Marines

New treatment for PTSD, TBI in the works

19 Aug 2011 | Cpl. Damany Coleman

Traumatic brain injuries have been called the signature wound of the wars in Iraq and Afghanistan. According to a Research and Development Corporation study released in 2008, about 320,000 service members may have experienced a TBI during deployment. With injuries ranging from mild concussions to severe penetrating head wounds, just 43 percent reported ever being evaluated by a physician for that injury.

Today, the Department of Defense as well as medical universities and entities around the world are working on a new solution for post-traumatic stress disorder and TBI – a Hyperbaric Chamber that treats patients with oxygen at a level higher than atmospheric pressure.

Possible benefits include improvement in thinking ability, quality of life and reduction of PTSD symptoms. Results will be measured by brain blood flow imaging, written tests for memory and thinking and questionnaires about quality of life and health. However, there may be side effects whatsoever.

According to the Centers for Disease Control and Prevention, a TBI is caused by a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. The CDC also estimates that at least 5.3 million Americans currently have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI.

The severity of TBI ranges from mild to severe, with symptoms of anything from brief change in mental status or consciousness to an extended period of unconsciousness or amnesia after the injury. These sometimes “invisible injuries” also contribute to a substantial number of deaths and cases of permanent disability every year.

Lt. Cmdr. Jason Gordon, second year resident with Family Medicine, Naval Hospital Camp Lejeune, said the Surgeon General signed off on naval approval for testing in 2009 and if successful, these pressure treatments for PTSD and TBI patients could be the most significant yet.

If it works, the next step would be to get TriCare and Medicare to fund the procedure. Also, steps are being taken toward getting the Food and Drug Administration to approve it as a drug as opposed to an intervention.

“How can you prove today that post-concussive headaches are treated by the Hyperbaric Chamber?” asked Gordon. “The brain isn’t something you can look at and see its internal workings. There’s nothing actually moving in the brain – we cannot really tell what can be causing a headache. We think the treatment could work based on previous studies, but the gold standard in health care is that randomized tests show conclusive results.”

Due to the high level of TBI and PTSD injuries from the war, it’s congressionally mandated that the Department of the Navy pursue these studies to see if the treatments work.

“The basic premise of hyperbaric treatment is the theory that increased partial pressure of the oxygen helps heal the brain,” said Gordon. “We have to find out how, for example, increased pressure helps recurring headaches. After we find out how increased oxygen will benefit a TBI/PTSD patient, we then have to determine at what level of treatment will suffice for them. If 1.5 atmospheres will help him, why not 1.6? What are the limits? We have to figure out the right dose at the right time.”

Gordon added Hyperbaric Chamber treatment is a low risk to the patient, based on prior anecdotal studies. Testing on people with mild TBI has already begun, which involves troops with symptoms, such as loss of consciousness for up to 30 minutes, headache or dizziness for up to 24 hours, and post-traumatic amnesia.

“We need to test on enough people to prove a solid outcome,” said Gordon. “As far as we know, there are no signs that the treatment will worsen one’s TBI, but there may be some adverse events or mild side effects.”

Gordon said that for testing purposes, each patient undergoes 40 sessions in a 10-week period with a goal of proving a reduction in TBI symptoms.

“We cannot see the headaches, so our results are all based upon if they say they feel better or not – there is no definitive way to tell if each treatment works, and that is the challenging thing about this,” said Gordon. “We are trying to objectively look at subjective things.”

The Marine Corps officials are currently being briefed on the tests which may be conducted on some of their Marines.

For those who would like to participate in the tests with mild TBI, call 877-445-3199.