The
administration of hyperbaric oxygen to patients with multiple sclerosis did not
improve symptoms or prevent deterioration.
Clinical Bottom Line:
1.
No evidence of benefit in multiple sclerosis from the application of
hyperbaric oxygen
2.
Trend to worse performance on disability scale after hyperbaric oxygen
Appraised
by: Mike Bennett, Dept of Diving and
Hyperbaric Medicine,
Prince of Wales Hospital,
Sydney; Friday, 24 December 1999
Clinical
Scenario: A patient with chronic
progressive multiple sclerosis.
Three-part
Question: For patients with chronic
stable or progressive multiple sclerosis, does the administration of hyperbaric
oxygen, compared to no specific treatment, result in any amelioration of the
symptoms and signs of MS, or prevent further deterioration?
Search
Terms: Hyperbaric oxygenation,
multiple sclerosis
The
Study:
Double-blinded controlled trial
with intention-to-treat.
Patients with either stable or
progressive multiple sclerosis.
Control group (N = 16; 15
analysed): 60 minutes breathing 10.5%oxygen at 2ATA daily, 5 days each week for
a total of 20 treatments.
Experimental group (N = 34; 34
analysed): As above plus 100% oxygen at 2ATA or 2.3ATA. The latter patients were
also given diazepam 5mg pre-treatment.
The
Evidence:
|
Outcome |
Time
to Outcome |
Control
group |
HBO
group |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Disability
Status Score Worse |
4
weeks |
0 |
0.118 |
INF |
-0.12 |
-8 |
|
95%
CIs: |
|
|
|
|
-0.23
to -0.11 |
-105
to -4 |
|
Disability
Status Score Worse |
6
months |
0.333 |
0.5 |
-50% |
-0.17 |
-6 |
|
95%
CI: |
|
|
|
-100%
to 37% |
-0.46
to 0.13 |
NNT=8
to INF NNH=2 to
INF |
|
Symptomatic
Improvement |
4
weeks |
0.600 |
0.441 |
27% |
0.16 |
6 |
|
95%
CIs: |
|
|
|
-23%
to 76% |
-0.14
to 0.46 |
NNT=2
to INF NNH=7 to
INF |
Comments:
1. Some unexplained loss to
follow-up and the groups are unequal, ?true randomisation.
2. A trend to worse outcome in
the active groups.
3. 18 authors!
Expiry date: January 2005
References:
1.L'Hermitte F, Roullet E, Lyon-Caen O et al. Hyperbaric oxygen treatment
of chronic multiple sclerosis. Results of a placebo-controlled, double-blind
study in 49 patients. Revue de Neurologie 1986; 142:201-206.
