There was no evidence of subjective or functional improvement associated with the administration of hyperbaric oxygen to patients with chronic progressive multiple sclerosis.

Clinical Bottom Line:

1. No evidence of significant functional improvement with the addition of hyperbaric oxygenation to the treatment of multiple sclerosis.

Appraised by: Mike Bennett

Dept of Diving and Hyperbaric Medicine

Prince of Wales Hospital

Sydney; Monday, 8 March 1999

Clinical Scenario:  A patient with chronic progressive multiple sclerosis presented for treatment. We wondered if the addition of hyperbaric oxygen would improve function or prevent deterioration.

Three-part Question: In patients with chronic progressive multiple sclerosis, does the addition of hyperbaric oxygen therapy to the usual on-going measures, result in any addition benefit in terms of functional improvement or subjective awareness of improvement?

Search Terms: Hyperbaric oxygenation, multiple sclerosis

The Study:

Double-blinded concealed randomised controlled trial with intention-to-treat.

Known chronic progressive multiple sclerosis with no acute relapse in the past year and no steroids or immunosuppression in the past six months.

Control group (N = 44; 44 analysed): Twenty sham hyperbaric oxygen sessions, 5 times per week for 5 weeks, by the administration of air at 1.1ATA.

Experimental group (N = 44; 44 analysed): Twenty hyperbaric oxygen sessions at 2ATA on 100% oxygen by the same treatment schedule as above.

The Evidence:

Non-Event Outcomes           Time to outcome  Air group   HBO group   P-value

Patient assessment of

change compared to pre-trial     1 month         +0.7       +10.1      >0.05

(mm) on a scale 0-100mm

Neurologist assessment           1 month         -1.9        -0.2      >0.05

(similar to above)

Timed walk over 50m (sec)        1 month          2.9        -2.0      >0.05

Change in Kurtzke disability

score (0-10)                     1 month         +0.01       +0.05     >0.05

Comments:

1. Good methodological study with 90% power to detect a difference in improvement of disability score of 1.0 points.

2. The design planned for further assessment at 3 months, 6 months and 1 year but the results do not appear to have been published.

3. Data was analysed by multiple regression to account for any treatment centre bias and 5 patients who did not tolerate treatment were analysed by intention to do so.

Expiry date:  January 2005

References:

 1. Wiles CM, Clarke CR, Irwin HP, Edgar EF, Swan AV. Hyperbaric oxygen in multiple sclerosis: a double blind trial. British Medical Journal 1986; 292:367-371.