Wood
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 | NNT4 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 | NNT3 to INF NNH9 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 Three placebo group patients withdrawn with aural barotrauma, demonstrating that hyperbaric oxygen is not without complications.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 2015 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.
