No
evidence for reduced progression of multiple sclerosis with the addition of
hyperbaric oxygen to management.
Clinical Bottom Line:
1.
There was no reduction in the proportion of those deteriorating in global
functional score with progressive multiple sclerosis following the application
of hyperbaric oxygen.
2.Bladder
and bowel function deteriorated less often in the hyperbaric oxygen group.
3.
There was no evidence for either improvement or reduced progression in six
other elements of the scale.
Appraised
by: Mike Bennett, Dept. of Diving and
Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Wednesday, 14 July 1999
Clinical
Scenario: A patient with progressive
multiple sclerosis presents for treatment. We wondered if the administration of
hyperbaric oxygen would be of any benefit.
Three-part
Question: In patients with an established
diagnosis of progressive multiple sclerosis, does the administration of
hyperbaric oxygen in addition to other on-going treatment, result in any
improvement in the rate of progression or increase in functional ability?
Search
Terms: Hyperbaric oxygenation,
multiple sclerosis
The
Study:
Double-blinded randomised
controlled trial with intention-to-treat.
Patients with an established
diagnosis of progressive multiple sclerosis
Control group (N = 9; 8 analysed):
Usual care plus sham hyperbaric oxygen treatments by the administration of 100%
oxygen at 1.1 to 1.2 ATA in a monoplace chamber for 90 minutes daily, five days
each week to a total of 20 treatments.
Experimental group (N = 8; 8
analysed): As above, but 100% oxygen administered at 2.5 ATA during treatment
sessions.
The
Evidence:
|
Outcome |
Time to
Outcome |
Control
group |
HBO group |
Relative
risk increase |
Absolute
risk increase |
NNT |
|
Kurtzke disability score worse |
1 year |
0.25 |
0.375 |
50% |
0.13 |
8 |
|
95% Confidence Intervals: |
|
|
|
-100% to 100% |
-0.33 to 0.58 |
NNH=2 to INF
NNT=3 to INF |
|
Sphincter function worse |
1 year |
0.75 |
0.25 |
-67% |
0.5 |
2 |
|
95% Confidence Intervals: |
|
|
|
-100% to 10% |
-0.92 to 0.08 |
1 to 13 |
Comments:
1. Abstract only available in
English. Full text translation awaited.
2. Very small study with low
power.
3. It is possible that the
reduced deterioration in sphincter function is of real clinical significance
Expiry
date:
January 2005
References:
1. Confavreux C, Mathieu C, Chacornac
R, Aimard G, Devic M. Hyperbaric oxygen in multiple sclerosis. A double-blind
randomised placebo-controlled study. La Presse Medicale 1986; 15:1319-1322.
