The use of hyperbaric oxygen therapy (HBOT) for treatment of
multiple sclerosis was advocated by RichardA. Neubauer, M.D., in
the late 1970s. I became acquainted with Dr. Neubauer when
searching for a solution for my father-in-law’s problem of loss of
balance and deteriorating speech. After evaluation at four of the top
neurological centers in the Southeast gave no definite diagnosis and
no offer of treatment, I looked for a center performing hyperbaric
oxygen therapy (HBOT).
I first learned about HBOT while on active duty in the Navy,
when I was part of the plutonium decontamination team. Later,
when I was chief of radiation therapy at Ochsner Clinic and
Foundation Hospital in New Orleans, HBOT was planned as an
adjunct to radiation therapy in the new department.
My father-in-law’s symptoms were well controlled for three
years after a course of HBOT at Dr. Neubauer’s center.At that time,
it was customary to wait until symptoms recurred before providing
additional treatment. Since then, experience with multiple sclerosis
(MS) patients has shown that periodic HBOT can provide better
long-term results. My father-in-law’s good years might have been
extended had he received maintenance therapy.
When I established Gulf South Radiation Therapy Center in
Largo, Florida, in the early 1980s, our facility provided not only the
first linear accelerator in Pinellas County, but also the first HBOT
facility in the area. I was aware of Dr. Neubauer’s report of
excellent response in MS patients, but because I was not sure that
HBOT was of benefit in that condition, I treated a number of MS
patients without charge. I was pleased by the results. Although
HBOT does not cure MS, my impression was that it provided
significant symptomatic relief and delayed or decreased
progression. I viewed it as being similar to the use of insulin or other
antidiabetic medications in that regard.
Because of my interest in treating MS with HBOT, I joined the
Gulf Coast Chapter of the MS Society, and after several years of
membership was elected chapter chairman in 1985. This elevation
in rank brought me to the attention of the National Multiple
Sclerosis Society. When it learned that I practiced hyperbaric
medicine and advocated HBOT for MS patients, the NMSS asked
that I not be reelected upon completion of my term in 1986.
Over the years, my experience with HBOT for MS has
continued to be excellent. I estimate the response rate to be better
than 80 percent, particularly with regard to regaining bladder
control and increasing mobility and strength. The majority of
neurologists that I dealt with, however, did not agree with my
assessment. For example, one of my MS patients could barely
walk from the parking lot into the building—about 60
feet—before HBOT was started. After 2 months of treatment, she
was walking 2 miles on the beach. Nonetheless, her neurologist
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:
wsmaxfield@earthlink.net.
sumber : Journal of American Physicians and Surgeons Volume 10 Number 4 Winter 2005
Tayang ulang oleh dr.erick supondha (hyperbaric and diving medicine consultant) dokter ahli hiperbarik dan kesehatan penyelaman ,
jakarta, indonesia, 021 99070050
