Confavreux
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 | NNH2 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 2015 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.
