Hyperbaric
oxygen administration was not associated with objective benefit in multiple
sclerosis.
Clinical
Bottom Line:
1.
No objective functional improvement was associated with administration of
hyperbaric oxygen.
2.
Symptomatic improvement in bladder/bowel function was associated with
hyperbaric treatment but not confirmed by objective assessment.
3.
Some evidence of a reduced rate of cerebellar degeneration in the hyperbaric
group.
Appraised
by:
Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital,
Sydney; Saturday, 23 January, 1999
Clinical
Scenario: A patient with established, stable multiple sclerosis.
Three-part
Question:
In patients with multiple sclerosis, does the administration of hyperbaric
oxygen in addition to all normal care, result in an improvement in clinical
state or reduction in the duration and severity of relapse?
Search
Terms:
Hyperbaric oxygenation, multiple sclerosis.
The
Study:
Double-blinded
randomised controlled trial with intention-to-treat. Patients with chronic,
stable multiple sclerosis.
Control
group (N = 60; 56 analysed): All normal care on-going plus sham treatments
breathing air in the chamber at 1ATA
Experimental
group (N = 60; 60 analysed): As
above but oxygen at 2ATA for 90 minutes daily for 20 days.
The
Evidence:
|
Outcome |
Time
to Outcome |
Placebo
rate |
HBO
rate |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
No
objective bladder/bowel function improvement |
1
year |
0.893 |
0.833 |
7% |
0.06 |
-167 |
|
95%
CI: |
|
|
|
-7%
to 21% |
-0.06
to 0.18 |
NNT=5
to INF NNH=16 to
INF |
|
Relapse |
1
year |
0.304 |
0.30 |
1% |
.004 |
250 |
|
95%
CI: |
|
|
|
-54%
TO 56% |
-0.16
to 0.17 |
NNT=6
to INF NNH=6
to INF |
|
No
subjective bladder/bowel function improved |
20
days |
0.946 |
0.783 |
17% |
0.16 |
6 |
|
95%
CI: |
|
|
|
5%
to 30% |
0.04
to 0.28 |
4
to 23 |
|
No
subjective bladder/bowel function improvement |
1
year |
0.976 |
0.833 |
10% |
0.01 |
10 |
|
95%
CI: |
|
|
|
-2%
to 23% |
-0.02
to 0.21 |
NNT=5
to INF NNH=50 to
INF |
Comments:
1.
Multiple subjective and objective assessments yielded no significant differences
in outcome.
2.
Subjective findings of improvement were not confirmed on objective testing,
suggesting some differential placebo effect.
Expiry date: January 2005
References:
1.
Barnes MP, Bates D, Cartlidge N, French J, Shaw D. Hyperbaric oxygen and
multiple sclerosis: short-term results of a placebo-controlled, double-blind
trial. Lancet 1985; 8425:297-300.
2. Barnes MP, Bates D, Cartlidge N, French J, Shaw D. Hyperbaric oxygen
and multiple sclerosis: final results of a placebo-controlled, double-blind
trial. Journal of Neurology, Neurosurgery and Psychiatry 1987; 50:1402-1406.
