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Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP Research Group
J P Collet1, M Vanasse, P Marois
1Randomised Clinical Trial Unit, Jewish General Hospital, Montreal, Quebec, Canada. jpcollet@epid.jgh.mcgill.ca
Insights
Hyperbaric oxygen therapy did not improve gross motor function or other outcomes in children with cerebral palsy compared to sham treatment. Ear problems were more common in the hyperbaric oxygen group.
Area of Science:
- Pediatric Neurology
- Rehabilitative Medicine
- Oxygen Therapy
Background:
- Hyperbaric oxygen (HBO) therapy is increasingly used for children with cerebral palsy (CP) globally.
- Scientific evidence supporting its efficacy in CP is limited.
- This study aimed to evaluate HBO's effectiveness and side effects in pediatric CP.
Purpose of the Study:
- To assess the efficacy of hyperbaric oxygen therapy in improving gross motor function in children with cerebral palsy.
- To evaluate the impact of hyperbaric oxygen on secondary outcomes, including daily living activities, attention, memory, and speech.
- To identify and compare the side effects of hyperbaric oxygen therapy versus sham treatment in this population.
Main Methods:
- A randomized controlled trial involving 111 children (aged 3-12 years) with cerebral palsy.
- Participants were assigned to receive either hyperbaric oxygen (100% O2 at 1.75 ATA) or slightly pressurized room air (1.3 ATA) for 40 treatments over 2 months.
- Outcomes included gross motor function, activities of daily living, attention, working memory, and speech.
Main Results:
- Both hyperbaric oxygen and sham treatment groups showed improvements across all measured outcomes.
- No statistically significant difference was observed between the hyperbaric oxygen and sham air groups for gross motor function (mean difference -0.40, p=0.544).
- Ear problems were significantly more frequent in the hyperbaric oxygen group (27 children) compared to the sham air group (15 children, p=0.004).
Conclusions:
- Hyperbaric oxygen therapy demonstrated no significant benefit over sham treatment for children with cerebral palsy.
- The observed improvements in both groups warrant further investigation into the underlying mechanisms.
- The increased incidence of ear problems highlights a potential safety concern with hyperbaric oxygen in this patient group.
Background:
The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. We did a randomised trial to assess the efficacy and side-effects of this form of therapy in children with cerebral palsy.
Methods:
111 children with cerebral palsy aged 3-12 years were randomly assigned hyperbaric oxygen (n=57) or slightly pressurised room air (n=54). All children received 40 treatments over 2 months. Hyperbaric oxygen treatment was 1 h in 100% oxygen at 1.75 atmospheres absolute (ATA); children on slightly pressurised air received air at 1.3 ATA (the lowest pressure at which pressure can be felt, thereby ensuring the maintenance of masking). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech.
Findings:
For all outcomes, both groups improved over the course of the study, but without any difference between the two treatments. The score on the global gross motor function measure increased by 3.0% in the children on slightly pressurised air and 2.9% in those on hyperbaric oxygen. The mean difference between treatments was -0.40 (95% CI -1.69 to 0.90, p=0.544). Other changes were seen in speech, attention, memory, and functional skills. Ear problems occurred in 27 children treated by hyperbaric oxygen and in 15 treated with hyperbaric air (p=0.004).
Interpretation:
In this study, hyperbaric oxygen did not improve the condition of children with cerebral palsy compared with slightly pressurised air. The improvement seen in both groups for all dimensions tested deserves further consideration.
