Safety of hyperbaric oxygen therapy in non-emergent patients with a history of seizures: A retrospective cohort study

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BACKGROUND: Hyperbaric oxygen therapy (HBOT) is well established as a treatment for various medical conditions. However, it poses a risk of oxygen toxicity, which can cause seizures particularly in individuals with pre-existing seizure disorders. Consequently, seizure disorders are considered a relative contraindication to HBOT. Despite this, the relative risk of HBOT-induced seizures in this patient population remains unclear. This retrospective cohort study aims to evaluate the safety of HBOT among patients with pre-existing seizure disorders. METHODS: After obtaining approval from the Research Ethics Board, we retrospectively reviewed the patient charts of individuals with a history of seizures who were referred to the Rouge Valley Hyperbaric Medical Center and Toronto General Hyperbaric Medicine Unit for HBOT between January 2020 and December 2023. Relevant demographic information, past medical history, and HBOT session treatment protocols, such as the treatment pressure set in absolute atmospheric pressure (ATA) and number of air breaks, were recorded. The collected data was analyzed using descriptive statistics. RESULTS: A total of 43 patients were referred to HBOT during the study period, and 21 patients did not proceed with the treatments. In total, 634 HBOT sessions were administered to 22 patients in monoplace chambers with five-minute air breaks, and one patient experienced a seizure event. Each patient completed an average of 29 (range 3-60) sessions lasting 90-120 minutes at 1.8 ATA (n = 3), 2.0 ATA (n = 18), or 2.4 ATA (n = 1). Fifteen patients were on oral antiseizure medications during the HBOT course. The overall incidence of seizures was one in 634 treatments. CONCLUSION: While patients with a history of seizures may develop seizure activity during HBOT, the majority can safely undergo treatment when predetermined protocols are followed. With careful management and adherence to established protocols, HBOT can be a viable treatment option for those with seizure histories.

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