Hyperbaric oxygen for neurologic indications--action plan for multicenter trials in: stroke, traumatic brain injury, radiation encephalopathy & status migrainosus.

Introduction: There is great interest in using hyperbaric oxygen (HBO) to treat neurological disease. The exquisite sensitivity of neural tissue to hypoxia makes increased oxygenation attractive as a therapy for disease processes that induce ischemia, edema, and, more recently, apoptosis. Four things specifically exist as targets for future projects and clinical trials: (1) stroke (2) traumatic brain injury (3) radiation induced necrosis and (4) status migrainosus.Methods: Specific aims: Stroke: determine if the use of HBO in the treatment of acute ischemic stroke is effective at improving outcomes. TBI: determine whether use of HBO in the acute state after traumatic brain injury is effective at improving outcomes and reducing elevated ICP. RIN: determine whether HBO treatment of radiation necrosis of brain results in improvement of neurological function and reduction of necrosis. Migraine: determine whether use of HBO will relieve headache pain in status migrainosus. Results: Stroke: there is evidence from animal studies that focal cerebral ischemiamay improve after HBO treatment. TBI: the interest in using HBO to treat TBI is based upon the premise that hypoxia, edema and apoptosis play significant roles in the pathophysiology of the disease. RIN: the evidence suggests that in caseswhere either the patient is not improving onmedical therapies or when surgical resection is not possible, HBO should be considered as a treatment option. Migraine: there is some evidence looking at HBO as an effective treatment of acute migraine attack. Summary: Each is discussed further with proposed study design and justification for their respective parameters. As our action plan moving forward, it is our goal to investigate in each areawithmultidisciplinary,multi-centered, case controlled double blind crossover studies. © 2012 Published by Elsevier Urban & Partner Sp. z o.o. on behalf of Polish Pediatric Society. Presented at 2nd Polish-American Pediatric Meeting 2010, Rzeszow, Poland. * Corresponding author at: Department of Pediatric Neurology, Medical College of Wisconsin, 8701W, Watertown Plank Rd, CCC 540, Milwaukee, WI 53226, United States. Tel.: +1 414 266 7544; fax: +1 414 266 3466. Available online at www.sciencedirect.com journal homepage: www.elsevier.com/locate/pepo E-mail address: hwhelan@mcw.edu (H.T. Whelan). 0031-3939/$ – see front matter © 2012 Published by Elsevier Urban & Partner Sp. z o.o. on behalf of Polish Pediatric Society. http://dx.doi.org/10.1016/j.pepo.2012.08.001 p e d i a t r i a p o l s k a 8 7 ( 2 0 1 2 ) 4 2 9 – 4 3 7 430