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  1. Comment on the paper "Transient global amnesia following a whole-body cryotherapy session"

    Dear Editor,

    We read with interest the case report concerning a transient global amnesia (TGA) in an individual who was previously submitted to a session of whole body cryotherapy (WBC).1

    The scientific literature is already sufficiently wide to realize that the WBC is a safe procedure, while it could seem apparently dangerous due to very low temperature of the air used in the chambers during treatment.2 Only burns owing to sweat or water traces are reported as adverse events, considering some pathological, universally accepted, conditions as exclusion criteria for the treatment.3-9

    It is possible that some rare adverse events are neither known nor described in literature, thus possible pathological modifications of metabolism or behaviour can be important. However, in the case report,1 in order to build on a robust hypothesis about WBC-induced TGA, we believe that additional findings are needed. The patient previously underwent to WBC, thus the direct cause-effect relationship is in doubt; we outline that a standard treatment is based on two or three weeks (10-15 sessions). Moreover, the type of treatment should be more deeply detailed: was that a classical cryochamber doing a whole-body treatment or, instead, a cryosauna which is used to treat the body but the head; in the latter case the nitrogen could partially escape possibly causing nervous symptoms.

    The anamnestic evaluation lacks of drugs eventually taken by the individual and of mental reactivity and cognition evaluation, in order to exclude early sign of cognitive impairment due to Alzheimer or similar diseases. Furthermore, since the speculative association between WBC and TGA, it should be also taken into account the possible side effects (i.e., amnesia) of the proton pump inhibitors (PPI, e.g., omeprazole), taken by the patient, which were previously reported by Fireman et al.10 More recently, Feng et al. also reported about the psychotic symptoms of dissociative disorder, including amnesia, in a patient treated with clarithromycin and the PPI rabeprazole.11 Hence, if cold could be a risk factor for TGA, as reported by the authors,1 also the PPI use cannot be excluded as a potential trigger.

    The description of the case is important to outline the impact of WBC on nervous system, since this procedure is now indicated for the symptomatic treatment of nervous and psychiatric disorders, after the successful symptomatic treatment of chronic inflammatory ones.12,13 However, care should be taken in associating this universally considered safe procedure with possibly spurious, and not surely associated, adverse events.

    References

    1. Carrad J, Lambert AC, Genn? D. Transient global amnesia following a whole-body cryotherapy session. BMJ Case Rep. Epub Aehad of Print. doi: 10.1136/bcr-2017-221431

    2. Lombardi G, Ziemann E, Banfi G. Whole-Body Cryotherapy in Athletes: From Therapy to Stimulation. An Updated Review of the Literature. Front Physiol 2017;8:258. doi:10.3389/fphys.2017.00258

    3. Cholewka A, Stanek A, Sieron A, Drzazga Z. Thermography study of skin response due to whole-body cryotherapy. Skin Res Technol 2012;18(2):180-7. doi:10.1111/j.1600-0846.2011.00550.x

    4. Hausswirth C, Schaal K, Le Meur Y, et al. Parasympathetic activity and blood catecholamine responses following a single partial-body cryostimulation and a whole-body cryostimulation. PloS One 2013;8(8):e72658. doi:10.1371/journal.pone.0072658

    5. Demoulin C, Vanderthommen M. Cryotherapy in rheumatic diseases. Joint Bone Spine 2012;79(2):117-8. doi:10.1016/j.jbspin.2011.09.016

    6. Louis J, Schaal K, Bieuzen F, et al. Head Exposure to Cold during Whole-Body Cryostimulation: Influence on Thermal Response and Autonomic Modulation. PloS One 2015;10(4):e0124776. doi:10.1371/journal.pone.0124776

    7. Pournot H, Bieuzen F, Louis J, et al. Time-course of changes in inflammatory response after whole-body cryotherapy multi exposures following severe exercise. PloS One 2011;6(7):e22748. doi:10.1371/journal.pone.0022748

    8. Kruger M, de Marees M, Dittmar KH, et al. Whole-body cryotherapy's enhancement of acute recovery of running performance in well-trained athletes. Int J Sport Physiol Perform 2015;10(5):605-12. doi:10.1123/ijspp.2014-0392

    9. Schaal K, Le Meur Y, Louis J, et al. Whole-Body Cryostimulation Limits Overreaching in Elite Synchronized Swimmers. Med Sci Sports Exerc 2015;47(7):1416-25. doi:10.1249/MSS.0000000000000546

    10. Fireman Z, Kopelman Y, Sternberg A. Central nervous system side effects after proton pump inhibitor treatment. J Clin Gastroenterol 1997;25(4):718.

    11. Feng Z, Huang J, Xu Y, et al. Dissociative disorder induced by clarithromycin combined with rabeprazole in a patient with gastritis. J Int Med Res 2013;41(1):239-43. doi: 10.1177/0300060513475384.

    12. Bettoni L, Bonomi FG, Zani V, et al. Effects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients. Clin Rheumatol 2013;32(9):1337-45. doi: 10.1007/s10067-013-2280-9.

    13. Bouzigon R, Grappe F, Ravier G, Dugue B. Whole- and partial-body cryostimulation/cryotherapy: Current technologies and practical applications. J Therm Biol. 2016;61:67-81. doi: 10.1016/j.jtherbio.2016.08.009.

    Conflict of Interest:

    None declared

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