ZERIFIN, ISRAEL. Post-stroke treatment involves intensive functional therapy and other rehabilitation programs. The results are variable but generally only partially successful and many victims are left with serious incapacity and quality of life issues. One of the therapies that has been tried is hyperbaric oxygen therapy (HBOT) but five controlled clinical trials were either inconclusive or contradictory. However, these trials all involved intervention early after the event. A recent study has just reported which tested the hypothesis that HBOT had its greatest potential for benefit if carried out after the damage phase is over.

In this randomized, controlled trial, those who had suffered a stroke 6 to 36 months earlier were randomized into two groups. One was given 40 treatments whereas the other group served as a control and then also received the same treatment. In the controlled phase, no improvements were observed in the control group but significant neurological improvements were found, even in those in late, chronic stages. When the control group was then treated, similar beneficial results were obtained. Imaging studies (two types of scan) were found to correlate well with clinical improvements and elevated brain activity was detected mostly in regions of live cells with low activity. Three case histories were given with accompanying scan pictures. The recovery of significant functionality and quality of life should impress anyone who reads these histories. For the initially treated group and the subsequently treated control group, highly significant changes were observed in the National Institutes Stroke Score Scale and scores in daily living and quality of life. The scatter plot provided suggests that everyone benefited. There was no overlap.

This study supports the hypothesis that HBOT should be given during the regeneration phase of stroke recovery rather than during the degeneration phase, and that benefits result that most stroke patients and their families would welcome. Furthermore, the authors comment that in their experience, more than 40 treatments may provide additional benefit.

The protocol involved 5 daily treatments a week for 8 weeks, 90 minutes each, 100% oxygen at 2 times normal atmospheric pressure. HBOT requires a hyperbaric chamber and they are not that common. If the results of this study became common knowledge among stroke patients and their families, the demand would probably skyrocket and face opposition form skeptics and those devoted to upholding evidence-based medicine who might demand much larger trials and long post treatment follow-up, and ignore the sensational case histories presented. Such is the nature of medicine today. This would be unfortunate since HBOT is far cheaper than prolonged physical therapy and appears to work much better than existing therapies in the time frame at issue.

Efrati S, Fishlev G, Bechor Y et al. Hyperbaric oxygen induces late neuroplasticity in post stroke patients--randomized, prospective trial. PLoS One 2013;8(1):e53716