Hyperbaric oxygen therapy for hypoxic-ischemic encephalopathy in non-fatal drowning

Area of Science:

• Neurology
• Pediatrics
• Hyperbaric Medicine

Background:

• Hypoxic-ischemic encephalopathy (HIE) following non-fatal drowning can lead to complications like paroxysmal autonomic instability syndrome with dystonia (PAISD).
• PAISD presents with autonomic dysfunction, motor abnormalities, and can negatively impact HIE prognosis.
• Hyperbaric oxygen (HBO2) therapy has been explored for its potential to enhance recovery in neurological conditions.

Observation:

• A 5-year-old boy with HIE post-drowning developed severe PAISD, characterized by dystonia, autonomic instability, and altered consciousness (Glasgow Coma Score of 6).
• Neurological assessments revealed diffuse slow wave activity on EEG and hypoxia-related lesions on MRI.
• The patient's condition was challenging to manage, requiring multiple medications for symptom control.

Findings:

• The patient received physiotherapy, normobaric oxygen, and subsequently underwent 66 sessions of hyperbaric oxygen (HBO2) therapy at 2 atmospheres.
• HBO2 therapy was associated with a progressive reduction in dystonic episodes, allowing for gradual discontinuation of anti-dystonic medications.
• Significant improvements were observed in spasticity, non-verbal communication, and head control.

Implications:

• This case underscores the diagnostic and therapeutic challenges posed by PAISD in pediatric HIE.
• It suggests that HBO2 therapy may be a beneficial adjunctive treatment for improving neurological outcomes in the subacute phase of HIE with PAISD.
• Further research into the role of HBO2 in managing PAISD and promoting recovery from HIE is warranted.