Hyperbaric oxygen for multiple sclerosis. Review of controlled trials

This review assesses the evidence of the efficacy of hyperbaric oxygen in multiple sclerosis. Material & methods - We used a list of predefined criteria for good methodology and interpreted the results of 14 identified controlled trials with emphasis on the quality. Results - At least eight trials can be considered to have a reasonable to high quality. In one of these 8 trials the results were in favour of hyperbaric oxygen treatment; the others found no clear positive effects. The patients had chronic progressive or chronic stable multiple sclerosis. In most trials, hyperbaric oxygen was supplied at pressures of 1.75-2 ATA, during 20 sessions of 90 min in 4 weeks. The principle endpoint was the (Expanded) Disability Status Score [(E)DSS] and the Functional Status Score as described by Kurtzke. Also specific outcomes such as evoked potentials were frequently used, but no consistent positive effects were demonstrated. Side effects were generally minor, ear and visual problems predominated. Conclusions - The majority of controlled trials could not show positive effects. Further evidence might consist of trials in patients with disease of recent onset or with other dosing regimens but the case for such further trials is not strong. Considering the state of affairs we cannot recommend the use of hyperbaric oxygen in the treatment of multiple sclerosis.