Lettre ouverte aux chercheurs dans le champ de l'autisme
Autisme et oxygène Depuis plusieurs années, des enfants autistes sont traités par oxygénothérapie hyperbare avec des résultats spectaculaires. Un des précurseurs en la matière a été le Dr Neubauer, récemment décédé. Mais, comme souvent, les cliniciens ne s’arrêtent pas pour publier, accordant leur temps d’abord à leurs patients, et la nouvelle technique reste objet de controverse très longtemps. Sans parler des intérêts financiers derrière…histoire de remboursements médicaux, et des praticiens hospitaliers et chercheurs à qui les parents demandent des études…et qui répondent qu’ils ne feront rien tant qu’ils n’ont pas des résultats convaincants de publications scientifiques! Je vous en prie, chercheurs de tous domaines ayant affaire aux enfants autistes et leurs familles, prenez le temps de lire et d'écouter ces témoignages, essayez de changer de perspective, et de comprendre ces parents qui cherchent à vous faire part des changements notables observes chez leurs enfants mais n'ont pas les moyens scientifiques de vous convaincre. La balle est dans VOTRE camp. A l’heure actuelle, l’oxygénothérapie hyperbare (HBOT en anglais) fait l’objet d’un véritable engouement pour le traitement des enfants, autistes notamment. Faites-vous votre idée en lisant et écoutant témoignages et études. Pour finir, je reprends la remarque d’une maman : « on traite les sportifs de haut niveau avec ces méthodes, pourquoi les refuserait-on à nos enfants ? ». Capucine Témoignages de parents, pas seulement d’enfants autistes mais aussi parfois de paralysies cérébrales. Vidéos en bas de la page du Dr Neubrander -être patient car souvent l’écran met plusieurs dizaines secondes pour s’ouvrir : http://www.drneubrander.com/pageHBOT.html (autisme) Témoignage de la fondatrice du mouvement MUMS, dont la fille est atteinte de paralysie cérébrale : http://www.netnet.net/mums/story.html, suite a : http://www.netnet.net/mums/JessieHBO.htm autres témoignages (autisme) du site MUMS http://www.netnet.net/mums/AutismHBO.htm Interview du Dr Harch http://www.netnet.net/mums/Harch.htm Témoignages sur le site d’une clinique spécialisée dans les traitements de l’autisme à Singapour : http://www.the-autism-clinic.com/hbot.html Chiropracticien canadien http://www.drdesforges.com/smartsection+print.itemid+33.htm Témoignages divers http://www.hbotreatment.com/testimonials.htm http://www.reimerhbo.com/autism.htm (autisme) Témoignage de la maman de Grace (maladie mitochondriale, puis autisme régressif) http://www.ihausa.org/ppt/skautism1.htm http://www.ihausa.org/video/montel.html (interview television Montel) Pour discuter avec d’autres parents (en anglais) Forum sur neuroHBOT (pour usages neurologiques, 1130 membres) http://groups.yahoo.com/group/NeuroHBOT/ Forum mildH BOT (104 membres) http://health.groups.yahoo.com/group/mildhbot/ Forum sur HBOT en général ( http://p070.ezboard.com/Hyperbaric-Oxygen-Therapy-HBOT/fanoxicinjurynetworkfrm23 Forum High Dosage Oxygen Therapy pour l’autisme (1200 membres) http://health.groups.yahoo.com/group/HDOTherapyforAutism/ Lettre ouverte au Président Bush en français traduite de l’anglais http://www.hyperbare.ca/fr/dossiers/2006_petition_reveil.html Autres thérapies intéressantes utilisant la plongée ou l’oxygène http://forum.doctissimo.fr/sante/asthme-bronchite/jacquier-sujet_146324_1.htm http://lhommevolant.monsite.wanadoo.fr/index.jhtml Renseignements techniques scintigraphie et HBOT http://drspectscan.com/presentation/pres.htm Applications officielles en France de HBOT http://www.oxynet.org/HBOIndex.htm http://www.uhms.org/ http://www.medsubhyp.com/ Etudes, articles, rapports scientifiques Conférence de Montréal autisme mars 07 http://www.autisme-montreal.com/freepage.php?page=399l Si le lien ne se fait pas, rendez-vous sur le site http://www.blogger.com/www.autisme-montreal.com , centre de documentation, résumé des conférences. Etude positive sur l’effet de HBOT dans certains cas de paralysie cérébrale http://www.hbot.com/McGillStudy.html Rapport négatif de 2003 http://www.ahrq.gov/clinic/epcsums/hypoxsum.htm Etudes sur la paralysie cérébrale http://miraclemountain.homestead.com/HBOTforCP.html Le traitement HBOT mobilise les cellules-souches : http://www.rxpgnews.com/article_3086.shtml Poster de la conférence DAN ! 2005 : voir a la fin du document Bibliographie sur Medline (HBOT neurologique) juin 2007 1: Med Hypotheses. 2007;68(6):1208-27. Epub 2006 Dec 4. Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism. Rossignol DA. University of Virginia, Department of Family Medicine, P.O. Box 800729, Charlottesville, VA 22908, USA. firstname.lastname@example.org Autism is a neurodevelopmental disorder currently affecting as many as 1 out of 166 children in the United States. Numerous studies of autistic individuals have revealed evidence of cerebral hypoperfusion, neuroinflammation and gastrointestinal inflammation, immune dysregulation, oxidative stress, relative mitochondrial dysfunction, neurotransmitter abnormalities, impaired detoxification of toxins, dysbiosis, and impaired production of porphyrins. Many of these findings have been correlated with core autistic symptoms. For example, cerebral hypoperfusion in autistic children has been correlated with repetitive, self-stimulatory and stereotypical behaviors, and impairments in communication, sensory perception, and social interaction. Hyperbaric oxygen therapy (HBOT) might be able to improve each of these problems in autistic individuals. Specifically, HBOT has been used with clinical success in several cerebral hypoperfusion conditions and can compensate for decreased blood flow by increasing the oxygen content of plasma and body tissues. HBOT has been reported to possess strong anti-inflammatory properties and has been shown to improve immune function. There is evidence that oxidative stress can be reduced with HBOT through the upregulation of antioxidant enzymes. HBOT can also increase the function and production of mitochondria and improve neurotransmitter abnormalities. In addition, HBOT upregulates enzymes that can help with detoxification problems specifically found in autistic children. Dysbiosis is common in autistic children and HBOT can improve this. Impaired production of porphyrins in autistic children might affect the production of heme, and HBOT might help overcome the effects of this problem. Finally, HBOT has been shown to mobilize stem cells from the bone marrow to the systemic circulation. Recent studies in humans have shown that stem cells can enter the brain and form new neurons, astrocytes, and microglia. It is expected that amelioration of these underlying pathophysiological problems through the use of HBOT will lead to improvements in autistic symptoms. Several studies on the use of HBOT in autistic children are currently underway and early results are promising. PMID: 17141962 [PubMed - in process] : Disabil Rehabil. 2006 Nov 30;28(22):1379-86. Improving neuropsychological function after chronic brain injury with hyperbaric oxygen. Golden Z, Golden CJ, Neubauer RA. University of Florida, Fort Lauderdale, FL 33314, USA. email@example.com PURPOSE: One suggested treatment for chronic brain injury (CBI) is the use of hyperbaric oxygen therapy (HBOT). The present study was an evaluation of neuropsychological improvement after HBOT in CBI patients. METHOD: Study 1 compared test - retest results of 21 CBI children treated with HBOT against test - retest results of 42 untreated brain injured and normal children. Study 2 compared 21 CBI adults treated with HBOT against 42 untreated normal and brain injured adults. In each study, subjects received pre and post assessments to evaluate neuropsychological function. RESULTS: The HBOT-treated children showed significant improvement when compared with the two control groups on measures of daily living, socialization, communication, and motor skills. The treated adults made significant gains in all neuropsychological areas tested as compared to controls. CONCLUSION: The studies were strongly supportive of HBOT as a treatment for lessening the neurological impact of CBI. These studies indicate that HBOT can be an effective aid in ameliorating the neuropsychological and physiological effects of CBI. The absence of a clear sham HBOT treatment group is an issue as it could be that there was a placebo effect, but it should be noted that the controls were receiving more traditional interventions during the study. PMID: 17071569 [PubMed - indexed for MEDLINE] 1: Can J Anaesth. 2005 Apr;52(4):403-8. Hyperbaric treatment of cerebral air embolism in an infant with cyanotic congenital heart disease. LeDez KM, Zbitnew G. Department of Anesthesia, Memorial University of Newfoundland, Health Sciences Centre, 300 Prince Phillip Drive, St. John's, Newfoundland A1B 3V6, Canada. firstname.lastname@example.org PURPOSE: Infants with cyanotic congenital heart disease are at risk for cerebral arterial gas embolism (CAGE) from iv infusion lines. Concern about the hazards and difficulty of caring for such patients inside a hyperbaric chamber may deter referral. We report a complex case in which a small infant was managed successfully using a modified hyperbaric oxygen treatment (HBOT) schedule. CLINICAL FEATURES: A four-month-old 6.19 kg male infant with a recent Glenn shunt for double-outlet right ventricle had a seizure and became unstable immediately after an iv drug infusion. The patient was sedated, intubated and ventilated and dobutamine was commenced. A computerized tomography (CT) scan performed ten hours later demonstrated three intracranial air bubbles. About ten hours later the patient was referred for HBOT which commenced soon afterwards in a multiplace chamber. Since the right-to-left shunt would greatly increase the risk of decompression illness from breathing hyperbaric air HBOT was modified by the use of an abbreviated schedule at reduced pressure. Two 90-min HBOT sessions were administered within 24 hr at 38 feet of sea-water pressure, equivalent to 2.15 atmospheres absolute without any air break. During treatment the infant was ventilated using an Oxford Penlon ventilator. A subsequent CT scan demonstrated the absence of air. After extubation he appeared neurologically intact except for some weakness of the left arm. CONCLUSION: Hyperbaric oxygen may be utilized to treat CAGE in small infants with right-to-left shunt and should be commenced promptly. PMID: 15814756 [PubMed - indexed for MEDLINE] 1: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004609. Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. Bennett MH, Trytko B, Jonker B. Diving and Hyperbaric Medicine, Prince of Wales Hospital, Barker St., Randwick, 2031, NSW, Australia. email@example.com BACKGROUND: Traumatic brain injury is common and presents a health problem with significant effect on quality of life. Hyperbaric oxygen therapy (HBOT) has been suggested to improve oxygen supply to the injured brain and, therefore, to reduce the volume of brain that will ultimately perish. It is postulated that the addition of HBOT to the standard intensive care regimen may result in a reduction in patient death and disability as a result of these additional brain-preserving effects. OBJECTIVES: To assess the benefits and harms of adjunctive HBOT for treating traumatic brain injury. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library Issue 4, 2003), MEDLINE (1966 - 2003), EMBASE (1974 - 2003), CINAHL (1982 - 2003), DORCTHIM (1996 - 2003), and reference lists of articles. Relevant journals were handsearched and researchers in the field were contacted. SELECTION CRITERIA: Randomised studies comparing the effect on traumatic brain injury of therapeutic regimens which include HBOT with those that exclude HBOT (with or without sham therapy). DATA COLLECTION AND ANALYSIS: Three reviewers independently evaluated the quality of the relevant trials using the validated Oxford-Scale (Jadad 1996) and extracted the data from the included trials. MAIN RESULTS: Four trials contributed to this review (382 patients, 199 receiving HBOT and 183 control). There was a trend towards, but no significant increase in, the chance of a favourable outcome when defined as full recovery, Glasgow outcome score 1 or 2, or return to normal activities of daily living (relative risk [RR] for good outcome with HBOT 1.94, 95% confidence interval [CI] 0.92 to 4.08, P=0.08). Pooled data from the three trials with 327 patients that reported mortality, showed a significant reduction in the risk of dying when HBOT was added to the treatment regimen (RR 0.69, 95% CI 0.54 to 0.88, P=0.003). Heterogeneity between studies was low (I(2) =0%), and sensitivity analysis for the allocation of dropouts did not affect that result. This analysis suggests we would have to treat seven patients to avoid one extra death (number needed to treat [NNT] 7, 95% CI 4 to 22). One trial suggested intracranial pressure was favourably lower in those patients receiving HBOT in whom myringotomies had been performed (WMD with myringotomy -8.2 mmHg, 95% CI -14.7 mmHg to -1.7 mmHg, P=0.01), while in two trials there was a reported incidence of 13% for significant pulmonary impairment in the group receiving HBOT versus 0% in the non-HBOT group (P=0.007). REVIEWERS' CONCLUSIONS: In people with traumatic brain injury, the addition of HBOT significantly reduced the risk of death but not of favourable clinical outcome. The routine application of HBOT to these patients cannot be justified from this review. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously, and an appropriately powered trial of high methodological rigour is justified to define those patients (if any) who can be expected to derive most benefit from HBOT. PMID: 15495120 [PubMed - indexed for MEDLINE] 1: Arch Phys Med Rehabil. 2004 Jul;85(7):1198-204. Comment in: Arch Phys Med Rehabil. 2004 Oct;85(10):1732. Arch Phys Med Rehabil. 2006 Apr;87(4):592-3; author reply 593. Hyperbaric oxygen therapy for traumatic brain injury: a systematic review of the evidence. McDonagh M, Helfand M, Carson S, Russman BS. Department of Medical Informatics and Clinical Epidemiology, Oregon Evidence-Based Practice Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. firstname.lastname@example.org OBJECTIVE: To identify the benefits and harms of hyperbaric oxygen therapy (HBOT) to treat traumatic brain injury (TBI). DATA SOURCES: MEDLINE, EMBASE, the Cochrane Library, HealthSTAR, CINAHL, MANTIS, professional society databases, and reference lists. Databases were searched from inception through December 2003. STUDY SELECTION: We included English-language studies of patients with TBI given HBOT and evaluating functional health outcomes. DATA EXTRACTION: Data were abstracted by 1 reviewer and checked by a second. Study quality was rated as good, fair, or poor. DATA SYNTHESIS: Two fair-quality randomized controlled trials of patients with severe brain injury reported conflicting results. One found no difference in mortality (48% HBOT vs 55% control) or morbidity at 1 year. In young patients with brainstem contusion, significantly more regained consciousness at 1 month with HBOT (67%) than control (11%) (P<.03). The other found a significant decrease in mortality in the HBOT group at 1 year (17%) compared with controls (31%) (P=.037). This decrease in mortality was accompanied by an increase in proportion of patients with severe disability. Patients with intracranial pressure (ICP) greater than 20 mmHg or a Glasgow Coma Scale score of 4 to 6 had significantly lower mortality at 1 year than controls. Five observational studies did not provide better evidence of effectiveness or adverse events. Two indicated a potential for initially reducing elevated ICP in some patients. However, rebound elevations higher than pretreatment levels occurred in some patients. Adverse events, including seizures, pulmonary symptoms, and neurologic deterioration, were reported; however, no study systematically assessed adverse events, and none reported adverse events in control groups. CONCLUSIONS: The evidence for HBOT for TBI is insufficient to prove effectiveness or ineffectiveness, and more high-quality studies are needed. The evidence indicates that there is a small chance of a mortality benefit, which may depend on subgroup selection. The effect on functional status and the incidence and clinical significance of adverse effects are unclear. PMID: 15241774 [PubMed - indexed for MEDLINE] : J Neurotrauma. 2004 Jan;21(1):41-8. Hyperbaric oxygen therapy for reduction of secondary brain damage in head injury: an animal model of brain contusion. Palzur E, Vlodavsky E, Mulla H, Arieli R, Feinsod M, Soustiel JF. Division of Neurosurgery and Acute Brain Research Laboratory, Rambam Medical Center, Faculty of Medicine, The Technion, Haifa, Israel. Cerebral contusions are one the most frequent traumatic lesions and the most common indication for secondary surgical decompression. The purpose of this study was to investigate the physiology of perilesional secondary brain damage and evaluate the value of hyperbaric oxygen therapy (HBOT) in the treatment of these lesions. Five groups of five Sprague-Dawley rats each were submitted to dynamic cortical deformation (DCD) induced by negative pressure applied to the cortex. Cerebral lesions produced by DCD at the vacuum site proved to be reproducible. The study protocol entailed the following: (1) DCD alone, (2) DCD and HBOT, (3) DCD and post-operative hypoxia and HBOT, (4) DCD, post-operative hypoxia and HBOT, and (5) DCD and normobaric hyperoxia. Animals were sacrificed after 4 days. Histological sections showed localized gross tissue loss in the cortex at injury site, along with hemorrhage. In all cases, the severity of secondary brain damage was assessed by counting the number of terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and caspase 3-positive cells in successive perilesional layers, each 0.5 mm thick. Perilesional TUNEL positive cells suggested the involvement of apoptosis in group 1 (12.24% of positive cells in layer 1). These findings were significantly enhanced by post-operative hypoxia (31.75%, p <>Can J Anaesth. 2003 Feb;50(2):204. Hyperbaric oxygen therapy (HBOT) in a child with suspected influenza-associated encephalopathy. Dohgomori H, Arikawa K, Kanmura Y. PMID: 12560321 [PubMed - indexed for MEDLINE] 1: Int J Neurosci. 2002 Feb;112(2):119-31. Improvement in cerebral metabolism in chronic brain injury after hyperbaric oxygen therapy. Golden ZL, Neubauer R, Golden CJ, Greene L, Marsh J, Mleko A. Ocean Hyperbaric Center, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314, USA. email@example.com While no research study has yet demonstrated convincing evidence for the efficacy of Hyperbaric Oxygen Therapy (HBOT) in patients with chronic neurological disorders (CND), anecdotal studies have been supportive of its use in improving healing of the damaged brain. The current study hypothesized that (1) individuals with CND show increases in cerebral blood flow and metabolism as measured by Single Positron Emission Computed Tomography (SPECT) in the cerebral hemispheres, but not on measures of cerebellar and pons blood flow; and (2) younger patients show more improvement than older patients. The study used archival data to compare 25 older and 25 younger subjects who were given SPECT scans pretherapy, midtherapy, and posttherapy. ANOVAs using the SPECT scans as a within subjects variable and age as a between subjects variable confirmed the hypothesis that the cerebral measures all changed but that the cerebellar and pons measures did not. Post-hoc t-tests confirmed that there was improvement in blood flow from the beginning to the end of the study. An age effect was found on only two of the five measures; however, there were no interactions. Analysis by post-hoc t-tests showed that the younger group had higher blood flows, but not more improvement than the older group. The results provided the first statistical research data to show the effectiveness of HBOT in improving blood flow in CND. These results indicate that HBOT can be an effective part of the treatment for such clients. The implications of these findings and future research directions were discussed. PMID: 12325401 [PubMed - indexed for MEDLINE] Related Links · Regional CBF in chronic stable TBI treated with hyperbaric oxygen. [Undersea Hyperb Med. 2004] · Improving neuropsychological function after chronic brain injury with hyperbaric oxygen. [Disabil Rehabil. 2006] · Evaluation of hyperbaric oxygen treatment of neuropsychiatric disorders following traumatic brain injury. [Chin Med J (Engl). 2006] · Cerebral perfusion SPECT imaging for assessment of the effect of hyperbaric oxygen therapy on patients with postbrain injury neural status. [Chin J Traumatol. 2003] · Hyperbaric oxygen therapy may improve symptoms in autistic children. [Med Hypotheses. 2006] See all Related Articles... 1: Lancet. 2001 Feb 24;357(9256):582-6. Comment in: Lancet. 2001 Jun 23;357(9273):2052-3. Lancet. 2001 Jun 23;357(9273):2052; author reply 2053. Lancet. 2001 Jun 23;357(9273):2053-4. Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP Research Group. Collet JP, Vanasse M, Marois P, Amar M, Goldberg J, Lambert J, Lassonde M, Hardy P, Fortin J, Tremblay SD, Montgomery D, Lacroix J, Robinson A, Majnemer A. Randomised Clinical Trial Unit, Jewish General Hospital, Montreal, Quebec, Canada. firstname.lastname@example.org BACKGROUND: The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. We did a randomised trial to assess the efficacy and side-effects of this form of therapy in children with cerebral palsy. METHODS: 111 children with cerebral palsy aged 3-12 years were randomly assigned hyperbaric oxygen (n=57) or slightly pressurised room air (n=54). All children received 40 treatments over 2 months. Hyperbaric oxygen treatment was 1 h in 100% oxygen at 1.75 atmospheres absolute (ATA); children on slightly pressurised air received air at 1.3 ATA (the lowest pressure at which pressure can be felt, thereby ensuring the maintenance of masking). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech. FINDINGS: For all outcomes, both groups improved over the course of the study, but without any difference between the two treatments. The score on the global gross motor function measure increased by 3.0% in the children on slightly pressurised air and 2.9% in those on hyperbaric oxygen. The mean difference between treatments was -0.40 (95% CI -1.69 to 0.90, p=0.544). Other changes were seen in speech, attention, memory, and functional skills. Ear problems occurred in 27 children treated by hyperbaric oxygen and in 15 treated with hyperbaric air (p=0.004). INTERPRETATION: In this study, hyperbaric oxygen did not improve the condition of children with cerebral palsy compared with slightly pressurised air. The improvement seen in both groups for all dimensions tested deserves further consideration. PMID: 11558483 [PubMed - indexed for MEDLINE] 1: Cancer. 1997 Nov 15;80(10):2005-12. Hyperbaric oxygen therapy for radiation-induced brain injury in children. Chuba PJ, Aronin P, Bhambhani K, Eichenhorn M, Zamarano L, Cianci P, Muhlbauer M, Porter AT, Fontanesi J. Department of Radiation Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan 48236, USA. BACKGROUND: Radiation-induced necrosis (RIN) of the brain is a complication associated with the use of aggressive focal treatments such as radioactive implants and stereotactic radiosurgery. In an attempt to treat patients with central nervous system (CNS) RIN, ten patients received hyperbaric oxygen treatment (HBOT). METHODS: Patients presented with new or increasing neurologic deficits associated with imaging changes after radiotherapy. Necrosis was proven by biopsy in eight cases. HBOT was comprised of 20-30 sessions at 2.0 to 2.4 atmospheres, for 90 minutes-2 hours. Sites of RIN included the brain stem (n = 2), posterior fossa (n = 1), and supratentorial fossa (n 7). Histologic types included brain stem glioma (n = 2), ependymoma (n = 2), germinoma (n = 2), low grade astrocytoma (n = 1), oligodendroglioma (n = 1), glioblastoma multiforme (n = 1), and arteriovenous malformation (n = 1). RESULTS: Initial improvement or stabilization of symptoms and/or imaging findings were documented in all ten patients studied and no severe HBOT toxicity was observed. Four patients died, with the cause of death attributed to tumor progression. Five of six surviving patients were improved by clinical and imaging criteria; one patient was alive with tumor present at last follow-up. CONCLUSIONS: HBOT may prove to be an important adjunct to surgery and steroid therapy for CNS RIN. PMID: 9366305 [PubMed - indexed for MEDLINE] 1: Clin Nucl Med. 1992 Jun;17(6):477-81. Identification of hypometabolic areas in the brain using brain imaging and hyperbaric oxygen. Neubauer RA, Gottlieb SF, Miale A. Ocean Hyperbaric Center, Lauderdale-by-the-Sea, Florida 33308. Current neurologic assessments consider idling neurons and ischemic penumbras to be metabolically lethargic and electrically nonfunctional or nonviable. Diagnosis, prognosis, and therapeutics of central nervous system dysfunctions require differentiation between viable and nonviable neurons. It is necessary to develop and document efficacious and safe techniques for reactivating idling neurons. The authors present a case study of a near drowning 12 years earlier. Areas of cortical hypometabolism were identified by using SPECT imaging in conjunction with hyperbaric oxygen therapy (HBOT). Delayed imaging after HBOT (1 hour, 1.5 atm abs) suggested viable but metabolically lethargic neurons. After HBOT (80 1-hour treatments, monoplace chamber, 1.5 atm abs), marked improvements in cognitive and motor functioning were demonstrated. The data support the hypothesis that idling neurons and ischemic penumbras, when given sufficient oxygen, are capable of reactivation. Thus, changes in tracer distribution after a single exposure to HBOT may be a good prognostic indicator of viable neurons. HBOT may be valuable not only in recovery from anoxic encephalopathy but also from other traumatic and nontraumatic dysfunctions of the central nervous system, including stroke. HBOT in conjunction with physical and rehabilitative therapy may help reactivated idling neurons to remain permanently active. PMID: 1617842 [PubMed - indexed for MEDLINE] Poster de la conférence DAN ! 2005 : FROM DAN CONFERENCE 2005: Here is the poster presented in the DAN poster session (the graphs and more info. will be on our study website www.hbotstudy.com, under construction) Introduction Recent research has discovered that autistic individuals have diminished cerebral blood flow, evidence of neuroinflammation, and increased markers of oxidative stress. Multiple independent single photon emission computed tomography (SPECT) and positron emission tomography (PET) research studies have revealed hypoperfusion to several areas of the autistic brain, most notably the temporal regions and areas specifically related to language comprehension and auditory processing. Decreased blood flow to these areas could account for many of the clinical features associated with autism including repetitive, self-stimulatory, and stereotypical behaviors and impairments in communication, sensory perception, and social interaction. Furthermore, in one study of autistic children of varying ages, this hypoperfusion worsened with increasing age. Hyperbaric oxygen therapy (HBOT) has been used with clinical success in several hypoperfusion syndromes including cerebral palsy, fetal alcohol syndrome, closed head injury, and stroke. HBOT can compensate for decreased blood flow by increasing the oxygen content of plasma and body tissues and can even normalize oxygen levels in ischemic tissue. In addition, several animal studies have shown that HBOT has potent anti-inflammatory effects (with equivalence to diclofenac 20 mg/kg noted in one study), and may reduce oxidative stress. Based upon these findings, it was hypothesized that HBOT will improve symptoms in autistic children. Methods Six children started and five completed forty one-hour sessions of low pressure HBOT at 1.3 atmosphere over a three month period. One child (Child C) only finished 25 treatments due to scheduling conflicts but was included in the analysis. All six children had a prior diagnosis of autism, were already taking multiple antioxidants, and had not previously received HBOT. A low pressure portable hyperbaric oxygen chamber was used. Room air mixed with oxygen from an oxygen concentrator was pumped into a pressurized chamber resulting in a final chamber oxygen concentration of 28% by direct oximetry measurement using a MoxyTM oxygen monitor. Parent rated pre- and post-treatment scores were calculated for each subject using the Autism Treatment Evaluation Checklist (ATEC), Childhood Autism Rating Scale (CARS) and Social Responsiveness Scale (SRS). ATEC is a scoring system published by the Autism Research Institute. CARS is a widely used scale for screening and diagnosing autism and has been shown to correlate very well with the DSM-IV criteria for autism diagnosis. SRS is a recently validated test of interpersonal behavior, communication and stereotypical traits in autism. Results Low pressure HBOT was well tolerated by all six children with no adverse effects noted. More dramatic improvements were seen in children age 4 and under (see Figures 4-6). Two children had further improvements after 56 sessions (Figure 7). Discussion This case series demonstrates that low pressure HBOT may be helpful in the treatment of autism. An interesting finding was that the younger children had more significant improvements. Previous studies confirm that younger patients tend to improve more dramatically, and 50-80 HBOT sessions are often needed for significant improvements. The younger children in this case series may have had less overall hypoperfusion to overcome because diminished cerebral blood flow to areas associated with communication has been shown to worsen with increasing age. The mechanism of clinical improvements in ATEC, CARS and SRS scores in the children studied may be secondary to increased oxygenation of underperfused areas of the autistic brain, reduced neuroinflammation, decreased oxidative stress or a combination of these. Further testing is needed to clarify this. Autism and hypoxic brain injuries are considered by many to be permanent conditions. However, new research is revealing that hypoxic brain injuries may be partially reversible. Recently, stem cells have been isolated in the adult brain and a possible scenario for inducing brain repair through the use of these has been described in the literature. This repair is dependent on an intact vascular supply and is also oxygen dependent. There is a strong possibility that HBOT could play an integral role in improving brain disorders associated with hypoperfusion including autism; further research in this area is urgently needed. We are currently in the planning phase of a larger study of HBOT in autism. If you are interested in being part of the study please contact me privately by email with your child age and your location. There will be other sites doing the study so I will let you know if there is site in your location. We plan to do a larger HBOT study in Charlottesville, Virginia and with other centers in different regions of the country. So if you are interested, email me privately your child's age, your location and your contact information and we will let you know if there will be a center in your location.
Publié par Capucine à 04:59