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'''The addition of hyperbaric oxygen therapy to multiple sclerosis patients was associated with self-reported improvement but not functional scale scores'''. 

'''Clinical Bottom Line:''' 
1.The addition of hyperbaric oxygen was associated with an improvement in subjective self-assessment (NNT 2) and in the expanded disability status score (NNT 3) in patients with chronic, stable multiple sclerosis. 
2.There was no similar improvement in the functional systems scale. 

'''Appraised by''': Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Tuesday, 25 May 1999 

'''Clinical Scenario:''' A patient with chronic stable multiple sclerosis presented for treatment and we wondered if the addition of hyperbaric oxygen to the treatment regime would be of any benefit. 
'''Three-part Question:''' For patients with chronic, stable multiple sclerosis, does the addition of hyperbaric oxygen to their already established treatment, result in any improvement in disability? 
'''Search Terms:''' multiple sclerosis 

'''The Study:''' 
Double-blinded randomised controlled trial with intention-to-treat. Patients were all classified with an expanded disability status scale of 5/25 or less and had a duration of multiple sclerosis of more than ten years, with no exacerbations in the previous six months. Those established on steroids or immunosuppressants were continued on these. 
'''Control group''' (N = 22; 22 analysed): Compressed to 2.5ATA on air for 90 minutes daily, five days each week for one month, followed by a weekly treatment of the same protocol for a year. 
'''Experimental group''' (N = 22; 22 analysed): On the same schedule as above, the patients were given 100% oxygen at 2.5ATA for 90 minutes. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Control group''' || '''HBO group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Improved EDSS score''' || 1 year || 0.182 || 0.545 || -199% || -0.36 || -3 
|-
| '''95% CI:''' || || || || -100% to -55% || -0.63 to -1.01 || -10 to -2 
|-
| '''Improved FSS score''' || 1 year || 0.409 || 0.409 || 0% || 0.0 || 0 
|-
| '''95% CI:''' || || || || -71% to 71% || -0.29 to 0.29 || NNT'''3 to INF NNH'''3 to INF 
|-
| '''Subjective improvement''' || 1 year || 0.091 || 0.636 || -599% || -0.55 || -2 
|-
| '''95% CI:''' || || || || -100% to -341% || -0.78 to -0.31 || -3 to -1 
|-
|}

'''Comments:''' 
1. The differences in EDSS were not significant at 1 or 6 months. 
2. Tendon reflexes and strength measured but not reported. Some shortening of latencies in visual and auditory brainstem potentials was noted in the HBO group. 
3. Follow-up and treatment regime was longer than comparable studies. 
4. The control group received 21% oxygen at 2.4ATA, i.e. an inspired oxygen of 0.52ATA 

'''Expiry date:''' January 2015 
'''References:''' 
1. Oriani G, Barbieri S, Cislaghi G, Albonico G, Scarlato G, Mariani C, Pirovano C. Long-term hyperbaric oxygen in multiple sclerosis: a placebo-controlled double-blind trial with evoked potentials studies. Journal of Hyperbaric Medicine 1990; 5:237-245. 
2. Oriani G, Barbieri S, Cislaghi G, Albonico G, Scarlato G, Mariani C, Pirovano C. Long-term hyperbaric oxygen and multiple sclerosis: a placebo-controlled double-blind trial with evoked potentials studies. Annals of Hyperbaric Medicine 1988; 1:44-48. 
3. Pirovano C, Barbieri S, Cislaghi G, Albonico G, Scarlato G, Mariani C, Oriani G. Long-term hyperbaric oxygen in multiple sclerosis: a placebo-controlled, double-blind trial with evoked potentials studies. Proceedings of the XIIIth Annual Meeting of the Eurpoean Undersea Biomedical Society. Palermo 1987: 196-203 

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'''[[Multiple Sclerosis | BACK]]'''

Oriani - Revision history

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