The
addition of hyperbaric oxygen therapy to multiple sclerosis patients was
associated with self-reported improvement but not functional scale scores.
Clinical Bottom Line:
1.The
addition of hyperbaric oxygen was associated with an improvement in subjective
self-assessment (NNT 2) and in the expanded disability status score (NNT 3) in
patients with chronic, stable multiple sclerosis.
2.There
was no similar improvement in the functional systems scale.
Appraised
by: Mike Bennett, Dept. of Diving and
Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Tuesday, 25 May 1999
Clinical
Scenario: A patient with chronic stable
multiple sclerosis presented for treatment and we wondered if the addition of
hyperbaric oxygen to the treatment regime would be of any benefit.
Three-part
Question: For patients with chronic,
stable multiple sclerosis, does the addition of hyperbaric oxygen to their
already established treatment, result in any improvement in disability?
Search
Terms: multiple sclerosis
The
Study:
Double-blinded randomised
controlled trial with intention-to-treat. Patients were all classified with an
expanded disability status scale of 5/25 or less and had a duration of multiple
sclerosis of more than ten years, with no exacerbations in the previous six
months. Those established on steroids or immunosuppressants were continued on
these.
Control
group (N = 22; 22 analysed):
Compressed to 2.5ATA on air for 90 minutes daily, five days each week for one
month, followed by a weekly treatment of the same protocol for a year.
Experimental
group (N = 22; 22 analysed): On the
same schedule as above, the patients were given 100% oxygen at 2.5ATA for 90
minutes.
The
Evidence:
|
Outcome |
Time
to Outcome |
Control
group |
HBO
group |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Improved
EDSS score |
1
year |
0.182 |
0.545 |
-199% |
-0.36 |
-3 |
|
95%
CI: |
|
|
|
-100%
to -55% |
-0.63
to -1.01 |
-10
to -2 |
|
Improved
FSS score |
1
year |
0.409 |
0.409 |
0% |
0.0 |
0 |
|
95%
CI: |
|
|
|
-71%
to 71% |
-0.29
to 0.29 |
NNT=3
to INF NNH=3 to
INF |
|
Subjective
improvement |
1
year |
0.091 |
0.636 |
-599% |
-0.55 |
-2 |
|
95%
CI: |
|
|
|
-100%
to -341% |
-0.78
to -0.31 |
-3
to -1 |
Comments:
1. The differences in EDSS were
not significant at 1 or 6 months.
2. Tendon reflexes and strength
measured but not reported. Some shortening of latencies in visual and auditory
brainstem potentials was noted in the HBO group.
3. Follow-up and treatment
regime was longer than comparable studies.
4. The control group received
21% oxygen at 2.4ATA, i.e. an inspired oxygen of 0.52ATA
Expiry
date:
January 2005
References:
1.
Oriani G, Barbieri S, Cislaghi G, Albonico G, Scarlato G, Mariani C,
Pirovano C. Long-term hyperbaric oxygen in multiple sclerosis: a
placebo-controlled double-blind trial with evoked potentials studies. Journal of
Hyperbaric Medicine 1990; 5:237-245.
2.
Oriani G, Barbieri S, Cislaghi G, Albonico G, Scarlato G, Mariani C,
Pirovano C. Long-term hyperbaric oxygen and multiple sclerosis: a
placebo-controlled double-blind trial with evoked potentials studies. Annals of
Hyperbaric Medicine 1988; 1:44-48.
3.
Pirovano C, Barbieri S, Cislaghi G, Albonico G, Scarlato G, Mariani C,
Oriani G. Long-term hyperbaric oxygen in multiple sclerosis: a
placebo-controlled, double-blind trial with evoked potentials studies.
Proceedings of the XIIIth Annual Meeting of the Eurpoean Undersea Biomedical
Society. Palermo 1987: 196-203
