Improvement of attention span and reaction time with hyperbaric oxygen treatment in patients with toxic injury due to mold exposure

Discussion

While ADD is usually thought of as a disorder in the young, it can certainly occur in adults. In this case, it should be considered as acquired, i.e., secondary to toxic exposure. ADHD in adults is reasoned to be similar in nature to the commonly known childhood disorder with regard to cognitive and psychiatric findings [15].

In recent years, there have been an increasing number of patients who were exposed to mold and mold toxins. Many of these patients complain of impaired brain function and turn out to have abnormal neuropsychological tests, abnormal SPECT brain scans, and abnormal TOVA tests. The TOVA test may be repeated many times and remains a valid indicator of attention span and reaction time because there is no learning experience with this test. Therefore, it is ideal for following a patient before, during, and after treatment. Hence, mold exposure can result in toxic encephalopathy and ADD, which can be treated with mHBOT.

TOVA tests support the idea of abnormal physiological behavior characteristic of patients with a history of mold exposure. Other studies likened to revealing these abnormalities resulted in similar conclusions using different techniques were done by Anyanwu et al. As mentioned earlier, contemporary objective neurophysiological tests include EEG, BAEP, VEP, and SSEP. Questionnaires were utilized to analyze response times for abnormalities, as well as the examination of EEGs. Whereas this study involved abnormality regarding response times, in all of Anyanwu et al.’s patients, delays were found in conduction parameters within the brain. BAEP showed waveform abnormalities in 90% of their patients, VEP showed abnormalities with decreased latencies bilaterally. In the right tibial, there was a slowing of conduction at an average of 36.9 ms, the right distal sensory latencies were prolonged compared to the ulnars bilaterally in contrast to the lack of any latencies in the control group [5]. Motor conductions were significantly slow and neurological deficits affecting the behavioral status of children were attributed to the extent of their toxic mold exposure.

Multiple articles endorse the treatment of mold, specifically mucormycosis [16, 17], zygomycosis [18, 19], and candidiasis [20], with hyperbaric oxygen [21]. While some of the mechanisms of action of HBOT, as they apply to the healing and reversal of symptoms, are yet to be discovered, it is known that HBOT has many effects on the body. HBOT greatly increases oxygen concentration in all body tissues, even with reduced or blocked blood flow. It stimulates the growth of new blood vessels in locations with reduced circulation, improving blood flow to areas with arterial blockage. There is a rebound arterial dilation after HBOT, resulting in an increased blood vessel diameter greater than when therapy began, improving blood flow to compromised organs. HBOT stimulates an adaptive increase in superoxide dismutase (SOD), one of the body’s principal, internally produced antioxidants and free radical scavengers [22]. Finally, HBOT greatly aids the treatment of infection by enhancing white blood cell action and potentiating germ-killing antibiotics.

The potential mechanism that may underlie the effectiveness of hyperbaric oxygen on ADD symptoms is not clear. HBOT may play a role in the repair or reconstruction of injured lower motor neurons [23] and has been suggested to provide an effective strategy for the prevention and treatment of numerous neurologic handicaps [24].

Stem or progenitor cells have been found in the adult brain in the past decade that can lead to neural regeneration [25], a recovery process that is oxygen-dependent. Capillary density can be increased in the adult mammalian brain [26], aiding nutrient delivery to regenerating tissues. HBOT has been shown to be useful in the treatment of neurologic injury, even if applied in the nonacute period [27, 28].

The results obtained through the current study are preliminary due to the lack of a control group with a possible placebo structure. It is important to take the implications of this small study and implement a controlled, randomized, double-blind experimental study to test the true therapeutic capabilities of hyperbaric oxygen medicine on patients with toxic mold exposure. Control studies with hyperbaric oxygen are very difficult to perform and have been recently discussed by Clarke [29].

In a recent multicenter, randomized, double-blind, controlled trial, children with autism who received hyperbaric treatment at 1.3 ATM and 24% oxygen for 40 hourly sessions had significant improvements in overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air [30]. Other studies have also provided evidence for the hyperbaric treatment of autism [31–35].

While not new, HBOT has only lately begun to gain recognition for the treatment of chronic degenerative health problems related to diabetic gangrene [36], atherosclerosis [37], stroke [38], chronic vascular wound management [39], diabetic foot ulcers [36], wound healing [40], cerebral palsy [41], brain injury [42], multiple sclerosis [43], macular degeneration [44], and many other disorders. Wherever blood flow and oxygen delivery to vital organs are reduced, function and healing can potentially be aided with HBOT.

Memory, reaction time, and visual-motor speed assessments were compared before, during, and after hyperbaric oxygen therapy in a case of fetal alcohol syndrome involving a teenage male patient [45]. The authors were able to show that this patient benefited from a short course of low-pressure hyperbaric oxygen therapy, sustained durable cognitive improvements, and continued to exhibit improvement with another short course of treatments [45].

Previous literature has shown HBOT to be effective in improving cerebral palsy using three-dimensional displays of SPECT of the cerebral hemispheres of patients before and after treatment with mHBOT [13]. The computer program used in this study makes a regional quantitative comparison of an individual’s SPECT scan with a group of more than 20 controls. Using the same procedure for the 15 patients suffering from toxic injury due to mold exposure, the baseline impairment of perfusion moved into the normal zones after treatment with HBOT. The quantitative aspects of this study are currently being studied.

Low-pressure HBOT is therapy with an extremely low-risk profile and relatively low cost, with potential benefits that seem to be significant and measurable for a condition with few other treatments at our disposal. In this study, 15 adults with symptoms associated with exposure to mold and mycotoxins benefited from a short course of low-pressure HBOT and sustained durable cognitive improvements. Given the implications, these results should receive consideration for a broader study.