reported “no improvement” because she still had a wide-based gait and some minor neurological symptoms. With continued HBOT, her MS remained stable. I now have 20 years of follow-up on two of my first MS patients. One continues to have minimal symptoms. Another, whose condition was more advanced, had been told that she would be bedridden in 6 months if she did not take methotrexate, a treatment that is no longer recommended. She opted for HBOT and other “alternative” treatments, completed her Ph.D., had two children, and continues to practice as a speech therapist, although she now uses a wheelchair. Her initial prognosis for remaining time until incapacitation was off by a factor of about 40. In my years of active practice using HBOT, both with my own patients and as a consultant for other centers, I am unaware of any significant complications from the use of HBOT for the MS patient. There is the well-recognized occurrence of an occasional seizure,one per 10,000 compressions. These seizures do not produce long-term sequelae, and indicate the need for lowering the treatment pressure. Many of my patients switched to Betaseron when it became available, but a significant number of these returned to HBOT when their symptoms progressed. The NMSS still states that HBOT is ineffective in MS. I have learned, however, that some physicians who initially had an unfavorable view of HBOT in MS now serve as consultants to hyperbaric facilities. Insurance reimbursement for the use of HBOT in neurologic conditions has generally been unavailable. Precedents are being set, however. Blue Cross/Blue Shield of Texas bought a monoplace chamber for one of my MS patients. With HBOT, she was able to resume the active practice of law and has had minimal progression of her MS. One of my MS patients, who had a complete reversal of her MS symptoms with HBOT, sued Blue Cross/Blue Shield in Hillsborough County, Florida, for coverage of her HBOT costs. She was awarded full reimbursement plus payment for any additional HBOTthat was needed. The cost-effectiveness of HBOT may be improved by the development of the portable low-pressure chamber. Patients whose symptoms can be controlled at pressures of 1.25 to 1.3 atmospheres absolute (ATA) can, for a moderate investment, use a chamber at home. Chambers that provide higher pressures may soon be available. In calculating cost-effectiveness, one must certainly consider the reports of patients who lived active, productive lives for years or decades rather than rapidly progressing to the point of needing nursing home care as their clinicians had predicted. William S. Maxfield, M.D., F.A.C.N.M. is a radiologist and consultant in hyperbaric medicine. He is certified by the American Board of Radiology, the American Board of Nuclear Medicine, and the American Board of Hyperbaric Medicine. Contact: P.O. Box 162, Odessa, Fla. 33556. E-mail: firstname.lastname@example.org.
sumber : Journal of American Physicians and Surgeons Volume 10 Number 4 Winter 2005