A Few Notes about HBO and MS

Who does it help?
Patients in the early stages of relapsing-remitting MS do best as there is less irreversible damage to the nervous tissue. However, trials have shown that among those on long term treatment (10-13 years), whatever their MS state, there is an advantage. After a prolonged period of Hyperbaric Oxygenation (HBO) 23% may be no worse, 7% actually showing improvement and a few people don't respond to it. Then there are some people that have problems over pressurization.

How often do l need it?
To derive some benefit one requires an initial course, in order to thoroughly oxygenate the body, followed by regular HBO top-ups. Top-ups, taking the form of a minimum of a one-hour session per fortnight, are required to appreciably arrest progression but one session per week has been found to be the most effective therapy. This was established by The Federation of MS Therapy Centres with a long-term study conducted between 1983 and 1995.

Published evidence
For their study the Federation used a group of patients spread over 28 centres, probably the most comprehensive study ever made of HBO. Of this Federation group of patients only 22% came from the relapsing-remitting state thought to be most responsive to any form of therapy and some 8% of the group were over 60 years of age. Bearing these figures in mind it is encouraging to see that improvements were experienced across all MS states and not just the younger or the r/r patients.

Does it provide relief?
Of 703 patients in the study group some 47% experienced night time continence improvement and 24% daytime improvement after the initial course of oxygenation. After four years of therapies 73% still retained their improvements, including improvements in speech, fatigue relief, balance and/or walking and bladder control. Only a few people in the study group experienced deterioration while a minority reported no changes.

So what are the problems?
Initially 7% of patients experienced transient short sight while 40% experienced improvement of visual defects. Eardrum pressure, requiring slower pressurization or the valsalver manoeuvre is common (as it is when people fly or scuba-dive). In the longer term 3% experienced short-lived visual disturbance, 17% experienced eardrum pressure (which did not stop their treatment) and 20% experienced fatigue. Fatigue, followed by deep sleep, is a common reaction to initial oxygenation and sleeping during the therapy is by no means uncommon.

Those who took no further treatment deteriorated by a mean of 1.8 KDS (Kurtzke Disability Scale) after six years, the difference between walking and being confined to a wheelchair.

Definite contra-indications are middle ear and upper-respiratory tract infections and, in this country, it is not the practice to provide treatment during pregnancy. It is important for the HBO therapy centre to know an applicant’s medical problems and treatment is never given without their doctors consent. Non-routine cases are referred to our own specialist at the Wolfson Institute, University of Dundee, for protocols.

What about commitment?
Of the patients in the Federation study who completed the initial course some 66% continued for at least three years, stabilizing their condition or retarding their rate of deterioration. However, after 10 years only 38% were still attending regularly. The importance of commitment is emphasized by the fact that among those receiving less than ten follow-on treatments deterioration was equivalent to 3.18 KDS.

Folklore
Oxygen is a colourless, odourless, tasteless and non-irritant gas. It is non-inflammable and for this reason, like all inert gasses, it is fed through connectors with right- hand threads. It is slightly heavier than air, can linger when there is a lack of ventilation and speeds up all reactions, including combustion. But then we are trying to speed up reactions within the body, are we not?

Supervision
HBO chambers are pressurized with "ordinary" air delivered through sealed pipe-work and passed through six filters before it enters the therapy chambers. For absolute safety all users are given precise instructions about using the chambers which they must obey and there are deluge systems fitted. At maximum pressure chambers can be depressurised within a few minutes (in an emergency) and patients with problems can be accompanied during therapy.

Chambers are fitted with intercom systems (we can hear you breathe!) so that assistance can be summoned immediately and
those in the chambers are always visible to the operators. Operators themselves are always under supervision.

Chamber doors are only locked for a few seconds during pressurization, thereafter they are "held" only by the pressure. In an
emergency it is possible to depressurise from inside a chamber.

Substitutes
Topical oxygen therapies promise cosmetic and performance enhancing improvements. HBO therapy, however, involves systemic delivery of oxygen at 2-3 times atmospheric pressure causing a 10-15-fold increase in plasma oxygen concentration and a resultant increase in tissue oxygenation, which is very different. In addition to MS, HBO is now used to treat a wide and increasing variety of medical problems.

Safety
In overall terms the Federation gave 1,013,441 treatments with HBO between 1983 and 1995 without significant incident. Let us continue to work with the same objective in mind.

(With grateful acknowledgement to The Federation of MS Therapy Centres)