International Brain Research Foundation

Importance: The Defense and Veterans Brain Injury Center reported 358,088 mild traumatic brain injury (mTBI) among U.S. service members worldwide between the years 2000 and 2020. Veterans with mTBI have higher rates of Post-Traumatic Stress Disorder (PTSD), depressive disorder, substance use disorder, anxiety disorder, and suicide than their healthy counterparts. Currently, there is no effective treatment for mTBI. Objective: To assess the efficacy of hyperbaric oxygen therapy (HBOT) as a treatment option for mTBI. Design, Setting, Participants: This is a case series of 39 U.S. Veterans diagnosed with mTBI and treated with HBOT. Of these participants, 36 were men and 3 women, and their ages ranged between 28 and 69. The treatment was administered by The 22 Project (a veteran-centered nonprofit organization) using monoplace hyperbaric chambers located in Delray Beach, Florida. Neuroimaging using Single Photon Emission Computer Tomography (SPECT) brain scans performed pre- and post-HBOT were made available for secondary analysis. Nilearn Python Library was utilized to visualize the corresponding neuroimaging data. A two-sided paired t-test in R was used to compare the pre- and post-treatment results. Intervention: A full treatment of HBOT involved 40 sessions. Each session consisted of the administration of 100% oxygen at 1.5 atmospheres for 90 min, twice a day, for 20 days, Mondays to Fridays only. Main Outcome and Measure: Perfusion in the brain’s Brodmann Areas (BA) comparing pre- and post-HBOT using NeuroGam software analysis from brain SPECT scan neuroimaging and multi-symptom self-reports. Results: A comparison between the pre- and post-HBOT brain scans showed significant improvement in the brain perfusion, and the difference was statistically significant (p < 0.001). Separately, participants reported reduced pain, improved mood, and better sleep, an outcome that translated into an average of about 46.6% improvement in the measured symptoms. Conclusions and Relevance: This series demonstrated that HBOT could be a useful treatment for mTBI in U.S. veterans. The participants in the study showed marked improvement in both brain perfusion measured on SPECT scan imaging and measured mTBI symptoms. This is the first study to use brain SPECT scans with quantitative numerical measurements to demonstrate improvement in brain perfusion in veterans with mild TBI treated with HBOT and measured mTBI symptoms. Future research studies are currently being done to validate these important findings.

Objective: Describe a comprehensive multi-modal approach to reversing brain death. Background: Historically, treating coma, vegetative (VS) or minimally conscious states (MCS) is rarely attempted due to poor prognosis, especially after 3 months.2,3,4 5 Trials of drugs, transcranial magnetic or direct current stimulation have suggested benefit 6-8 but the first aggressive, multimodal approach (N=41)demonstrated 78% to 86% of VS and 100% MCS subjects “emerged” under the International Brain Injury Foundation’s Advanced Care Protocol (ACP).3 This same ACP was here used in the first ever reversal of brain death (BD). Methods: Four neurologists diagnosed a female, aged 28 as brain dead (BD) following overdose-induced (quetiapine, diazepam) asystole. No cooling protocol ensued; isoelectric EEG and absence of brainstem reflexes, respiratory drive and motor response to noxious stimuli correlated with loss of CT grey-white differentiation. At five months our team noted Bispectral Index of 15 (0-100 consciousness scale), essentially isoelectric QEEG, malacic corpus callosum, brainstem without cortical laminar necrosis on MRI and trace MRA flow. Nutraceuticals (e.g. vitamins, amino acids, antioxidants, neurotransmitter precursors); various stimulation_median nerve (MNS), transcranial direct current (tDCS) and cranial electric (CES)_and off-label pharmacotherapies to enhance neurotransmission were added. Results: The following changes evolved over three to six weeks on the ACP. QEEG recorded robust, differentiated activity; BIS exceeded 80 sustained for 20 after CES. Vital signs coupled to noxious stimuli; body temperature stabilized. Evoked potentials correlated to familiar voices; desmopressin intervals increased from 18 to 32 hours; head lateralized to mother’s voice; semi-purposeful finger movements emerged with inconsistent ‘thumbs-up’ to command. Conclusions: Treatment-induced reversal of BD was evidenced by functional recovery across several domains. ACP neuromodulation optimizes cerebral functioning: electrical stimulation increases metabolic coupling; nutraceuticals promote healing, repair and neurotransmitter production while attenuating inflammatory cascades and free-radical damage. BD may not be definitively irreversible and deserves therapeutic consideration.

Increased awareness of traumatic brain injury (TBI) in the military, a persistent call for evidence-based treatment, and recent government funding have revealed new research opportunities in neuroscience. This paper describes a relatively new frontier for research: that of the facilitation or enhancement of neuroplasticity and brain repair in TBI using novel treatment protocols. Such protocols, algorithmically introduced, may be tailored to the individual through the matching of neuromarkers with specific interventions. Examples of neuromarkers and interventions employed for the purpose of neuromodulation are reported. Problems with lack of controlled studies and inferring causation in correlational research are noted. Healthy skepticism and open-minded creativity are needed so that we can think in unorthodox ways, create partnerships, harness available knowledge and expertise, and ultimately develop effective treatments.