Intervention Review

Hyperbaric oxygen therapy for multiple sclerosis

  1. Michael H Bennett1,*,
  2. Robert Heard2

Editorial Group: Cochrane Multiple Sclerosis Group

Published Online: 14 APR 2010

Assessed as up-to-date: 29 MAY 2011

DOI: 10.1002/14651858.CD003057.pub2

Database Title

Additional Information

How to Cite

Bennett MH, Heard R. Hyperbaric oxygen therapy for multiple sclerosis. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003057. DOI: 10.1002/14651858.CD003057.pub2.

Author Information

  1. 1

    Prince of Wales Hospital, Department of Anaesthesia, Randwick, NSW, Australia

  2. 2

    Prince of Wales Hospital, Department of Diving and Hyperbaric Medicine, Randwick, Australia

*Michael H Bennett, Department of Anaesthesia, Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia. m.bennett@unsw.edu.au.

Publication History

  1. Publication Status: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 14 APR 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Multiple Sclerosis (MS) is a chronic, recurrent and progressive illness with no cure. On the basis of speculative pathophysiology, it has been suggested that Hyperbaric Oxygen Therapy (HBOT) may slow or reverse the progress of the disease.

Objectives

The object of this review was to evaluate the efficacy and safety of HBOT in the treatment of MS.

Search methods

We searched the Cochrane Multiple Sclerosis Group's Trials Register (25 February 2011).

Selection criteria

All randomised, controlled trials involving a comparison between HBOT and a sham therapy in MS were evaluated.

Data collection and analysis

Two reviewers independently appraised all comparative trials identified, extracted data and scored them for methodological quality.

Main results

We identified ten reports of nine trials that satisfied selection criteria (504 participants in total). Two trials produced generally positive results, while the remaining seven reported generally no evidence of a treatment effect. None of our three a priori subgroup analyses placed these two trials in the same group and were therefore unable to account for this difference. Three analyses (of 21) did indicate some benefit. For example, the mean Expanded Disability Status Scale (EDSS) at 12 months was improved in the HBOT group (group mean reduction in EDSS compared to sham -0.85 of a point, 95% confidence interval -1.28 to -0.42, P = 0.0001). Only the two generally positive trials reported on this outcome at this time (16% of the total participants in this review).

Authors' conclusions

We found no consistent evidence to confirm a beneficial effect of hyperbaric oxygen therapy for the treatment of multiple sclerosis and do not believe routine use is justified. The small number of analyses suggestive of benefit are isolated, difficult to ascribe with biological plausibility and would need to be confirmed in future well-designed trials. Such trials are not, in our view, justified by this review.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Hyperbaric oxygen therapy, which involves people breathing pure oxygen in a specially designed chamber, for the treatment of multiple sclerosis

Multiple sclerosis (MS) is a chronic disease of the nervous system which affects young and middle-aged adults. Repeated damage to parts of the nerves leads to progressive weakness and disability. Hyperbaric oxygen therapy (HBOT) involves people breathing pure oxygen in a specially designed chamber (such as used for deep sea divers suffering pressure problems after resurfacing). HBOT is sometimes used for MS in case a lack of oxygen to the affected nerves may be making MS worse, but this theory is unproven. The review of nine trials found no consistent evidence that HOBT can improve disability or modify the progression of MS. There is little need for further research.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

多發性硬化症的高壓氧療法

多發性硬化(MS)是一種慢性、週期性、和進行性的無法治癒的疾病。根據病生理的推論，建議高壓氧療法(HBOT)可能會減慢或扭轉疾病的進展。

目標

這篇評論的宗旨是評估用HBOT治療MS的效力和安全性。

搜尋策略

我們搜尋the Cochrane MS Group trials register (June 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2006), MEDLINE (January1966 to June 2006) 和the National Library of Medicine (NLM) database (June 2006)及專業的高壓氧資源，也徒手搜尋相關期刊和學報。

選擇標準

評估所有在MS病人採用HBOT治療或虛假療法的隨機對照試驗。

資料收集與分析

二個評論者獨自鑑定所有經確認的比較試驗、引用的數據、並且就方法學特性加以評分。

主要結論

我們確認了符合選擇標準的九個試驗中十份報告(總共504個參與者)。其中二個試驗有整體正向的結果，其餘七個試驗普遍沒有治療效果的證據。我們三個「先驗式次群組分析」都沒有把這二個試驗放在同一次群組中，因此無法解釋上述的差異。21個分析中有3個顯示出一些好處。例如，在HBOT組中平均 Expanded Disability Status Scale (EDSS)在12個月時有改善(HBOT組的平均EDSS下降值與虛假療法組的下降值，相差 −0.85 點，95% 信賴區間 −1.28 to −0.42，P = 0.0001)。目前只有二個整體正向試驗在結果中顯示出HBOT對MS的EDSS下降效果 (佔此篇回顧總參加人數的16%)。

作者結論

我們沒有發現一致的證據來證實用高壓氧治療多發性硬化症的好處，而且不相信常規使用高壓氧是正當的。少數建議HBOT有好處的分析是孤立的，難以用生物學的合理性來解釋，需要未來有設計良好的試驗中來證實，我們認為在這篇回顧中沒有找到上述設計良好的試驗。

翻譯人

本摘要由新光醫院吳亞縈翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

多發性硬化症的高壓氧療法多發性硬化症是一種神經系統影響到年輕人和中年人的慢性疾病。部分神經的重複受損導致逐漸虛弱與殘疾。高壓氧療法(HBOT)是讓病人在特別設計的房間裡呼吸純氧(如同深海潛水員浮上水面遭受壓力改變問題時所使用的一樣)。缺氧對MS病人受損的神經有可能加重惡化，HBOT有時被用來治療MS，不過這個理論尚未被證實。九個試驗的評論並沒有發現HBOT可以改善失能或該變MS進程的一致證據。因此，對於此議題不太須要做進一步的研究。

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