Stroke is the leading cause of disability in the world. It is estimated that of the 15 million people who have suffered one, 5 million have been left with permanent sequelae, such as motor, sensory disorders, urinary incontinence, speech alteration, and understanding, etc.
“When a stroke occurs, the time to apply a treatment to return the blood supply and the arrival of blood to the brain (ischemic stroke) or stop a hemorrhage (hemorrhagic stroke) is precious. In fact, in every minute that the brain is without a blood supply, almost two million neurons and 14,000 million synapses die”, explains Dr. Elías López, head of BioBarica in Madrid.
The sooner treatment is applied and the affected functions of the brain are recovered, the less (or none in some cases) will be the sequels that each patient will have after recovering in specialized neurorehabilitation units in this pathology.
Hyperbaric Oxygen Treatment (HBOT), an adjunct to neurorehabilitation therapy
“Patients affected by an ischemic stroke (85% of the cases) who, in addition to neurorehabilitation therapy, are treated with hyperbaric oxygen, in a large percentage of cases obtain an improvement, thus reducing the recovery time. In addition, the earlier you start with this treatment as an adjuvant, the better are the results”, explains Dr. Elías Lopez.
The reason for this shortening in the rehabilitation time is due to the activation that hyperbaric oxygen has on the activation of the central nervous system. HBOT promotes axonal regeneration, both central and peripheral, decreasing cerebral edema.
Its anti-inflammatory effect decreases the severity of cerebral infarction, thus maintaining the integrity of the blood-brain barrier, in addition to improving tissue perfusion by preventing the spread of ischemia and limiting, therefore, the area of injury. In addition, the increase in oxygen available in the blood plasma is able to vascularize the affected area, so that the adjoining areas can quickly recover the functions lost after a stroke.
Dr. Javier Chirivella, president of the FIVAN Foundation, points out that recent reviews also show the efficacy of HBOT for patients affected by hemorrhagic stroke.
“It is difficult to reason hyperbaric oxygen therapy in a cerebral hemorrhage; however, this type of stroke also implies a hypoxic component in the tissue surrounding the hemorrhagic lesion with cells that ‘fight’ for oxygen. In addition, as a response to hyperbaric oxygenation, vessels contract and this may attenuate bleeding. It can also cause a decrease in edema, decreasing intracranial pressure and, therefore, can improve microcirculation. Finally, treatment with a hyperbaric chamber can also improve secondary phenomena after hemorrhage, including oxidative stress, cell death, etc., while increasing brain regeneration”, adds Chirivella.
From the Spanish Stroke Federation, its president, Carmen Aleix, explains that “we have observed that hyperbaric medicine can help patients who have suffered a stroke. It is a suitable coadjuvant therapy applied along with other treatments, whether they are pharmacological or minimizing the risk factors associated with this pathology “.
Treatment with Hyperbaric Oxygen in late stages after a stroke
Dr. Chirivella clarifies that after suffering an ischemic stroke one can speak of 3 temporary windows that are related to recovery: one for reperfusion (6-8 hours), another for the survival of the neurons encompassed in the penumbra area (between 24 hours and 17 days) and a window for neurofunctional recovery, which extends to at least 3 months after a stroke.
“If we think of more chronicity, there is a work published in 2013 by the Assaf Harofeh Medical Center of Israel in which they saw significant neurological improvements in patients more than 6 months after the stroke. This conclusion is very important because it involves the activation of neuroplasticity long after the brain damage”, says the expert of the FIVAN Foundation.
This stimulation of neuroplasticity is one of the battle horses of interest to the scientific community. In the study “Hyperbaric Oxygen Induces Late Neuroplasticity in Post Stroke Patients – Randomized, Prospective Trial”, published by the scientific journal ‘Plos ONE’, the results obtained indicated that HBOT can lead to significant neurological improvements in patients who have suffered a stroke, even in late chronic stages.
Although the results are better the sooner HBOT therapy is applied, in this case, the patients evaluated had suffered a stroke from 6 to 36 months before being included in the study and had at least one motor dysfunction. After two months and 40 sessions of HBOT of 90 minutes each (5 times a week), improvements were observed in the neurological functions and the quality of life of the patients. The study concluded that the observed clinical improvements imply that neuroplasticity can still be activated long after the onset of damage in regions where there is a decrease in cerebral perfusion measured by SPECT.
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