Can hyperbaric oxygen therapy cause seizures

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In this article, we will be discussing the topic on whether can hyperbaric oxygen therapy cause seizures or not. The short answer is yes, HBOT can cause seizures in rare cases. But before you jump into bias conclusions about this revolutionary treatment and anti-aging therapy continue reading below what the medical literature has to say about this.

Can hyperbaric oxygen therapy cause seizures?

Hyperbaric oxygen therapy (HBOT) is a medical treatment in which a person is exposed to high levels of oxygen in a pressurized chamber.

The increased pressure allows the lungs to absorb more oxygen than would be possible at normal atmospheric pressure, leading to higher oxygen levels in the blood and tissues.

HBOT is used to treat a variety of conditions such as carbon monoxide poisoning, decompression sickness, severe anemia, idiopathic sudden deafness, crush injuries, and certain types of infections, such as necrotizing soft tissue infections and osteomyelitis.

It has also been used as an adjunctive therapy in the treatment of traumatic brain injuries, radiation injury, tinnitus and certain types of wound healing disorders.

The main question being addressed in the article is whether HBOT can cause seizures. While HBOT is generally considered a safe and well-tolerated treatment, some concerns have been raised about the potential for seizures to occur during or after HBOT.

The purpose of the article is to review the literature on this topic and provide a summary of the current understanding of the relationship between HBOT and seizures.

a young doctor standing next to a hyperbaric chamber
A young doctor is standing next to a hyperbaric chamber talking with senior patient

What The Research Says?

There is limited research on the relationship between hyperbaric oxygen therapy (HBOT) and seizures. The available studies have yielded inconsistent findings, with some reporting an association between HBOT and seizures and others finding no such link.

A case report from 2000 described a patient who experienced a seizure during HBOT for carbon monoxide poisoning.

Another case report from 2004 described a patient who developed seizures after HBOT for a chronic wound. These case reports suggest a possible link between HBOT and seizures.

On the other hand, a case series of patients with carbon monoxide poisoning treated with HBOT found no seizures among the patients.

More specifically from a total of 62,614 hyperbaric sessions, administered to 2,334 patients, were included in the analysis. The overall incidence of seizures during hyperbaric sessions was 0.011% (1:8,945), occurring in seven (0.3%) patients. Only one patient had a clear oxygen toxicity-induced seizure, with an overall incidence of 1:62,614. [1]

A systematic review and meta-analysis of HBOT for carbon monoxide poisoning also found no seizures among the patients. [2]

In addition, a study of patients with traumatic brain injury who received HBOT found that the incidence of seizures was not significantly different between the HBOT and control groups. [3]

KEY TAKEAWAY
The existing research on the relationship between HBOT and seizures is limited and inconclusive. More studies are needed to better understand the potential link between these two conditions.

Examples where individuals have experienced seizures during or after HBOT

There have been a few case reports of individuals experiencing seizures during or after hyperbaric oxygen therapy (HBOT). Following are some case where people reported a seizure during or after their HBOT treatment.

Study on Korean Patients

One example is a study on Korean patients. This study collected data from a Korean hospital on patients who received hyperbaric oxygen therapy (HBOT) and developed seizures during the treatment between October 2016 and December 2019.

The most common reason for the treatment was carbon monoxide poisoning. During the study, 5 seizures occurred out of 10,425 treatments.

The seizures were more common in patients treated for carbon monoxide poisoning and arterial gas embolism, but none of the patients had lasting effects from the seizures. [4]

The case of a 51-year old man

Another example is a case of a 51-year-old man who was diagnosed with a brain tumor and underwent surgery, radiation therapy, and chemotherapy.

Two months after the surgery, he started experiencing seizures that spread through his left arm, face, and leg.

These seizures became more frequent and did not respond to treatment with phenytoin, valproic acid, and clonazepam.

He had a second surgery and the seizures stopped, but he was experiencing worsening symptoms.

He was advised to start both warfarin and hyperbaric oxygen therapy (HBOT). While receiving HBOT, he experienced seizures after 12 minutes of breathing oxygen and the HBOT was discontinued. [5]

The case of an 87-year-old patient

A case report from 2011 described an 87-year-old patient who was admitted to a clinic for seizures (tonic-clonic contractions) on his left arm while undergoing hyperbaric oxygen therapy (HBOT) for a decubitus ulcer.

After several more treatments, he had more seizures in the same arm. The doctors did tests and found no damage in his brain. He was treated with a medicine called phenytoin, given through an IV and then orally. He did not have any more seizures afterwards. [6]

IMPORTANT
It’s worth noting that these examples are case reports and not controlled studies, so it’s hard to establish a clear causality between HBOT and seizures. However, these cases do raise the question if there’s a relationship between the two.

It’s also worth noting that these case reports are rare incidents, and it’s hard to draw conclusions about a general population based on them. More research is needed to better understand the potential link between HBOT and seizures.

What are the possible factors that may contribute to the development of seizures during or after HBOT?

The available studies have yielded inconsistent findings, with some reporting an association between HBOT and seizures and others finding no such link.

One possible mechanism that has been proposed to explain the development of seizures during or after HBOT is the increased pressure and oxygen levels in the chamber. It has been suggested that these changes may lead to changes in the brain’s electrical activity, which could potentially trigger seizures.

Another possible mechanism is that the seizures may be related to underlying conditions that the patient already have, such as a history of epilepsy or carbon monoxide poisoning, that are not related to the HBOT treatment.

Another factor that may contribute to the development of seizures is the duration of the treatment and the cumulative effect of multiple treatments. It’s known that seizures may appear after the treatment, therefore it’s important to monitor the patient for some time after the treatment.

Hyperbaric Oxygen Therapy Benefits - A picture of three Hyperbaric Chamber Therapy.
A picture of three Hyperbaric Chamber Therapy. Source: Wikimedia Commons

What can you do to minimize the possibility of developing seizures during or after HBOT?

The risk of developing seizures during or after hyperbaric oxygen therapy (HBOT) is considered to be low, however, there are a few steps that can be taken to minimize the possibility of seizures.

  1. Screening for underlying conditions: Patients with a history of epilepsy or other neurological conditions may be at higher risk of seizures during or after HBOT. It’s important to screen for these conditions and to consult with a neurologist or other specialist before starting HBOT.
  2. Monitoring vital signs: During the HBOT sessions, vital signs such as blood pressure, heart rate, and oxygen saturation should be closely monitored. Any changes in these vital signs should be immediately reported to the healthcare provider.
  3. Gradual increase of pressure: To minimize the risk of seizures, pressure in the hyperbaric chamber should be gradually increased over several minutes rather than rapidly.
  4. Medication adjustments: If a patient is taking anti-seizure medication, the healthcare provider may adjust the dosage before and during the HBOT sessions to minimize the risk of seizures.
  5. Post-treatment follow-up: After the HBOT treatment, patients should be closely monitored for signs of seizures or other complications.
A woman is sitting in a vertical hyperbaric chamber of home use.
Image from above from the inside of a HBOT chamber for home use showing a sitting woman | Source: Summit To Sea Grand Dive Vertical HBOT Chamber

Bottom Line

The research on the relationship between hyperbaric oxygen therapy (HBOT) and seizures is limited and inconclusive. Some studies have reported an association between HBOT and seizures, while others have found no link.

Possible mechanisms that have been proposed to explain the development of seizures during or after HBOT include changes in the brain’s electrical activity due to increased pressure and oxygen levels in the chamber, and underlying conditions such as a history of epilepsy or carbon monoxide poisoning.

Based on the current research, it is difficult to make definitive conclusions about the relationship between HBOT and seizures or to provide specific recommendations for clinical practice.

However, it is important for clinicians to be aware of the potential for seizures during or after HBOT and to monitor patients for this complication.

It is recommended that further research is conducted in this area to better understand the potential link between HBOT and seizures, and to identify any specific risk factors or warning signs that may predict the development of seizures during or after HBOT.

This could include controlled studies, larger case series, and long-term follow-up studies of patients who have undergone HBOT.

Additionally, studies looking into the possible mechanisms and factors that may contribute to the development of seizures during or after HBOT would be valuable.

References

  1. Hadanny A, Meir O, Bechor Y, Fishlev G, Bergan J, Efrati S. Seizures during hyperbaric oxygen therapy: retrospective analysis of 62,614 treatment sessions. Undersea Hyperb Med. 2016 Jan-Feb;43(1):21-8. PMID: 27000010.
  2. Lee WG. Carbon Monoxide Poisoning Presenting as Non-Convulsive Status Epilepticus Treated with Hyperbaric Oxygen Therapy. J Epilepsy Res. 2018 Dec 31;8(2):100-104. doi: 10.14581/jer.18018. PMID: 30809506; PMCID: PMC6374531.
  3. Peterson K, Bourne D, Anderson J, et al. Evidence Brief: Hyperbaric Oxygen Therapy (HBOT) for Traumatic Brain Injury and/or Post-traumatic Stress Disorder [Internet]. Washington (DC): Department of Veterans Affairs (US); 2018 Feb. [Table, STRENGTH OF EVIDENCE]. 
  4. Lee CH, Choi JG, Lee JS, Lee Y, Kim H, Kim YS, Cha YS. Seizure during hyperbaric oxygen therapy: experience at a single academic hospital in Korea. Undersea Hyperb Med. 2021 First Quarter;48(1):43-51. doi: 10.22462/01.03.2021.5. PMID: 33648032.
  5. https://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2005.69804.x
  6. Seckin M, Gurgor N, Beckmann YY, Ulukok MD, Suzen A, Basoglu M. Focal status epilepticus induced by hyperbaric oxygen therapy. Neurologist. 2011 Jan;17(1):31-3. doi: 10.1097/NRL.0b013e3181d2a933. PMID: 21192190.


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