Multiple Sclerosis and Hyperbaric Oxygen Therapy

STUDY RESULTS

ARMS—The Federation of Multiple Sclerosis Treatment Centers

In 1982, after a British pilot study confirmed the effectiveness of hyperbaric oxygen therapy for multiple sclerosis, patients and their families formed the charitable Action for Research into Multiple Sclerosis (ARMS—now the Federation of Multiple Sclerosis Treatment Centers). This group installed 56 hyperbaric centers throughout the U.K. Over 30 years, these treatment facilities compiled extensive longitudinal studies, reporting that 70 percent of 4,000 HBOT-treated patients benefited. With individualized adjustment, virtually all patients improved. More than 1.5 million HBO treatments with thousands of MS patients have shown that not only can the disease be stopped, in some cases, it can reverse. This surprising result has been confirmed by MRI scans.

A two-year ARMS study published in 1989 by researchers from Ninewells Medical School at the University of Dundee in Scotland compared 128 HBOT-treated MS patients with an equal number of untreated controls. Seventy percent of the treated patients did not deteriorate, had their conditions stabilize, or showed small improvements.

The Federation recruited 703 Relapsing/Remitting, Chronic Progressive, or Chronic Static MS patients from 28 centers. These patients suffered neurologist-confirmed MS and had been told there was no effective treatment. Patients were evaluated and assigned Kurtzke Disability Scores (KDS).

Study Results for Multiple Sclerosis Patients

Table 20.1 Patients Recruited to the Study
	Females	Males	total
	464=66%	239=34%	703
Mean Age (range)	47 (20-70)	47(19-73)
Average duration of MS (range)	14 years (0-54)	15 years (0-50)
Diagnosis confirmed by neurologist	670 = 95%
MS Type
Relapsing/Remitting	126=18%	41=6%	167
Chronic Progressive	262=37%	155=22%	417
Chronic Static	76=11%	43=6%	119

In the initial course of five daily treatments, patients breathed oxygen from a face mask in a compressed air chamber (1.2 ATA). For patients who improved for 2 or more symptoms, a 4-week course of twenty one-hour treatment sessions was completed at this pressure. For others, the pressure was increased weekly in 0.25 increments until the patient responded or five treatments at 2.0 ATA had yielded no improvement. Follow-on treatments were on a weekly or as-needed basis.

After 20 treatments, about 70% of patients obtained relief of two or more symptoms. Although there was little change in the KDS, 25% of Relapsing/Remitting patients improved on this value. Notably, 64 to 77% of symptoms improved.

Table 20.2 The Patient's Assessment of Symptomatic Response to Initial Course
		Improved	No Change	Worse
	N	%	%	%
Fatigue	567	70	22	8
Speech	187	64	34	1
Balance	562	59	37	4
Bladder	523	68	30	0
Walking	638	77	19	4

Tn four years of regular treatment, 73% of patients retained many quality of life improvements.

Subjective relief of bladder symptoms were confirmed by recording urinary frequency.

Table 20.3 Urinary Frequency of 523 Patients – Before and After Initial Course
	Sum total of times voided
	Before Initial Course		After Initial Course		Improvement
Frequency		x		x
-at night	1232	2.4	651	1.2	47%
-during the day	3873	7.4	2960	5.7	24%

Improvement was not immediate and universal. Some symptoms worsened—patients complained of fatigue 20%, leg weakness 5%, visual disturbance 3% and limb numbness 1%—these difficulties were short lived. Minor eardrum pressure problems occurred in 17%, but did not require stopping treatment. If patients stopped treatment, improvements dissipated within a week or two.

Four hundred and sixty-four patients (66%) continued treatment for at least three years, stabilizing or, at least, slowing the rate of deterioration. Those who received at least 8 quarterly treatments over 6 years did not deteriorate. Four actually improved by a mean of 0.8 on the KDS. Sixty seven percent of the 3 patients who did not continue treatment deteriorated by a mean of 1.8 KDS in the same period of times. Four years after that, 38 patients receiving less than 10 follow on treatments deteriorated 3.18 KDS.

After 10 years, a number of patients could not continue analysis. For the 447 patients evaluated after 10 to 13 years, 23% were no worse, and 7% actually improved. Over 10 years, these studies show that 300 treatments are required to appreciably arrest progression. More than 500 is more effective. Relapsing/Remitting patients receiving less than two follow-on treatments deteriorated by 2.0 on the KDS after 10+ years. The 31 who received more than 400 had only deteriorated by 1.1 KDS.

Table 20.4 Specific Abilities Regained After Initial Course and Maintained 2 or 4 Years Later
	After Initial Course	With 0-227 treatments 2 years	With 1-104 treatments in 4th year
N=703		After initial course
	%	%	%
Brushing teeth	39	26	20
Doing up buttons	81	54	40
Threading a needle	50	34	29
Holding a cup	54	46	23
Brushing hair	48	33	26
Fastening brassiere	25	22	11
Cutting up food	36	11	18
Shaving	30	11	18
	Abilities
	regained	maintained
	67% of 410	73% of 276

In a real sense, skills regained and retained involve essential daily skills.