L'Hermitte
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 | NNT8 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 | NNT2 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 2015 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.
