Multiple sclerosis is an enigmatic disease that is thought to have immunologic origins with resultant breakdown of the blood brain barrier. Hyperbaric oxygen therapy effects on MS have been published in a variety of studies, the review of which is beyond the scope of this website. The data is confusing and conflicting, but the fact remains that the most rigorous study on this subject matter showed an unequivocal beneficial effect of HBOT. It was published in the New England Journal of Medicine (23) In the early 1980's Dr. Keith Van Meter performed a similarly rigorous study at our institution (non-published) and used bladder function as an outcome measure (24). The results were similarly positive. One of the key issues is that the preponderance of evidence supports the use of HBOT in MS at pressures below 2.0 atmospheres absolute as shown in a nice review article by Sheldon Gottlieb in 1989 (25). These published studies underpin the formation of the non-profit organization of nearly 90 hyperbaric centers in the UK that until recently treated exclusively MS. Interestingly, the protocol developed by Dr. D.J. Perrins and used at these centers for MS is very similar to the protocol developed independently by Dr. Harch and colleagues in New Orleans for chronic brain injury and Dr. Neubauer in South Florida. Below is a case of acute relapsing MS in a middle-aged man treated with HBOT whose improvements are captured on SPECT brain imaging.

Case presentation:

The patient is a 36 year old permanently disabled male with acute relapsing MS of six years duration. The patient underwent SPECT brain imaging before and after a single low-pressure HBOT (Figure 1 and 2) and then a course of 80 HBOT's (Figure 3). All images are transverse. He experienced improvement in speech, cognition, gait, and urinary habits. The final SPECT registers this improvement non-specifically as a global smoothing and overall increase in brain blood flow (increased yellow with less orange).

23. Fischer BH, et al. Hyperbaric oxygen treatment of multiple sclerosis. A randomized placebo-controlled double-blind study. N England J Med, 1983;308:181-186.

24. Appell A, et al. The effects of hyperbaric oxygen therapy on the neurogenic vesico-urethral dysfunction of multiple sclerosis. Presented at the Southeastern Section of the American Urological Association Meeting, Nashville, Tenn., April 1, 1984 and the Urodynamics Society Meeting, New Orleans, La, May 5, 1984.

25 . Gottlieb SH, Neubauer RA. Multiple Sclerosis: its etiology, pathogenesis, and therapeutics. J Hyperbaric Med, 1988;3:143-164.