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Hyperbaric Oxygenation for Polyneuropathy, a case report

A 41 year old female, presented a history that included a diagnosis of Lyme Disease since August 1995. Her medication consisted of long term oral antibiotic cephradine and IV antibiotic vancomycin along with percodan for pain control. She had several acute medical episodes in 1998, prior to receiving hyperbaric oxygen therapy, that involved bilateral distal parathesia, muscle weakness, intermittent flaccid paralysis that included what was called bipolar Bell's Palsy and she had intermittent loss of consciousness. Several of these episodes required hospitalization. One episode required intensive care for respiratory failure June 19, 1998. She was placed on mechanical ventilation for 15 hours. Spinal tap showed protein but no cells in the CSF. Around this time she had intermittent bilateral lower extremity motor loss requiring wheel chair support. While the prior medical regime addressed the Lyme infection the later condition involved several acute episodes of polyneuropathy.

At the time of her presentation to the hyperbaric facility she was ambulatory without support but walked with postural kyphosis approaching full flexion. Muscular weakness made it difficult for her to stand upright. She had constant daily migraine headaches. She said she did not sleep well as her memory of waking in the hospital with the mechanical ventilation scared her such that she feared going to sleep and having respiratory arrest again. She was taking oxycodin for pain control. She had a history of cigarette smoking. Social history: married, no children.

Hyperbaric oxygenation was started on August 18, 1998 at 22 psig (2.5 ata abs) twice per day for 60 minutes at full pressure each session, six days per week for the first two weeks, five days per week thereafter. Patient used oxygen hood at full pressure and kept hood on for most of the decompression. After 75 sessions the patient reported that "something clicked" and her headaches were gone, pain and motor loss were gone, energy resumed and she "got her life back". Her posture was no longer kyphotic and she was able to smile during conversations. She continued HBO2 twice per day (2.0 to 2.38 ata abs) and during her 122nd session reported that her "hand tingling" disappeared. She resumed long walks and started helping other people with their own difficulties. Her headaches cleared. She reported sleeping better and lost her fear regarding respiratory arrest. She said she was more comfortable inside the chamber than anywhere else. Her treating medical physician, who initially did not recommend hyperbaric oxygenation, expressed wonder at C.P.'s improvement and now thinks HBO2 is a good therapy. The only reported side effect was some noticeable myopia that stabilized after 80 sessions. After that time the patient reported her overall vision improved.

Discussion:

Lyme complications often involve neurological complications such as polyneuropathy. (ref. # 2-5). Bilateral distal sensory and motor disturbance progressing to the cranial nerves with impaired respiration presents a polyneuropathy that can be life-threatening. Unrecognized tissue hypoxia, especially after episodic respiratory failure, further complicates this chronic disease condition. Hyperbaric oxygenation therapy was applied over a prolonged time to compare the outcome over several months as earlier studies showed promise (ref.#1). This patient responded well after 75 sessions and continued improving to full function up to 144 sessions. The impact on her social well being transformed her from weak and dependent to outgoing and helpful. The temporary side-effect of myopia was minimal compared to the overall improvement. The per session cost averaged about $85 each including a subsidized portion from a charity fund. After looking at this particular treatment cost compared to the years of debilitation, social loss and medical bills in this chronic condition one may conclude his HBO2 therapy was cost effective and useful.

References:

#1 Ter Arkh 1986;58(7):105-9 [Place of hemocarboperfusion and hyperbaric oxygenation in the treatment of patients with rheumatoid arthritis with systemic symptoms]. [Article in Russian] Saikovskii RS, Alekberova ZS, Dmitriev AA, Ashurova LL, Mach ES HBO2 is appropriate in such systemic symptoms as ischemic polyneuropathy, digital arteritis, trophic ulcers and Raynaud's syndrome.

#2 Muscle Nerve 1997 Aug;20(8):969-75 Detection of Borrelia burgdorferi DNA and complement membrane attack complex deposits in the sural nerve of a patient with chronic polyneuropathy and tertiary Lyme disease. Maimone D, Villanova M, Stanta G, Bonin S, Malandrini A, Guazzi GC, Annunziata P Institute of Neurological Sciences, University of Siena, Italy. We report a patient who developed a chronic sensory-motor polyneuropathy and a progressive myelopathy 4 years after a tick bite. The presence of complement membrane attack complex deposits and macrophage infiltrates around epineurial vessels and within the endoneurium suggests that the neuropathy in our patient was immune-mediated.

#3 Am J Phys Med Rehabil 1996 Jul-Aug;75(4):314-6 Lyme borreliosis neuropathy. A case report. Deltombe T, Hanson P, Boutsen Y, Laloux P, Clerin M Department of Physical Medicine and Rehabilitation, University Hospital of Mont-Godinne UCL, Yvoir, Belgium. Lyme borreliosis is responsible for a large variety of peripheral neurologic manifestations including axonal polyneuropathy, radiculopathy, and facial nerve palsy.

#4 Enferm Infecc Microbiol Clin 1996 Feb;14(2):72-9 [Frequency of the clinical manifestations of Lyme borreliosis in Spain]. [Article in Spanish] Guerrero A, Escudero R, Marti-Belda P, Quereda C Unidad de Enfermedades Infecciosas, Universidad de Alcala de Henares, Madrid. Neurological manifestations were presented by 40 patients (62.5%) (in control group 23%, p < 0.05) cutaneous lesions by 20 patients (31%), articular manifestations by 18 patients (28%) (in control groups 56%; p < 0.05) and cardiac manifestations in two. Cutaneous manifestations included 17 erythema migrans, 2 acrodermatitis chronica atrophicans and 1 lymphocytoma). Artritis was present in 18 cases. Neurological manifestations included 16 cases of meningitis (2 with encephalitis), 11 of craneal neuropathy and 25 of peripheral neuropathy (13 of polyneuropathy).

#5 N Engl J Med 1990 Nov 22;323(21):1438-44 Chronic neurologic manifestations of Lyme disease. Logigian EL, Kaplan RF, Steere AC Department of Neurology, Tufts University School of Medicine, Boston, MA 02111. Lyme disease, caused by the tick-borne spirochete Borrelia burgdorferi, is associated with a wide variety of neurologic manifestations. To define further the chronic neurologic abnormalities of Lyme disease, we studied 27 patients, in 16 patients electrophysiologic testing showed an axonal polyneuropathy.

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