hopes For Brain Repair
Hyperbaric oxidative treatments bring new hopes of brain repair from strokes,
traumatic brain injuries and even metabolic disorders.
By Efrati et al:
By Eshel Ben-Jacob
January, 27, 2013
Currently, stroke is the leading cause of inability to maintain independent life among
adults in the US. Every year, more than 800,000 people in the US suffer a stroke. With
the aging of the population, the severity of the problem posed by stroke (and brain
injuries mainly due to home accidents) is expected to increase. Experts agree that novel
methods to repair and protect the brain from damage caused by strokes, traumatic injuries
and metabolic disorders (which can lead to dementia and Alzheimer) are needed more
than ever before.
New Hopes
New results by a team headed by Dr. Shai Efrati of Asaf Harofeh Medical Center and Tel
Aviv University suggest that hyperbaric oxidative treatment (HBOT) should be employed
to repair the brain from strokes and traumatic brain injuries (TBI). The results imply that
in the future, the HBOT might also be exploited to protect the brain from dementia and
Alzheimer (for reasons explained further below). The team illustrated and analyzed the
dramatic improvements in brain function and quality of life following two months of
HBOT treatment, in Seventy-four participants, 6-36 months after the stroke, whose
condition was no longer improving prior to the treatment. Yet, the neurological functions
and life quality of almost all the patients (over 95%) were significantly improved after the
HBOT sessions. Analyses of brain imaging (by SPECT scans) showed that the treatment
led to an increase in brain activity in brain locations with neurons that stayed alive but did
not have sufficient energy (blood supply) to function (generate firing of signals).
Granted new freedom
When asked, many of the patients say that the treatment gave them back the freedom they
lost due to the stroke (or TBI). The patients’ relatives say that their loved ones returned to
them. They also mention the new freedom by being relieved from the time and economic
pressure imposed by the need to take continuous care of disabled people. Going from the
patients and the families to the national level, billions of dollars will be saved every year
once HBOT is adopted as routine to treat stroke and TBI patients. Right now, the total
cost of stroke in the US is over $50 Billion per year. The cost of two months HBOT care
per person is only about $5-10K.
Figure1: Changes in the neurological evaluations. Each circle and diamond shows the changes
(statistically normalized) in the NIHSS (NIH stroke scale) and the ADL (activity of daily living) of
the patients over a period of two months. Blue circles correspond to the changes during the two
month control (when no treatment was given). The changes are close to zero (no changes) which
provides confirmation that the patients were at chronic stage. Red circles correspond of the
changed during the two months that these patients were treated. Red diamonds correspond to
changes during two months of treatment of the additional group of patients. We see that the
results for the two independent groups are similar – both indicate significant improvements
(negative changes mean improvement). (Courtesy of Dr. Efrati)
As evident from the graph, the results show dramatic improvement. Yet, the current study
aimed at “proof of concept” that HBOT can benefit stroke patients, so all patients
underwent 40 HBOT sessions. Based on the accumulated clinical experience, more
sessions of HBOT may be needed, at least for some patients, in order to obtain the
maximal improvement effect.
A new paradigm with new hopes
During most of the 20th century, the central paradigm has been that neuroplasticity can
only be activated during childhood and during a limited time window following brain
damage. The dramatic improvements in the stroke patients with chronic late stage brain
damage imply reactivation of neuronal activity in stunned areas (brain regions in which
the activity stopped following the stroke). Stroke damages the blood flow in the brain and
causes various degrees of brain injuries. Most severe is cell death (necrosis). However,
surrounding necrotic tissue, where cells are entirely lost, there are also quiescent regimes
of neurons that are impacted by metabolic dysfunction. They have the energy to stay
alive but not enough for full activity (firing of electric signals). These are the brain
locations that HBOT targets. By increasing the supply of energy (oxygen), it leads to the
formation of new blood vessels and, in parallel, enables the inactive neurons to become
active and form new links with neurons inside and outside the damaged areas. To confirm
the reactivation of the quiescent areas, the researchers evaluated the anatomical features
and functionality of the brain using a combination of CT scans to identify necrotic tissue
and SPECT scans to determine the metabolic activity level of the neurons surrounding
damaged areas. The research was based on the idea that damaged brain areas with non
active but live neuron regions can be activated by providing the cells with high oxygen.
Comparison of SPECT scans before and after treatment revealed increase in neural
activity in the quiet live neurons. Examples of CT and SPECT scans are shown in Figure
2.
Figure 2: SPECT (the colored pictures) and CT (the B&W picture) of a patient suffering from
left hemiparesis due to ischemic stroke that occurred 26 months prior to treatment. The upper
two images show the infracted brain (deep blue color) involving the right antero-postero-lateral
frontal, right superior-parietal and right parieto-occipital regions. Curved sagittal view in CT
(bottom left) shows the anatomical stroke area (V = posterior horn of right ventricle). The peri-
infarct region shows improved perfusion as demonstrated by SPECT image (right upper image).
Quantitation of the cerebral blood flow (CBF) change (before and after treatment) is
demonstrated in the right lower image. (Courtesy of Dr. Efrati)