Hyperbaric therapy and hyperbaric oxygen therapy are treatments that have vexed the medical profession for 359 years. Hyperbaric therapy consisted of the exclusive use of compressed air from 1662 until the 1930s-1950s when 100% oxygen was introduced to recompression tables for diving accidents. Broader clinical application of 100% hyperbaric oxygen to radiation cancer treatment, severe emergent hypoxic conditions, and “blue baby” operations occurred in the late 1950s-1960s. Since that time hyperbaric oxygen therapy has become the dominant term to describe all therapy with increased pressure and hyperoxia. It has been defined as the use of 100% pressurized oxygen at greater than 1.4 or 1.0 atmospheres absolute (ATA) to treat a narrow list of wound and inflammatory conditions determined by expert opinions that vary from country to country. This “modern” definition ignored the previous 300 years of clinical and basic science establishing the bioactivity of pressurized air. The Collet, et al randomized trial of hyperbaric oxygen therapy in cerebral palsy in 2001 exposed the flaws in this non-scientific definition when a pressurized oxygen and a pressurized air group, misidentified as a placebo control group, achieved equivalent and significant cognitive and motor improvements. This study confused the hyperbaric medicine and neurology specialties which were anchored on the 100% oxygen component of hyperbaric oxygen therapy as a necessary requirement for bioactivity. These specialties were blind to the bioactivity of increased barometric pressure and its contribution to the biological effects of hyperbaric/hyperbaric oxygen therapy. Importantly, this confusion stimulated a review of the physiology of increased barometric pressure and hyperoxia, and the search for a more scientific definition of hyperbaric oxygen therapy that reflected its bioactive components (
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The purpose of this Research Topic is to review the science of hyperbaric therapy/hyperbaric oxygen therapy according to its main constituents (barometric pressure, hyperoxia, and possibly increased pressure of "inert" breathing gases), and review the literature on hyperbaric therapy/hyperbaric oxygen therapy for acute to chronic neurological disorders according to the dose of oxygen, pressure, and "inert” breathing gases employed. Contributing authors are asked to abandon the non-scientific and restrictive definition of hyperbaric oxygen therapy with its arbitrary threshold of greater than 1.0 or 1.4 atmospheres absolute of 100% oxygen and adopt the more scientific definitions of hyperbaric and hyperbaric oxygen therapy. Those definitions embody therapeutic effects on broad-based disease pathophysiology according to the effects of increased barometric pressure, hyperoxia, and “inert” breathing gases. Recent basic science research has elucidated some of these effects on gene expression. Researchers have demonstrated that increased pressure and hyperoxia act independently, in an overlapping fashion, and interactively, to induce epigenetic effects that are a function of the dose of pressure and hyperoxia. Differential effects of pressure and hyperoxia were revealed in a systematic review of HBOT in mTBI/PPCS where the effect of pressure was found to be more important than hyperoxia. In retrospect, the net effect of HBO on disease pathophysiology in both acute and chronic wounding conditions has been demonstrated for decades as an inhibition of inflammation, stimulation of tissue growth, and extensive effects on disease that are pressure and hyperoxic dose-dependent. This Special Topics issue will focus on the scientific definitions of hyperbaric and hyperbaric oxygen therapy, principles of dosing, and an understanding of many neurological diseases as wound conditions of various etiologies. Contributing authors should apply these concepts to articles on the basic science of hyperbaric/hyperbaric oxygen therapy and their clinical applications to acute and chronic neurological diseases.
Scope: Basic science and clinical applications of hyperbaric/hyperbaric oxygen therapy to neurological conditions with attention to dose. Editors welcome all article types accepted by Frontiers in Neurology.
• Basic science of hyperbaric/hyperbaric oxygen therapy as a dual-component treatment consisting of increased barometric pressure and hyperoxia whose targets are common disease pathophysiology.
• Basic science of hyperbaric/hyperbaric oxygen therapy that addresses its widespread epigenetic gene-modulatory effects.
• Reviews of evidence for characterization of neurological conditions as wounds in the central nervous system and their shared responsiveness to hyperbaric/hyperbaric oxygen therapy.
• Reviews of clinical application to emergency neurological conditions with analysis based on dose of hyperbaric/hyperbaric oxygen therapy and/or dose of pressure and hyperoxia, e.g, stroke, traumatic brain injury, global ischemia (birth asphyxia, drowning, hanging, cardiac arrest), toxic brain injury, encephalitis, genetic disorders, etc.
• Reviews of clinical applications to subacute neurological conditions with analysis based on dose of hyperbaric/hyperbaric oxygen therapy and/or dose of pressure and hyperoxia, e.g, stroke, traumatic brain injury, global ischemia (birth asphyxia, drowning, hanging, cardiac arrest), toxic brain injury, encephalitis, genetic disorders, etc.
• Reviews of clinical applications to chronic neurological conditions with analysis based on dose of hyperbaric/hyperbaric oxygen therapy and/or dose of pressure and hyperoxia, e.g, stroke, traumatic brain injury, global ischemia (birth asphyxia, drowning, hanging, cardiac arrest), toxic brain injury, encephalitis, genetic disorders, etc.
