1. HYPERBARIC OXYGEN THERAPY AND AUTISM
Giuseppina Benincasa-Feingold, MD
HYPERBARIC OXYGEN THERAPY AND AUTISM
GIUSEPPINA BENINCASA-FEINGOLD M.D.
USAAA 2006 International Conference

3. Hyperbaric Medicine Definition Hyperbaric Oxygen:
Hyperbaric Oxygen (HBO2) treatment, in which a patient breaths 100% oxygen while the pressure of the treatment chamber is increased to a point higher than sea level pressure (i.e. > 1 ata)

4. BOYLE’S LAW
ABSOLUTE PRESSURE AND VOLUME ARE INVERSELY PROPORTIONAL

5. DALTON’S LAW
TOTAL PRESSURE OF A MIXTURE OF GASES IS EQUAL TO THE SUM OF PARTIAL PRESSURES OF THE GASES IN THE MIXTURE

6. HENRY’S LAW
THE PARTIAL PRESSURE OF ANY GAS IN A LIQUID IS EQUAL TO THE PARTIAL PRESSURE OF THAT GAS EXERTED ON THE SURFACE OF THE LIQUID IN EQUILIBRIUM

7. CHARLES’ LAW
P1V1=P2V2
T T2
AS YOU COMPRESS GAS IT GETS HOTTER, CONVERSELY AS YOU DECOMPRESS IT GETS COOLER

8. HYPERBARIC OXYGEN THERAPY
CAN A HUMAN BEING SURVIVE BREATHING LESS THAN 21% OXYGEN?
YES: AT 7 ATA 3%OXYGEN IS EQUAL TO 21% O2
EXPERIMENT WITH A DOG-BLOODLESS LIFE

9. ACUTE EFFECTS OF HBOT
CLEARANCE OF OBSTRUCTING GAS BUBBLES-SIZE IN CIRCULATION DECREASED
CARBON MONOXIDE POISONING-DISPALCES CO FROM HEMOGLOBIN AND CYTOCHROME C, INCREASES ATP AND DECREASES LACTATE FORMATION

10. ACUTE EFFECTS OF HBOT
WOUND HEALING-ENHANCES FIBROBLAST PROLIFERATION AND COLLEGEN PRODUCTION
PROMOTES NEOVASCULARIZATION
ACUTE INJURIES- DECREASES EDEMA, IMPROVES REPERFUSION INJURY

11. ACUTE EFFECTS OF HBOT
INFECTIONS-INCREASES PARTIAL PRESSURE OF OXYGEN IN THE TISSUES
ACTIVATES NEUTROPHILS
INHIBITS THE PRODUCTION OF ALPHA TOXIN BY CLOSTRIDIUM PERFRINGENS

12. ACUTE EFFECTS OF HBOT
IN VITRO- AEROBIC ORGANISMS GROW FASTER WITH INCREASING OXYGEN PRESSURE (1.3 ATA) GROWTH IS INHIBITED AT HIGHER PRESSURE
IN VIVO- AEROBES ARE KILLED WITH HBOT

13. TISSUE OXYGENATION MUSCLE- 3 HOURS SUBCUTANEOUS- 4 HOURS
ARTERIAL BLOOD – 2 MINUTES

14. FREE RADICALS AND HBOT FREE RADICALS TRANSIENTLY INCREASE DURING HBOT
HBOT BLOCKS NEUTROPHIL ADHEREENCE TO ENDOTHELIUM AND RELEASE OF SUPEROXIDE
SOD INCREASES AFTER FIRST TREAMENT WITH HBOT

15. FREE RADICALS AND HBOT
HBOT HAS A QUENCHING EFFECT ON LIPID PEROXIDATION
IN EXPERIMENTAL MODELS OF ISCHEMIA /REPERFUSION INJURY, HBOT HAS A SIGNIFICANT BENEFICIAL EFFECT ON SURVIVAL OF TISSUE

16. CONTRAINDICATIONS TO HBOT-ABSOLUTE
PNEUMOTHORAX
DOXORUBICIN- NOT AT THE SAME TIME
BLEOMYCIN-IF GREATER THAN 6 MONTHS OK FOR TX
CIS-PLATINUM
DISULFIRAM- VASOCONSTRICTION

17. CONTRAINDICATIONS RELATIVE
EMPHYSEMA
VIRAL INFECTIONS
CONGENITAL SPHEROCYTOSIS
OPTIC NEURITIS
HISTORY OF SPONTANEOUS PNEUMOTHORAX
UNCONTROLLED HIGH FEVER

18. CONTRAINDICATIONS RELATIVE
UPPER RESPIRATORY INFECTION
CHRONIC SINUSITIS
PLACEMENT OF A STRUT FOR OTOSCLEROSIS

19. RISKS AND SIDE EFFECTS OF HBOT
BAROTRAUMA
ALTERNOBARIC VERTIGO
FIRE
PNEUMOTHORAX
O2 TOXICITY-pulmonary CNS,

20. RISKS AND SIDE EFFECTS OF HBOT
SEROUS OTITIS
VISUAL CHANGES-CHANGES IN REFRACTION- MYOPIA WORSENS, PRESBYOPIA IMPROVES
NUMB FINGERS

21. HYPERBARIC OXYGEN
MONOPLACE
MULTIPLACE
PORTABLE

22. MULTIPLACE CHAMBER

23. HBOT MONOPLACE CHAMBER
Giuseppina Benincasa-Feingold, MD
HBOT MONOPLACE CHAMBER
USAAA 2006 International Conference

24. MONOPLACE CHAMBER HBOT is a medical treatment that saturates the
body with 100% pure oxygen under pressure,
enhancing the body’s natural healing process.

25. HBOT
Extremely valuable tool in treatment of multitude acute and chronic disease states and damage from traumatic injury.
Oxygen levels in the bloodstream raised up to 10 times normal.
As a result, oxygen is more easily delivered to cells and tissues, improving functionality, accelerating healing and controlling infection.

26. PORTABLE HYPERBARIC CHAMBER

27. Pediatric Experience with HBOT
More than 80 articles detail the treatment of infants and children with HBOT.
CO poisoning, radiation-induced sequelae, purpura fulminans, wound healing, peripheral ischemia secondary to DIC, necrotizing infections.
Few side effects reported. Ventilated children are at greater risk for problems.

28. Studies on HBOT caveats
Animals are not humans
Healthy volunteers are not ill patients
Different responses to different pressures
Very few animal or human studies have been done at 1.5 ATA.

29. NEURODEVELOPMENTAL DISORDER EFFECTING 1/166 CHILDREN
AUTISM
NEURODEVELOPMENTAL DISORDER EFFECTING 1/166 CHILDREN

30. AUTISM-POSSIBLE MECHANISMS
DECREASED CEREBRAL BLOOD FLOW
EVIDENCE OF NEUROINFLAMMATION
INCREASED MARKERS OF OXIDATIVE STRESS

31. HYPOPERFUSION
SPECT SCANS OF AUTISTIC CHILDREN SHOW HYPOPERFUSION OF SPECIFIC AREAS OF THE BRAIN RESPONSIBLE FOR SOME TYPICAL BEHAVIORS AND SYMPTOMS SEEN IN AUTISM

32. HYPOFERFUSION AND AUTISM
TEMPORAL REGION-language comprehension and auditory processing, obsessive desire for sameness, impairment of communication and social interaction
THALAMUS-repetitive, self-stimulatory and unusual behaviors such as resistance to change
AMYGDALA-impairment in processing facial expressions and emotions

33. SPECT PRE-TREATMENT AUTISM

34. SPECT POST-TREATMENT AUTISM

35. AUTISM-CEREBRAL BLOOD FLOW
DOPPLER OF AUTISTIC CHILDREN SHOWED THAT THERE IS DECREASED BLOOD FLOW AND INCREASED MIDDLE CEREBRAL ARTERY RESISTANCE UPON AUDITORY STIMULATION, NEUROTYPICAL CHILDREN SHOWED OPPOSITE FINDINGS

36. AUTISM AND CEREBRAL HYPOPERFUSION
NEURONS/ASTROCYTES/VASCULAR CELLS- FUNCTIONAL UNIT WHICH MAINTAINS PROPER BLOOD FLOW AND OXYGENATION OF THE BRAIN

37. AUTISM AND CEREBRAL HYPOPERFUSION
RECENT STUDY SHOWED EVIDENCE OF NEUROINFLAMMATION AND ASTROGLIAL ACTIVATION IN AUTISM. IT IS POSSIBLE THAT THIS MAY AFFECT THE CONTROL OF BLOOD FLOW REGULATED BY ASTROCYTES

38. AUTISM AND NEUROINFLAMMATION
AUTOPSY OF AUTISTIC CHILDREN-inflammation of middle frontal gyrus, anterior cingulate gyrus and cerebellar hemispheres
CSF- living children showed “prominent proinflammatory profile”
AUTOANTIBODIES- to brain elements and neuron specific antigens such as myelin basic protein

39. AUTISM AND INFLAMMATION
AUTISTIC CHILDREN HAVE MORE ANTIBODIES TO GLIADIN AND CASEIN
PRODUCE MORE PRO-INFLAMMATORY CYTOKINES
IMBALANCE OF CD4+ AND CD8+ CELLS

40. AUTISM AND OXIDATIVE STRESS
SERUM GLUTATHIONE LEVELS ARE LOWER IN AUTISTIC CHILDREN
OXIDIZED GLUTATHIONE HIGHER IN AUTISTIC CHILDREN

41. AUTISM AND OXIDATIVE STRESS
LOWER SERUM ANTIOXIDANT ENZYME, ANTIOXIDANT NUTRIENT
HIGHER PRO-OXIDANT
IMPROVEMENT OF SYMPTOMS WITH USE OF ANTI-OXIDANTS

42. IDLING NEURON THEORY
CEREBRAL HYPOPERFUSION CAUSES HYPOXIA WHICH IN TURN CAUSES ELECTRICAL FAILURE. WORSENING OF HYPOXIA LEADS TO ION PUMP FAILURE AND EVENTUALLY CELL DEATH. CELLS WHICH HAVE ELECTRICAL FAILURE BUT RETAIN ION PUMP ABILITY- IDLING-
“ISCHEMIC PENUMBRA”

43. HYPERBARIC OXYGEN
INCREASES OXYGEN DELIVERY THUS OVERCOMING THE HYPOXIA CAUSED BY THE CEREBRAL HYPOPERFUSION

44. HBOT AND NEUROINFLAMMATION
HBOT HAS BEEN SHOWN TO HAVE POTENT ANTI-INFLAMMATORY EFFECTS
IN VITRO STUDIES- DECREASE THE INFLAMMATORY RESPONSE IN ARTHRITIS, COLITIS

45. HBOT AND OXIDATIVE STRESS
NEUTRAL EFFECT OF HBOT ON OXIDATIVE STRESS
RISE IN ANTIOXIDANT ENZYME-SOD FOUND 24h AFTER HBOT WITHOUT A DROP IN GLUTATHIONE

46. STEM CELL MOBILIZATION
RECENTLY SHOWN THAT HBOT AT 2.0 ATA AND 100% OXYGEN CAN MOBILIZE STEM/PROGENITOR CELLS FROM BONE MARROW OF HUMANS

47. MANY QUESTIONS !!!

48. QUESTIONS HBOT/AUTISM
WHO WILL RESPOND?
HOW MANY TREATMENTS?
WHAT DEPTH TO TREAT AT?