Hyperbaric
oxygen administration did not improve subjective or objective assessment of
symptoms and signs in multiple sclerosis.
Clinical
Bottom Line:
1. No evidence that hyperbaric oxygen is of benefit in multiple sclerosis.
Appraised by: Mike Bennett
Dept of Diving and Hyperbaric Medicine
Prince of Wales Hospital
Sydney; Tuesday, 12 January, 1999
Clinical Scenario: A patient with an established diagnosis of multiple sclerosis of a relapsing and remitting character.
Three-part Question: In the treatment of multiple sclerosis, does the application of hyperbaric oxygen in addition to usual care, result in any resolution of symptoms and signs or reduction in timing and severity of relapse?
Search Terms: Hyperbaric oxygenation, multiple sclerosis.
The
Study:
Double-blinded concealed randomised controlled trial with intention-to-treat.
Established MS with slow deterioration over six months or a relapsing and remitting nature and documented neurological signs.
Control group (N = 23; 20 analysed): Usual self and nursing care, but no specific regime. Placebo administration of 10% oxygen at 2ATA on same timing as active group.
Experimental group (N = 21; 21 analysed): 100% oxygen at 2ATA for 90 minutes to a total of 20 treatments over 28 days.
The
Evidence:
|
Outcome |
Time
to Outcome |
Control
rate |
HBO
rate |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Reported
improvement |
28 days |
0.350 |
0.381 |
-9% |
-0.03 |
-32 |
|
95%
CI: |
|
|
|
-93% to 75% |
-0.33 to 0.26 |
NNT=4 to INF NNH=3 to INF |
|
Objective
improvement |
28 days |
0.2 |
0.095 |
53% |
0.11 |
10 |
|
95%
CI: |
|
|
|
-55% to 100% |
-0.11 to 0.32 |
NNT=3 to INF NNH=9 to INF |
Comments:
1. Well-conducted study.
2. Small study with low power to detect a clinically significant improvement.
3. Three placebo group patients withdrawn with aural barotrauma, demonstrating that hyperbaric oxygen is not without complications.
Expiry date: January 2005
References:
1. Wood J, Stell R, Unsworth I, Lance J, Skuse N. A double-blind trial of hyperbaric oxygen in the treatment of multiple sclerosis. Medical Journal of Australia 1985; 143:238-241.
