Hyperbaric Oxygen Therapy for Post-Concussion Syndrome

Inclusion Criteria:

• Must have been evaluated within 3 weeks of injury and given a diagnosis ofconcussion by a medical professional

• Must be experiencing persistent symptoms 3-12 months after injury as defined ashaving at least symptoms that are moderate to severe (score 3-4) OR at least a totalscore of 10 with at least 1 symptom rated moderate to severe (3-4) on the RivermeadPost-Concussion Questionnaire (RPQ).

Exclusion Criteria:

Clinically significant cardiac, neurological, psychological/psychiatric, or respiratory impairment in the opinion of the investigators, including but not limited to:

1. Pulmonary:

• COPD with CO2 retention; previous/current imaging showing hyperinflation/airtrapping/bullous disease/blebs

• Current pneumothorax or previous spontaneous pneumothorax

2. Cardiac:

• Uncontrolled HTN (systolic >180 or diastolic >100)

• Known Ejection fraction < 35%

• Pacemaker / ICD in place (not approved for chamber use)

3. Hematological/Oncological:

• Current chemotherapeutic drug use, and past history of bleomycin use.

• Hereditary Spherocytosis

• Sickle cell anemia

4. Neurological and Psychological:

• Implanted nerve stimulators

• Uncontrolled seizure disorder

• Drug or alcohol abuse/dependence

• Current treatment for alcohol cessation with disulfiram

• Claustrophobia

5. Head and Neck:

• Inability to equilibrate the pressure of middle ears and sinuses

• Current or previous retinal detachment

• Retinal or vitreous surgery within the past 3 months

6. Miscellaneous:

• Current fever or active infection

• Implanted devices not on the approved list for use with HBOT

• Women who are pregnant. Women with childbearing potential are required to useeffective birth control if not surgically sterile or postmenopausal for >2years.

• Undergoing vestibular or other therapy during the intervention

• Planning a change in medication during the intervention

7. Relative exclusion criteria: Diagnosis of the conditions listed below will requireapproval of the hyperbaric medicine physician for enrollment into the study.

• Asthma

• Optic neuritis

• Otosclerosis surgery

• Thoracic surgery

• Chronic sinusitis

8. Medications: Individuals with recent (within the past six months) or concurrent useof these medications must be approved by the hyperbaric medicine physician.

• Antabuse - Predisposes to oxygen toxicity

• Antiseizure medications - Potential participants must have levels of theirseizure medications checked within a week of their initial screening visitbecause low levels can predispose to oxygen toxicity. Laboratory testing mustbe completed by their outside treating physicians to provide to the researchstaff for review; the study will not obtain labs for monitoring medicationlevels as part of the inclusion/exclusion criteria

• Meclizine - Predisposes to oxygen toxicity

• Bleomycin - May cause pulmonary fibrosis that can lead to air embolism orpneumothorax in the patient receiving hyperbaric oxygen treatment.

• Certain ointments/creams that cannot be removed - These may be allowed ifcovered with cotton dressings.

• Narcotics - Can lead to cessation of the hypoxic respiratory drive.

• Nitroprusside - HBOT vasoconstrictive effect interacts with nitroprusside'svasodilator effect, making intensive monitoring mandatory.

• Penicillin - Predisposes to oxygen toxicity

• Promethazine (Phenergan) - Predisposes to oxygen toxicity.

• Corticosteroids - Decreases the threshold for oxygen toxicity.

• Sulfamylon - Promotes CO2 buildup causing peripheral vasodilatation. Whencoupled with vasoconstriction, results are worse than with using either agentalone. Use silver sulfadiazine instead for wound care.