HBOTforMS

(NOTE: I do not have the charts in the following report)

Studies with thousands of Multiple Sclerosis patients have shown that not only can the disease be stopped, in some cases, it can reverse.

The chart above shows how 11 patients treated with Hyperbaric oxygen Therapy had fewer and fewer relapses each year. The 11 control subjects who did not receive Hyperbaric therapy had their disease progressively worsen.

While most authorities believe that MS is non- reversible, and the best that can be done is to slow the progression of the disease, these MRI pictures show how hyperbaric oxygen can actually reverse MS lesions.

A New Theory of the Causes of M.S.

The Gottlieb-Neubauer theory proposing that MS is caused by lack of oxygen, has been supported by research showing that HBOT, which overcomes a lack of oxygen, is an effective treatment method. Established medical circles have come to accept HBOT's effectiveness, although that acceptance was initially slow in coming.

Accepted by the Medical Community

The first sign of this acceptance came in January 1983, when a report on HBOT was published in the prestigious New England Journal of Medicine (NEJM). The wording of the report, which came after almost a year of extensive analysis, revision, and review, was cautious. But it did offer a good measure of hope: "These preliminary results [on HBOT] suggest a positive, though transient effect of hyperbaric oxygen on advanced multiple sclerosis (MS )warranting further study."

This report's impact on people with MS was electrifying, ... and their families went looking for hyperbaric chambers.

Clinical Studies Show great Results

The NEJM report was based on a controlled clinical trial conducted between 1980 and 1982 by Dr. B. H. Fischer, Dr. M. Marks, and Dr. T. Reich at New York University Medical Center. Forty patients with chronic MS were divided randomly into two groups. The experimental group received pure oxygen, and the control group received a mixture of 10% oxygen and 90% nitrogen. Both groups were treated at a pressure of 2.0 atmospheres absolute, but at an effective pressure of 1.4 atmospheres absolute due to leakage from the masks. Sessions lasted for ninety minutes, once a day, for a total of twenty exposures.

The investigators discovered that 12 of the 17 patients (70 percent) who received HBOT saw their symptoms improve. (Three of the 20 patients in this group dropped out of the study before it was completed.) But in the control group of patients who inhaled the equivalent of room air under pressure, just 1 in 20 (5 percent) improved.

Of the persons in the study who benefited from HBOT, 7 had short-term relief and 5 had long lasting relief of MS symptoms. Those with less severe forms of the disease experienced more favorable and prolonged responses.

After one year of followup, deterioration was found in only 2 of the patients (12 percent) who had received pure oxygen, compared with 11 patients (55 percent) in the control group.

A number of studies have criticized HBOT as a treatment for MS. In reviewing many of these studies, Dr. Neubauer (a well respected Hyperbaric physician) believes that there were a number of factors that were either not considered or inappropriate. For example, inappropriate pressures were used, patients had advanced MS, and not enough treatments were given. Interestingly enough, one of the authors of a negative report went on to open a hyperbaric center in Great Britain specifically to treat MS.

In 1984, Dr. Neubauer learned that more than 10,000 MS patients in fourteen countries had been treated with HBOT. In discussions with his colleagues, he found that the majority of these patients (70 percent) showed improvement in brain and bowel-bladder function, and lessening of muscular spasticity and other systemic disorders brought on by the disease. Objective measurement, or improvement that could be measures, occurred in about 25 percent of the patients. Subjective improvement, or improvement that was noted by the doctor or the patient but is difficult to measure, occurred in about 45 percent of the patients. There was also a marked absence of deterioration and few relapses among patients who participated in a periodic HBOT booster program.

In a double blind, placebo-controlled 1986 study conducted by Dr. T Yamada and colleagues in Japan, it was reported that all MS patients treated with HBOT led to a very significant decrease in the number of relapses.5

The cases of another 600 MS patients who had been treated with HBOT were reported on by Dr. Neubauer at a hyperbaric medicine conference. Some of these patients stopped receiving HBOT because of cost considerations, or because travel to and from the hyperbaric facility was inconvenient. Others continued to receive treatment. There were significant objective improvements, as well as a reduction in the number of relapses, for those patients who continued HBOT compared with those who did not.

One group that funded extensive research into MS and HBOT was Action for Research into Multiple Sclerosis (ARMS). The result of one ARMS study were published in 1989. The two-year study, conducted by researchers from Ninewells Medical School at the University of Dundee in Scotland, involved 128 HBOT-treated MS patients who were compared with an equal number of untreated controls. Seventy percent of the treated patients did not deteriorate, had their conditions stabilize, or showed small improvements. 6 Behind the studies and statistics are the improvements in daily life experienced by many MS patients who receive HBOT. One Massachusetts woman had been disabled by the disease - she could barely stand and needed a battery powered cart to move around. After her third hour of treatment, she "felt absolutely wonderful and asked my son to get my crutches out of the closet where they were stored. I got up out of my cart and walked around and was astounded at my progress; it was happening that quickly."

When the patient returned to her home, she continued taking HBOT treatments at a hyperbaric center in Pennsylvania. "When I wake up in the morning, I have a very positive, energetic feeling," she said. "I don't in any way see this HBO Treatment as being a cure for MS, though. If I hold the line at this point, that's terrific. If I slow down the process of deterioration, that's terrific too, as far as I'm concerned."7

As we've seen, HBOT is not a cure for MS. But it has proven to be an effective therapy. It as shown an ability to favorably alter the outcome of the disease. HBOT should be continued in regular, long-term treatments, especially when MS has caused dysfunctions of the cerebellum, and loss of bowel and bladder control.

For best results, HBOT treatment of MS should be started as early as possible following diagnosis. As with any other illness, MS becomes more difficult to control as the disease process continues. Oxygen cannot and does not reverse plaque formation, and functions best before there has been a consolidation of plaque. Some patients may require as many as eighty exposures in the initial series before stabilization and maximum improvement are achieved. HBOT can also be used to maintain a remission through the use of from one to two sessions a week, to one or two sessions a month.

Many cutting edge doctors now believe that MS is essentially a circulation problem linked to a lack of oxygen in the body's tissues. HBOT can overcome this lack of oxygen to help halt the progress of this disease. Unfortunately, this belief is shared by neither a majority of American doctors nor by many MS organizations. Just as insulin injections do not cure diabetes, HBOT does not cure MS. Rather, HBOT provides a significant chance for control and stabilization of MS, as insulin does for diabetes.

1. Gottlieb S.F. and Neubauer R. A. Multiple Sclerosis: its etiology, pathogenesis, and therapeutic with emphasis on the controversial use of HBO. Journal of Hyperbaric Medicine 3: 143-164, 1988.

2. Poulton G. A. Controversial MS treatment provides degree of help and hope for victims. Fort Lauderdale News 8/9/82, page 2B.

3. Haney D. Q. MS victims find hope i treatment. The Philadelphia Inquirer 9/25/83, pp1-c, 8-c.

4. Fischer B. H., Marks M., and Reich T. Hyperbaric oxygen treatment of multiple sclerosis. New England Journal of Medicine 308 (4):181-186, 1983.

5. Yamada T., Hirayama K., Saito H., and others. Hyperbaric oxygen treatment for multiple sclerosis: short term and long term therapy. Journal of Hyperbaric Medicine 21:215-219, 1986.

6. Davidson D. L. W. Hyperbaric oxygen therapy in the treatment of multiple sclerosis. Research from Action for Research into Multiple Sclerosis, London, England, 1989.

7. Haney D. Q. MS victims find hope in treatment. The Philadelphia Inquirer 9/25/83, pp 1-C, 8-C.

Much of the information in this report was found in the Textbook of Hyperbaric Medicine by K.K. Jain and Hyperbaric Oxygen Therapy by Neubauer and Walker.

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Since 1983 The UK Federation of Multiple Sclerosis Treatment Centres have treated over 250 patients who had been told that they had 'Chronic Fatigue Syndrome / Myalgic Encephalitis'. The response of 36 of them were reported in the J. Royal Society of Medicine in 1990. Vol 38, p 413. Thirteen responded after 20 treatments at 1.25 ata, ten at 1.5 ata, three at 1.75 ata and two at 2.0 ata. Briefly, between 50 and 80% reported improvement in fatigue, muscle pains, paraesthesiae, numbness, balance, bladder problems, speech etc. Some patients need to attend regularly to maintain their improvemments.

David Perrins.

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Q: How does oxygen help multiple sclerosis patients?

A: Multiple sclerosis is a disease in which there are multiple areas of leakage from the blood vessels in the brain and spinal cord causing symptoms. Treatment should be instituted when the first area is affected, but this is not yet an objective in neurology. Vessels in the nervous system are engineered to form a barrier - the blood-brain barrier - to prevent the leakage of large molecules such as proteins because their escape causes inflammation.

The blood vessels involved in MS are actually veins and the leakage causes inflammation in the surrounding area. This is usually in the white matter, which contains vulnerable cells which form the myelin sheaths. As the damage progresses the sheaths are removed and the fibres are destroyed causing disability. Further progression is characterised by loss of the structure of the tissue and healing by scarring - known as sclerosis. Once the sclerosis has formed, recovery of the normal architecture is not possible. The key to the successful management of the established disease is to give the normal recovery mechanisms the best environment to repair the tissue before scarring takes place. Magnetic resonance scanning techniques have shown both the leakage and the oxygen deficiency created by the swelling in the areas affected in MS. The object of giving a concentrated dose of oxygen is to restore the level of oxygen in the affected area to normal and interrupt the progression to scar formation.

Oxygen is necessary, not only for all metabolism, but also for the regulation of many aspects of blood vessel and blood cell function. The blood-brain barrier requires energy and oxygen to maintain its integrity. Giving more oxygen constricts the diameter of blood vessels and yet paradoxically improves the transport of oxygen to the tissues. Oxygen also modulates the behaviour of white blood cells and the inner lining of the vessels. Trials of oxygen therapy in MS patients have shown benefit especially in bladder function and balance but, because neurologists have wanted to avoid the possibility of spontaneous improvement - which is of course oxygen dependent - they have chosen to study patients who have advanced disability. Most trials have used patients with disease durations typically in excess of two years. The only trial in the history of multiple sclerosis which matched pairs of patients and then randomly allocated them to either treated or control groups, demonstrated unequivocal evidence of benefit. (p< 0.0001). Because the blood vessel barrier may not repair completely, many patients need to continue oxygen therapy on a regular basis. This is also the reason for the need to continue with beta interferon injections, which also acts by stabilising the blood-brain barrier.

Reference: Fischer BH et al. Hyperbaric oxygen in the treatment of multiple sclerosis; a randomised placebo-controlled double-blind trial. New England Journal of Medicine 1983;308:181-186.

Best wishes, Philip James

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MS its etiology, pathogenesis, and therapeutics with emphasis on the controversial

use of HBO2

Journal Hyperbaric Medicine 1988; 3(3):143-164 Gottlieb SF, Neubauer RA.

A review of the current hypotheses in the etiology and pathogenesis of multiple sclerosis

(MS) is presented together with the implications for therapy. A new hypothesis as to

etiology is presented. Special emphasis is placed on the controversy surrounding the use

of hyperbaric oxygen in a critical analysis of the published double-blind studies and

related discussions. Emphasis placed on the predominant infective and autoimmune

hypotheses cannot be supported, either from the pathology of the disease or by the

response to treatment. It is concluded that the evidence of beneficial effects of

hyperbaric oxygen therapy, despite the use of patients with advanced disease in trials, is

very impressive, especially in chronic progressive disease. It is also concluded that there

is need for further research and that such studies should examine the effects of

hyperbaric oxygenation alone, and in combination with other therapeutic agents, in

individual patients with the methods of realtime investigation now available. Meanwhile,

based on comparative efficacy and safety, hyperbaric oxygenation is recommended for

treating early stages of MS, especially for treating cerebellar and bowel-bladder

disorders. ACTH-cortisone, antiviral agents, co-polymer 1, double-blind studies,

hyperbaric oxygen therapy, immunosuppressants, Kurtzke disability scores, MS etiology,

MS pathophysiology MS therapy, multiple sclerosis (MS), plasmapheresis. Introduction:

Multiple sclerosis (MS) is classified as a demyelinating disease of the central nervous

system1 and is the most common of the demyelinating diseases. Despite over a century

of investigation MS remains one of the most frustrating diseases for patients and

physicians because there is no agreed upon etiology and there is no cure or agreed upon

therapy. Perhaps no other disease has had so many therapies proposed and had them fail

2, 3. The purpose of this article is to review some of the evidence for the etiology and

pathophysiology of MS and match the information with current therapies. Specific

attention will be directed at a critique of the basis for hyperbaric oxygen (HBO2) as a

new therapeutic modality for MS (summarized in Table 1). We concentrate on HBO2

because this therapeutic modality has generated an extremely emotional, as well as an

intellectual controversy, perhaps more so than any previously proposed treatment.

Conclusions: Of all the current therapies presumably based on an understanding of the

etiology and pathophysiology of the disease process, HBO2 has the soundest foundation.

It is also the safest "drug" available. It is not surprising, therefore, to find that there is

much positive evidence concerning the beneficial effects of HBO2 on cerebellar and

bowel-bladder function to sanction its use for treating MS. Based on comparative

efficacy and safety considerations, it is recommended that HBO2 be used for treating

early MS and for treating MS associated cerebellar and bowel-bladder dysfunction.

References: 1. Lumsden CE. The neuropathology of multiple sclerosis: multiple sclerosis

and other demyelinating diseases. In: Vinken P. Bruyn GW, eds. Handbook of clinical

neurology, vol. 9. Amsterdam: North Holland Publishing 1970: 217-309. 2. Waksman BH.

Rationales of current therapies for multiple sclerosis. Arch Neurol 1983; 40:671 672. 3.

Van den Noort S. Therapeutic fads and quack care. Arch Neurol 1983; 40:673-674. 4.

Adams CWM. Pathology of multiple sclerosis: progression of the lesion. Br Med Bull 1977;

33:15-20. 5. Allen IV. The pathology of multiple sclerosis-fact, fiction and hypotheses.

Neuropathol Neurobiol 1981; 7:169-182. 6. Brownell B. Hughes JT. The distribution of

plaques in the cerebrum in multiple sclerosis. Neurol Neurosurg Psychiatry 1962;

25:315-320. 7. Dawson Jw The histology of disseminated sclerosis. Trans R Soc Edinb

1916; 1 3)517-540. 8. Pollock M, Calder C, Alpress S. Peripheral nerve abnormality in

multiple sclerosis. Ann Neurol 1977; 2:41-48. 9. Han M. Periphlebitis retinae in

association with multiple sclerosis. Psychiatr Neurol Scand 1953; 29:175-189. 10. AitaJF,

Bennett DR, Anderson RE, Ziter F. Cranial CT appearance of acute multiple sclerosis.

Neurology 1978; 28:251-255. 11. Swank RL. Subcutaneous hemorrhages in multiple

sclerosis. Neurology 1958; 8:497-499. 12. Dow RS, Berglund G. Vascular pattern of

lesions of multiple sclerosis. Arc Neurol 1942; 47:118. 13. Brooks DJ, Leenders KL, Head

G. et al. Studies on regional cerebral oxygen utilization and cognitive function in multiple

sclerosis. J Neurol Neurosurg Psychiatry 1984; 47:1182-1191. 14. Kelly DL Jr, Lassiter

KRL, Vongsvivut A, Smith JM. Effects of hyperbaric oxygenation and tissue Oxygen

studies in experimental paraplegia.J Neurosurg 1972; 36:425-429. 15. Weiner HL. COP I

therapy for multiple sclerosis. N EngJ Med 1987; 317:442-444. 16. Waksman BH,

Reynolds WE. Multiple sclerosis as a disease of immune regulation. Proc Soc Exp Biol M Med 1984; 175:282-294. 17. Cook SD, Dowling PC. Multiple sclerosis and viruses: an overview. Neurobiology 1980; 30: 80-91. 18. Poser CM. Pathogenesis of multiple

sclerosis. Acta Neuropathol (Berl) 1986; 71:1-10. 19. Wolfgram F. What if multiple

sclerosis isn't an immune or a viral disease? The case for a circulating toxin. Neurochem

Res 1979; 4:1-4. 20. Waksman B. Pathogenic mechanisms in multiple sclerosis. Ann NY

Acad Sci 1984; 436:125-129. 21. Arnason B. Relevance of experimental allergic

encephalomyelitis to multiple sclerosis. Neurol Clin 1983; 1:765-782. 22. Hickey WF

Kimura H. Perivascular microglial cells of the CNS are bone marrow-derived and present

antigen in vivo. Science 1988; 239:290 292. 23. Spencer PS, Nunn PB, Hugon J. et al.

Guam amyotrophic lateral sclerosis---parkinsonism--- dementia linked to a plant excitant

neurotoxin. Science 1987; 237:517-522. 24. Lewin R. Environmental hypothesis for brain

diseases strengthened by new data. Science 1987; 237:483-484. 25 Kunzke

JF.Epidemiologic contributions to multiple sclerosis: an overview.Neurology 1980; 30:61

-79. 26. James PB. Evidence for subacute fat embolism as the cause of multiple

sclerosis. Lancet 1982; 1:380-385. 27. Stein EC, Schiffer RB,Jackson W. Young N.

Multiple sclerosis and the work place: report of an industry-based cluster. Neurology

1987; 37:1672-1677. 28. James PB. Oxygen for multiple sclerosis. Letter to editor.

Lancer 1983; 1:1161-1162. 29. Colover J. Oxygen for multiple sclerosis. Lancet ]983;

1:1383-1384. 30. Oppenheimer DR. Oxygen for multiple sclerosis. Letter to editor.

Lancet 1983; 11:632. 31. James PB. Oxygen for multiple sclerosis. Lancer 1987; 11:632.

32. Hassan HM. Chemistry and biochemistry of oxygen and its partially reduced

derivatives. In: Gottlieb SF, Longmuir IS, Totter JR, eds Oxygen: an in-depth study of its

pathophysiology. Bethesda, MD: Undersea Medical Society 1983:307-338. 33. McCord

JM. Superoxide radical: a link between reperfusion injury and inflammation. Adv Free

Radical Biol Med 1986; 2:325-345. 34. Kontos HA. George E Brown memorial lecture:

Oxygen radicals in cerebral vascular injury. Circ Res 1985; 57:508-516. 35 Halliwell B.

Oxidants and human disease: some new concepts. FASEB J. 1987; 1:358-364. 36.

Schmit PL, Gottlieb SF. Enhancement of cortical Nat, K + -ATPase by increased oxygen

tensions: evidence of a new controlling mechanism. Brain Res 19#2; 242:271 278. 37.

Pillunat LE, Stodtmeister R. Wilmanns 1. Pressure compliance on optic nerve head in low

tension glaucoma. BrJ Opht 1987; 71:181-7. 38. Kitazawa Y. Shirato S. Yamamoto T.

Optic disc hemorrhage in low tension glaucoma. Ophthalmology 1987; 93:853-857. 39.

McDonald Wl. Attitudes to the treatment of multiple sclerosis. Arch Neurol 1983;

40:667-670. 40. Ellison GW, Myers LW. Immunosuppressive drugs in multiple sclerosis:

pro and con. Neurology 1980; 30:28-32. 41. Johnson KP. Systemic interferon therapy for

multiple sclerosis. Arch Neurol 1983; 40:681682. 42. Rose AS, Kuzme JW, Kurtzke JF, et

al. Comparative study in the evaluation of therapy in multiple slerosis: ACTH vs placebo:

final report. Neurology 1970; 20:1-59. 43. MertinJ, Rudge P. Kremer M, et al.

Double-blind controlled trial of immunosuppression in the treatment of multiple sclerosis:

final report. Lancet 1982; 11:351-353. 44. Lhermitte F. Marteau R. Roullet E. Not so

benign long-term immunosuppression in multiple sclerosis. Br MedJ 1984; 28:276-277. 45.

Bornstein MB, Miller A, Slagle S. et al. A pilot trial of COP I in exacerbating-remitting MS

N EnglJ Med 1987; 317:408 414. 46. Hauser SL, Dawson DM, LehrichJR, et al.

Immunosuppression and plasmapheresis in chronic progressive multiple sclerosis. Arch

Neurol 1983; 40:687-690. 47. Stefoski D, Davis FA, Schauf CL. Acute improvement in

exacerbating multiple sclerosis produced by intravenous administration of mannitol. Ann

Neurol 1985; 18:443-4S0. 48. Boschetty V, Cernoch J. Aplikace kysliku za pretlaku u

nekterych neurologicy ch onemocneni. Bratisl Lek Listy 1970; 53:298-302. 49. Baixe JH.

Bilan de onze anees d'activite en medicine hyperbare. Med Aer Spatiale Med

Subaquatique Hyperbare 1978; 17:90-92. 50. Neubauer RA. Treatment of multiple

sclerosis with monoplace hyperbaric oxygenation. J Fla Med Assoc 1978; 65:101-104.

51. Neubauer RA. Exposure of multiple sclerosis patients to hyperbaric oxygen at 1.5-2..

ATA: a preliminary report. J Fla Med Assoc 1980; 67:498-S04. 52. Warren J. Sacksteder,

MR, Thuning CA. Oxygen immunosuppression: modification of experimental allergic

encephalomyelitis in rodents.J Immunol 1978; 121:315-320. 53. Powell MR, Kizer V,

Hruby S. Alvord EC Jr, Martin J. The effect of daily hyperbaric oxygen (2 ATA) on the

course of chronic relapsing murine experimental allergic encephalomy elitist In: Bove AA,

Bachrach AJ, Greebaum LJ Jr, eds. Underwater and hyperbaric physiology DE Proceedings

of the ninth international .symposium on underwater and hy perbaric physiology.

Bethesda, MD: Undersea and Hyperbaric Medical Society, 1987: 847-857. 54. Godovkin

Dl, Zaytsev VS, Lotovin AP. Hyperbaric oxygenation as an immunity stimulus in MS. Sov

Med 1982; 12:70-75. 55. Hansborough JF, Piacentine JG, Eiseman B. Immunosuppression

by hyperbaric oxygenation. Surgery 1980; 87:662-663. 56. Warren J. Sacksteder MR,

Thuning CA. Modification of allergic encephalomvelitis in guinea pigs by oxygen therapy.

Fed Proc 1977; 36:1298. 57. James PB, Hills BA. Micro-embolism multiple sclerosis and

the perivenous syndrome. Lancet 1988, in press. 58. Neubauer RA. The effect of

hyperbaric oxygen in prolonged coma. Possible identification of marginally functioning

brain zones. Med Subacquea Iperbarica 1985; 5:7S-79. 59. Myers RAM, chairman.

Hyperbaric oxygen therapy: a committee report. Bethesda, MD: UHMS, 1986. 60. Frey G.

Lampl L, Scherb W. HBO2 versus ACTH in multiple sclerosis--an alternative treatment!

Federal Republic of Germany: Federal Armed Forces Hospital, 1984. 61. Davis JC.

Hyperbaric oxygen for patients with multiple sclerosis. Letters to the editor. Br Med J

1984; 288:1831.

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Topic: Are there any long term benefits for MS patients receiving HBO2?

Only long-term controlled studies have shown persistent benefit of HBO2 for MS. A very

recent publication has endorsed their findings and concludes that HBO treatment should

be instigated as soon as the condition is diagnosed and before irreversible lesions have

become established. - Treatment of Multiple Sclerosis with Prolonged courses of

Hyperbaric Oxygen: A 13 year Update - Perrins D.J.D. & James P.B. In Proc. 12th

International Congress on Hyperbaric Med. Sept 1996, Best Publishing Company ISBN:

0-941332-63-2. The Permutter Hyperbaric Centre and MS Therapy. I have been involved

in the controversy over the use of more oxygen for MS patients since 1981. It would be

difficult to find a more convincing reason for increasing the oxygen dosage than in the

disease process which underlies the formation of the scars. It begins as an acute

swelling around veins in the nervous system and this process can be observed directly in

many patients during acute attacks in the retina. The dispute over the etiology of the

disease between the proponents of a vascular basis and the rest e.g. autoimmunity,

goes back to the 1860's. (Rindfleisch and Charcot) but the evidence of blood vessel

involvement is consistently ignored. Ian McDonald - who has just retired as Professor of

Neurology at the National Hospital in London stated in 1986. "The occurrence of vascular

lesions in an unmyelinated region (the retina) provides support for the view that the

vascular changes in multiple sclerosis are primary and not as some have suggested

secondary to myelin breakdown." Optic Neuritis. eds Hess RF, Plant GT. Cambridge

University Press 1986 p47. ISBN 0 521 30247 1. Multiple and sclerosis describe the

presence of scarring in the CNS - the end result of the attempts of the nervous system

to heal. The trials of the use of oxygen at addtional pressure selected patients whose

disease durations were typically 15 years. This is nonsense as magnetic resonance

spectroscopy has demonstrated lack of oxygen in the areas affected at the onset.

(Lancet 1991;337:58). However if the patient has only one area affected then they do

not have MULTIPLE areas of sclerosis and must wait a minimum of a month to qualify

under the "diagnostic criteria" for multiple sclerosis. The neurologists response to the

evidence from the controlled studies of oxygen therapy was less than enthusiastic,

despite positive findings in patients with end stage disease. It is necessary to study

history to understand the powerful factors that shape medical opinion and there is no

better starting point than the story of Semmelweiss and the controlled trial related to

the etiology of childbed fever in Vienna. I will be posting an article about the Fischer

trial from the New England journal of Medicine on the list soon, but if you want an object

lesson in medical prejudice read the isssue of the journal that carried the results - Jan 27

1983 vol 308 and the editorials. Philip James, Wolfson Hyperbaric Medicine Unit. 1.

Fischer BH, Marks M, Reich T. Hyperbaric-oxygen treatment of multiple sclerosis: A

randomised, placebo controlled, double-blind study. N Engl J Med 1983;308:181-6. (This

is a classic). 2. Pallotta R, Longobardi G, Fabbrocini G. Experience in protracted

follow-up on a group of multiple sclerosis patients periodically treated with hyperbaric

oxygen therapy. In Baixe J-H, ed. Symposium sur le traitment de la sclerosse multiple par

l'oxygene hyperbare. Paris, 1986; 15-19. (22 relapsing/remitting patients were followed

for 8 years. The incidence of relapses fell dramatically in the 11 treated patients and

increased in the 11 controls.) 3. Oriani G, Barbieri S, Pirovani C, Mariani C. Hyperbaric

oxygen in chronic progressive multiple sclerosis: a placebo-controlled, double-blind,

randomised study with evoked potentials evaluation. In: Oriani G, Proc. 13th annual

meeting of the European Undersea Biomedical Society. Palermo:1987 196-203 (44

patients with low disability scores. 22 treated once a week for a year and compared with

22 controls when there was an appreciable difference in outcome - P < 0.01.)

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N Engl J Med 1983 Jan 27;308(4):181-6

Hyperbaric-oxygen treatment of multiple sclerosis. A randomized, placebo-controlled, double-blind study.

Fischer BH, Marks M, Reich T.

Several uncontrolled studies have suggested a beneficial effect of hyperbaric oxygen on multiple sclerosis. We studied 40 patients with advanced chronic multiple sclerosis who were randomly divided into two matching groups. The experimental group received pure oxygen, and the placebo group received a mixture of 10 per cent oxygen and 90 per cent nitrogen; both groups were treated at a pressure of 2 atmospheres absolute for 90 minutes once daily, for a total of 20 exposures. Objective improvement occurred in 12 of 17 patients treated with hyperbaric oxygen and in 1 of 20 patients treated with placebo (P less than 0.0001). Improvement was transient in seven of the patients treated with oxygen and long-lasting in five. Those with less severe forms of the disease had a more favorable and lasting response. At one year of follow-up, deterioration was noticed in 2 patients (12 per cent) in the oxygen group, neither of whom had had an initial response, and in 11 patients (55 per cent) in the placebo group, one

Publication Types: Clinical Trial, Randomized Controlled Trial, PMID: 6336824

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UK Centers

Dear Robert,

Christopher has asked me to respond to your questions about the use of HBOT

in the UK for the treatment of Multiple Sclerosis. I will do my best.

There are approximately 60 centres in the UK offering HBOT for MS and over

the last 20 years, between them have carried out in excess of 1.3 million

treatments. The Federation of MS Therapy Centres has monitored the results

from these centres and produced a report entitled "The Experience of

Treating Multiple Sclerosis with Prolonged Courses of Hyperbaric Oxygen"(DR

D Perrins & Dr Philip James). The report is not a double blind study, but

follows the fate of 703 patients over a course of 10 to 13 years (too long

for a double blind I think!). The study assessed the Kurtzke Disability

Scale (KDS) of the patients and the severity of their symptoms. This was

compared to the known natural history of the disease.

Although there is a wide variation in the rate and pattern of decline, the

majority of patients deteriorate over a two year period of observation. In

this series the Relapsing/Remitting patients who had less than two follow on

treatments after the initial course had deteriorated by 2.0 on the KDS after

10+ years, while those who received more than 400 had deteriorated by only

1.1. This represents a difference of being able to walk without assistance

and the need to use two sticks, or the ability to walk 200 yards and being

confined to a wheelchair.

The most frequently reported symtpoms to improve with the continued use oh

HBOT were fatigue, speech, bladder control and balance.

From my own experience of seeing patients benefit from this treatement, I

(and the patients) am convinced of its effectiveness.

Our protocol in the UK is an initial course of 18 to 20 one hour treatments

over 4 to 6 weeks, commencing at 1.5 ATA and increasing to 1.75 or 2.0 ATA.

Most patients then continue with 1 one hour treatment per week, without end.

Studies you can refer to include:

Fischer et al. Hyperbaric Oxygen Treatment of Multiple Sclerosis, A

randomised, placebo comtrolled, double blind study. New England Journal of

Medicine 1983

Oriani et al. Hyperbaric Oxygen in Chronic Progressive Multiple Sclerosis:

a placebo controlled, double blind, randomised study with evoked potentials

evaluation. Proceedings of the 13th annual meeting of the European Undersea

Biomedical Society, Palermo 1987

Palotta et al. Experience in protracted follow-up on a group of Multiple

Sclerosis patients periodically treated with hyperbaric oxygen therapy.

Symposium sur le traitment de la sclerose multiple par l'oxygene hyperbare.

Paris 1986

Barnes et al. Hyperbaric oxygen and multiple sclerosis; short term results

of a placebo comtrolled double blind trail. The Lancet 1985 and Hyperbaric

oxygen and Multiple sclerosis: final results of a placebo controlled double

blind study. Journal of Neurology, Neurosurgery and Psychiatry 1987

Neubauer. Magnetic resonance imaging in multiple sclerosis following

hyperbaric oxygen. First Swiss Symposium on hyperbaric medicine 1986 &

Treatment of Multiple Sclerosis with monoplace hyperbaric oxygenation.

Journal of the Florida Medical Association 1978.

Gottlieb and Neubauer. Multiple Sclerosis: Its etiology, pathogenesis and

therapeutics with emphasis on the controversial ose of HBO. Journal of

Hyperbaric Medicine 1988.

The last paper concludes "Of all the current therapies presumably based on

an understanding of the etiology and pathphysiology of the disease process,

HBOT has the soundest foundation. It is also the safest drug available. It

is not surprising therefore to find that there is much positive evidendce

concerning the beneficial effects of HBOT on cerebellar and bowel bladder

function to sanction its use for treating MS. Based on comparative efficacy

and safety considerations, it is recommended that HBOT be used for treating

early MS and for treating MS associated cerebellar and bowel bladder

dysfunction".

There are, of course, more than this, but surely its time to stop arguing

the case and get as many MS people into HBO chambers as we can!

Alan Taylor

Manager

The Sussex MS Treatment Centre

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Ronnie Lane was a bassist for the rock band Faces, which also featured Rod

Stewart. What follows is an excerpt from a 1983 interview with Mr. Lane, an

MS sufferer, in which he recounts the experiences of Bo Fischer, often

referenced by Dr. James.

Mr. Lane from MS complications in I think 1997.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

from http://www.makingtime.co.uk/rfr/laneint.htm

LANE: Oh, yeah!! The MS Society, they've got it all sewn up, and they don't

want anybody else in there, you know? Oh, I could tell you some very

strange stories! I mean, let me tell you this story: You know this HBO,

this Hyperbaric Oxygen treatment, (has) basically saved my life-- mentally,

for me, because I had no energy. I couldn't speak, at one stage. I ,

certainly, didn't have any energy to exercise, or anything, until I took

oxygen under pressure. The MS Society have pooh-hood hyperbaric oxygen, and

put it aside and said, "it's dangerous, it's brain damage..." It's only

oxygen under pressure!! It's not a drug! I mean, they say that steroids are

all right, and things like that, which (makes raspberry) blow you up to

look like a hamster and all that. But, this oxygen under pressure is

'DANGEROUS', all of a sudden. I know THAT is absolute nonsense, and it's

what I want to put about.

The MS society hired a doctor Fischer, back in the Seventies, to prove ,

once and for all, that hyperbaric oxygen is no use, whatsoever, to people

with MS He worked on it for some years, and he couldn't do it. His report

came out in FAVOR of the hyperbaric oxygen! They asked him to go back and

write his report again. THREE TIMES they sent him back to rewrite his

report! The last time he finished it was in 1980-- while I was still

walkin' about. Ordinarily, I might add. They didn't rush-release the report

at all, because it was in FAVOR of HBO. In actual fact, it was only

released early this year, 1983! Meanwhile, I've become crippled, y'see?

They've dismantled his oxygen chamber. It's now in a car park in New York!

He could not prove that oxygen was no good. He could only prove that it is

of some help. Don't get me wrong, it's not a cure. But, it's of great

assistance for someone to keep it under control, and to live with it kind

of ordinarily, y'know? Lead a bit of a life, instead of gradually becoming

crippled all of the time. Anyway, that's a story about the MS Society, and

it's not a very nice story. Not a very nice story at all, but it happens to

be the case.

And I think it's disgusting, ya know?

DAVE: Did the tour get enough money to open your own Hyperbaric chamber?

LANE: Well, we did, but my point is that we can't do it in America like we

can over here. You see, we can open up our own chamber over here, where you

just breathe pure oxygen through a mask. And, your relatives can learn to

operate the chamber. But you won't be able to do that in America. The other

(system) is where you don't need a mask, the whole chamber is full of pure

oxygen (under pressure). There, you're talkin' about a BOMB, so you've got

to have trained, proper technicians to run it. What I hope to do is to get

something called an NMR scanner. Nuclear Magnetic Response (sic), would you

believe? That is kind of an x-ray, but it's not an x-ray. But, it's such a

fine instrument that it can actually take a picture of your nerves. What I

aim to do is to get someone with MS and get them under this NMR scanner,

and then put them through the (HBO) treatment, and then take a picture of

them after. (It's) to prove it, once and for all, that HBO does help. It's

not a cure, but it DOES help. I don't know. We've got a long way to go.

DAVE: What would the main obstacle be in the States, then?

LANE: Finding the people, I suppose. I don't know how to find the people.

Y'see, ARMS over here was CREATED by people with MS that got SO FRUSTRATED

at this whole attitude towards MS-- You know, this sort of, "Well, you've

got an incurable disease now. You're going to get crippled for the REST of

your life, but just sit back and accept it. We've got a nice wheelchair for

you out in the hall, and everything's going to be rosy. Don't make a panic,

you'll upset everyone." You know what I mean?! That's what you're given. So

they created ARMS, 'Action RESEARCH into Multiple Sclerosis', to try and

get some absolute answers, because we got fed up. Horrible thing to say,

this is, but I'm gonna say it-- It strikes me that, in a lot of cases, MS

is the bread ticket for a lot of so-called "Societies" and, without it,

they'd be out of a job. You know what I mean? Which makes me wonder about

cancer and leukemia, y'know? I wonder. I mean, I've seen it and I know that

is the case with MS, so what's happening with cancer and leukemia?

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Hello Bob,

Here are Medline sources for randomized controlled studies on multiple sclerosis and hyperbaric oxygen.

Best regards, Mike Lepawsky

Medline Search for: "Multiple sclerosis" AND "Hyperbaric Oxygen" Randomized Controlled Trials

1: Barnes MP, Bates D, Cartlidge NE, French JM, Shaw DA.

Hyperbaric oxygen and multiple sclerosis: final results of a placebo-controlled, double-blind trial.

J Neurol Neurosurg Psychiatry. 1987 Nov;50(11):1402-6.

PMID: 3320274 [PubMed - indexed for MEDLINE]

2: Maillard P, Clanet M, Bourdiol AM, Arne JL.

[Effects of hyperbaric oxygen therapy on the visual evoked potentials of patients with multiple sclerosis]

Bull Soc Ophtalmol Fr. 1987 Jan;87(1):43-5. French. No abstract available.

PMID: 3301038 [PubMed - indexed for MEDLINE]

3: Confavreux C, Mathieu C, Chacornac R, Aimard G, Devic M.

[Ineffectiveness of hyperbaric oxygen therapy in multiple sclerosis. A randomized placebo-controlled double-blind study]

Presse Med. 1986 Sep 6;15(28):1319-22. French.

PMID: 2950392 [PubMed - indexed for MEDLINE]

4: Harpur GD, Suke R, Bass BH, Bass MJ, Bull SB, Reese L, Noseworthy JH, Rice GP, Ebers GC.

Hyperbaric oxygen therapy in chronic stable multiple sclerosis: double-blind study.

Neurology. 1986 Jul;36(7):988-91.

PMID: 3520382 [PubMed - indexed for MEDLINE]

5: Wiles CM, Clarke CR, Irwin HP, Edgar EF, Swan AV.

Hyperbaric oxygen in multiple sclerosis: a double blind trial.

Br Med J (Clin Res Ed). 1986 Feb 8;292(6517):367-71.

PMID: 3080173 [PubMed - indexed for MEDLINE]

6: Wood J, Stell R, Unsworth I, Lance JW, Skuse N.

A double-blind trial of hyperbaric oxygen in the treatment of multiple sclerosis.

Med J Aust. 1985 Sep 16;143(6):238-40.

PMID: 3897808 [PubMed - indexed for MEDLINE]

7: Neiman J, Nilsson BY, Barr PO, Perrins DJ.

Hyperbaric oxygen in chronic progressive multiple sclerosis: visual evoked potentials and clinical effects.

J Neurol Neurosurg Psychiatry. 1985 Jun;48(6):497-500.

PMID: 3891920 [PubMed - indexed for MEDLINE]

8: Barnes MP, Bates D, Cartlidge NE, French JM, Shaw DA.

Hyperbaric oxygen and multiple sclerosis: short-term results of a placebo-controlled, double-blind trial.

Lancet. 1985 Feb 9;1(8424):297-300.

PMID: 2857361 [PubMed - indexed for MEDLINE]

9: Fischer BH, Marks M, Reich T.

Hyperbaric-oxygen treatment of multiple sclerosis. A randomized, placebo-controlled, double-blind study.

N Engl J Med. 1983 Jan 27;308(4):181-6.

PMID: 6336824 [PubMed - indexed for MEDLINE]