Hyperbaric oxygenation in subcortical frontal syndrome due to small artery disorders with leukoaraiosis
Correspondencia: Dr. José F. Vila. Plácido Marín, 1629. 1609 Boulogne, Buenos Aires, Argentina.
Email: abiusi@bigfoot.com
Introduction: Frontal leukoaraiosis (LA) is a common finding in patients with subcortical small-vessel disease and currently its pathogenesis is attributed to ischemic-hypoxic mechanisms. It associates to a vascular subcortical frontal syndrome (VSFS) for which an effective treatment does not exist.
Clinical cases: We present four subjects from a prospective patient-blind controlled pilot trial to study efficacy and safety of hyperbaric oxygen therapy (HBO) vs hyperbaric air in VSFS with LA. All of them had frontal or extended LA on computed tomography scan and lacunes in basal ganglia and centrum ovale, with moderate to severe gait disorders, urinary dysfunction, cognitive impairment, and dependence in the daily living activities. Deficits had begun two to ten years before and had remained stable three months previous to the treatment. Patients were assessed with validated scales and tests one week before and after being administrated ten daily sessions of HBO at 2.5 atmospheres absolute for 45 minutes with a multiplace chamber. Serious adverse effects did not occur. After treatment a noticeable gait, urinary and cognitive improvement was observed in all subjects, increasing their independence. They remained clinically improved during four to five months, after which the previous deficits reappeared. Then, three patients received ten daily sessions of air at 1.1 atmospheres absolute for 45 minutes (controls) and the other a new HBO regimen, which improved as the first time. From the controls, there were no changes in two, while the other did only improve cognitively.
Conclusion: These patients show that HBO is effective and safety in reversing, at least partially, although at great length, chronic neurological deficits associated to vascular frontal LA, highlighting that a functional reserve therapeutically useful exists.
Casos clínicos Presentamos 4 pacientes de un estudio prospectivo simple ciego controlado de oxigenoterapia hiperbárica (OHB) vs aire en el SFSV con LA. Todos mostraban LA frontal o extendida en la tomografía computarizada, con lagunas en ganglios basales y centros semiovales, y presentaban defectos de moderados a graves de la marcha y control miccional, deterioro cognitivo e incapacidad para realizar las actividades de la vida diaria. Llevaban de 2 a 10 años de evolución y sus defectos habían permanecido estables en los 3 meses previos al estudio. Fueron evaluados con escalas y pruebas validadas una semana antes y después de recibir 10 sesiones de OHB, de 45 minutos cada una, a 2,5 atmósferas absolutas (ATA). No hubo efectos adversos serios y en todos se observó mejoría notable motora, esfinteriana y cognitiva que se reflejó en un aumento de su independencia. Clínicamente se mantuvieron estables de 4 a 5 meses, al cabo de los cuales reaparecieron los defectos previos. Entonces, 3 pacientes recibieron 10 sesiones de 45 minutos cada una de aire a 1,1 ATA (controles) y el otro se volvió a tratar con OHB, mejorando como la primera vez. De los controles, en 2 no se apreciaron cambios y el restante sólo mejoró cognitivamente.
Conclusión Los 4 casos muestran que la OHB logra, al menos parcialmente, revertir durante meses defectos neurológicos crónicos asociados a LA frontal vascular señalando la existencia de una reserva funcional terapéuticamente aprovechable
