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HEALING WITH OXYGEN UNDER PRESSURE by: K.K. Jain,
M.D.
Edited by: Virginia Neubauer
MULTIPLE SCLEROSIS
Multiple sclerosis is a disease involving the central nervous system with areas of loss of
myelin covering of the neuronal processes (demyelination). The cause of the disease is
unknown, but among the popular theories have been viruses and immunological factors.
None of the treatments based on immunologic concepts, however, have been proven
effective.
The disease has a gradual downhill course with periods of remissions and exacerbations
(increases in symptoms or severity of the disease). Over a period of five years most of the
patients show a definite deterioration. Various treatments that have been used for
multiple sclerosis (MS) are not satisfactory. All of these treatments have some serious side
effects and drawbacks and none of them have been proven to be effective. Current
therapies for MS and their side effects are listed below:
Steroids (for example, ACTH) -Many complications, including: Short term
therapy - puffiness, psychosis, ulcer, infections, and acne. Long term therapy -
abnormalities of blood sodium and potassium levels, softening of bone, cataracts,
hypertension, diabetes and adrenal exhaustion.
Cyclophosphamide - Several deaths have been reported from the use of these
compounds.
Imuran - This substance is carcinogenic (cancer causing).
Plasmapheresis - In this procedure the plasma is removed from the withdrawn
blood and the cellular elements of the blood are retransfused into the donor. Generally
the type specific fresh frozen plasma albumin is used to replace the withdrawn plasma.
The main danger of this procedure is possible contamination of the plasma during
retransfusion.
Interferon - This is supposed to be an antiviral therapy, but there are
undesirable effects on the liver and the blood.
Snake Venom - This has been used, but it can lead to an anaphylaxis (a shock like
reaction).
Monoclonal antibodies - These have been used, but they can produce HBO - Only insignificant side effects such as slight damage to the ear drums and transient visual effects. One of the more recent theories proposed by Dr. P.B. James of Dundee, Scotland, indicates that the disease may be due to damage to the blood-brain barrier by fat embolization. The obstruction to blood flow leads to areas of brain damage surrounding the veins. This resembles the brain and spinal cord damage seen in diver's suffering from decompression sickness. The cause of the damage to the blood-brain barrier is not clear. An explanation of this has been given by Drs. Gottlieb and Neubauer. According to their
hypothesis, the primary defect in MS is a blood vessel disturbance leading to lack of blood
supply to certain areas of the brain. This in turn leads to production of free radicals and
narrowing of veins. The result is damage to the blood-brain barrier, swelling of the brain
tissues affected, and lack of oxygen supply which eventually leads to demyelination. MS is
a wound of the central nervous system and is therefore an indication for the use of HBO
in the same way as for wounds in any other part of the body. This hypothesis provides a
rational basis for HBO therapy in this disease. HBO reduces swelling and corrects the
hypoxia due to ischemia. HBO enhances remyelination and stabilizes the blood-brain
barrier.
The first report in the medical literature of the effectiveness of hyperbaric oxygenation is
that by Boschetty of Czechoslovakia in the year 1970. In the United States, the first
application of HBO in multiple sclerosis was carried out by Dr. Neubauer in 1975. The
first randomized double-blind controlled study was carried out by Dr. Boguslav Fischer in
1983 at the New York University Medical Center. His results were published in the New
England Journal of Medicine (Vol 308: 181-186). Forty patients with chronic MS were
divided randomly into two matching groups. The experimental group received pure
oxygen and the control group received a mixture of 10% oxygen plus 90% nitrogen. Both
groups were treated at a pressure of 2 ATA for 90 minutes, once daily for a total of twenty
exposures. The state of oxygenation in the control group at 2 ATA was comparable to that
which would be found in the same subjects breathing room air (20% oxygen plus 80%
nitrogen). Improvement occurred in 12 of the 17 patients (70%) treated with hyperbaric
oxygen and 1 in 20 (5%) of the control patients. Improvement was transient in 7 of the
patients treated with HBO and long lasting in 5. Those with less severe forms of the
disease had a more favorable and lasting response. After one year of follow-up,
deterioration was noticed in only two of the patients (12%) in the oxygen group as
compared to 11 patients (55%) in the control group. Fischer and his colleagues suggested
further trials of HBO in MS. The chamber at New York University was dismantled and no
further work was done on this subject. A number of other studies were done on this topic
and reported good results, whereas other studies reported no effects of HBO on MS
patients. The controversy continued. The most extensive experience in MS with HBO in
the United States is that of Dr. Neubauer in Lauderdale-by-the-Sea, Florida (1200
patients). The long-term longitudinal studies have shown improvement in the majority of
the patients. Dr. Neubauer has also reviewed the world literature on this subject. Over
10,000 MS patients treated by HBO in 14 different countries were reviewed in 1984 in
Toulon, France and improvement was noticed in 70% of the patients: objective
improvement (measured scientifically) in 25%, and subjective improvement
(improvement noted by doctor or patient, but not calculated or measurable scientifically)
in 45%. What then are the criteria of improvement resulting from the treatment of an
MS patient? MS is a slowly progressive disease. Surely one cannot cure it with any of the
known therapies. In the treatment of multiple sclerosis, objective evidence of
improvement does not necessarily correspond with recovery of function. Absence of
deterioration which normally occurs over the course of some years is in itself evidence of
the effectiveness of a therapy. Improvement of bladder function, reported frequently in
MS patients treated with HBO is not considered significant, but it certainly s hould be and
it is a definite evidence of an improvement. If one applies these criteria in evaluating the
results of HBO in MS even the reported negative studies have several positive aspects.
Some of the benefits of HBO are obvious from the recent report by Dr. Perrins of Oxford.
He has reviewed the records of over 5,600 MS patients from Action for Research in
Multiple Sclerosis (ARMS) treated with HBO for up to six years. Through this
association in the U.K. patients treat themselves with HBO. The conclusions of this long
term study are that: 1) The progressive nature of MS is modified by prolonged HBO
treatment. 2) The extent of the response is related to the duration and frequency of the
treatment. 3) The initial response is an unreliable guide to the outcome of the prolonged
treatments.
The significant finding was the lack of deterioration over a 5 year period. The results
were better in those that continued with "booster" sessions or "top-ups" after completing
an initial course of HBO. Those who stopped booster sessions did not do as well. HBO is
like a drug which has to be administered over a long period and the dose (pressure) of
which has to be adjusted to individual response. Maximum improvement was observed in
the relief of spasticity and in the bladder and bowel functions. Many of the patients who
were confined to wheelchairs prior to HBO treatment were able to walk independently
after HBO treatments.
Why then is the use of HBO in MS attended with so much controversy? This question is
rather difficult to answer. Emotionalism and political issues seem to cloud this form of
treatment more than they have any other therapy for this disease in the past. However,
modern techniques of neurological diagnosis such as evoked potentials and MRI have
objectively confirmed the subjective improvement reported by MS patients. The
indications for the use of HBO in MS are: 1) The acute stage - HBO may be used during
the first attack. In combination with MRI it may help in the eventual diagnosis of the
disease. 2) Relapses in the sub-acute stage. 3) Chronic progressive form of MS with: a)
Bowel and
bladder dysfunction, b) Visual impairment, c) Problems with balance, d) Partial
paralysis of limbs, e) Subjective symptoms of fatigue, (lack of stamina, etc. ).
Concern has been expressed about using HBO in patients with visual impairment due to
inflammatory changes of the optic nerve (optic neuritis). Because HBO leads to
narrowing of the blood vessels, it may further impair the blood supply of the optic
nerves. However, in practice, I have not observed this to impair the vision.
Case History of a Patient with Multiple Sclerosis:
The case of J.L. illustrates some of the experiences of a patient suffering from multiple
sclerosis which was eventually treated with HBO. Here is the story in her own words:
"In the early part of 1984, I was a 40 year old woman who felt as though she had the
world in her palm: a great husband, three neat kids, a very satisfying career, and good
health gave me an abundance of personal, professional, emotional and intellectual
satisfaction. Suddenly everything changed.
On June 25, 1984 I was involved in a car accident in which the car I was driving was hit
by another car. By the time I had dealt with injured passengers, an officious policemen,
and eyewitnesses, and arrived home that night, I had a severe headache, pain in my
neck and shoulders and a loss of feeling in my hands. During the next two days I began
to drop items which I was trying to hold. There also seemed to be an involuntary
salivation from the right side of my mouth and both eyes were watering. Frightened, I
made an appointment with an orthopedic physician and had my neck x-rayed. He
diagnosed a severe whiplash. He prescribed physical therapy and Tylenol -3. Over the
next 3 days my headaches became so severe that I had a constant stream of tears rolling
from my eyes. I was feeling both physically and emotionally unstable and somewhat
confused. I am not a wimp by nature and I do not cry very often, but during those days
I did cry; not only from severe pain, but also from the knowledge that my body was
behaving far differently from what it ever had. The whiplash I had suffered eight years
previously had felt nothing like this. My husband called the doctor back and asked him
if he would admit me into the hospital and if there was something else that could be
done. He said "no", it was just a whiplash; he would not admit me into the hospital. He
added: "I could go to the emergency department or I could live with the pain; it would
eventually get better". A couple of days later I made an appointment with a neurologist
for second opinion about the "whiplash". After his examination he also said it was a
whiplash and prescribed Elavil, a drug my body found very hard to tolerate. I have
always had severe reactions to almost any kind of drug. At the same time I entered a
traditional physical therapy program at a different hospital and found that, rather than
feeling better, I was feeling worse; the
therapy hurt. The headaches persisted, as did dizziness and nausea; all of which were
disabling. I was in a bad mood. Laughter and song, two of my best allies, deserted me.
At this time, I called a friend who is a psychiatrist and told him I needed to see him
because I was having a hard time dealing with all the frustration, tiredness and anxiety
and needed him to help me make sense of what was going on in my life. He saw me
immediately. I began working with the psychiatrist and we changed from the
traditional therapy at the hospital to having a physical therapist come into my home.
With the inhome physical therapist's help, I was able to begin to walk more securely;
perhaps it was due to her suggestion that I use a cane. I also had a considerable relief
from the pain in my shoulders and was able to control the nausea. By October the
headaches were decreasing and my eyes watered far less. However, I was experiencing
loss of bladder control, a tingling in my face, a drooping on the right side of my mouth,
and I felt at that time I was losing all my ability to think. My thoughts seemed
scrambled and my word retrieval system was very inadequate. I observed myself
stumbling through life, not as the controlled and caring person that I used to be. I
would like to remind you at this point that I had not been diagnosed as having MS. All I
was told, twice, was that I had a severe whiplash. I did not believe that, but I could get
no professional person with whom I came into contact to listen to what I was saying
about my body, except for the psychiatrist and the physical therapist. Both of them
believed me and helped me a great deal to maintain the little health I had and my
sanity.
October, 1984 was a somewhat better month. However, beginning in the early part of
November I began to experience dizzy spells again; I was stumbling. I had a loss of
feeling in my legs. I took several falls downstairs and I was depressed. I was doing
everything I knew. I had talked with a nutritionist in Oregon and begun a no -fat, no-
sugar diet, which was not hard as I had not had much of that in my diet anyway. I had
begun taking vitamins and primrose oil. I was taking as good care of myself as I could
and I didn't seem to be going anywhere but backwards. In late December I had another
fall down the stairs in my home and was once again confused because my efforts were
not getting the results I desired and needed. In the early part of January, while leaving
my home accompanied by another person, I fell again. She, along with the psychiatrist
and physical therapist insisted that I should see another physician and try to get an
MRI (magnetic resonance imaging) test. I was taken to see a neurologist who wrote a
prescription for the MRI. By mid-January 1985 I had lost my sight and was paralyzed
from the waist down. I had no feeling for approximately 3 1/2 months in my lower
extremities. I was relieved in February when the second neurologist reviewed my scan
with me and said it looked to him as though I had Lupus, MS, or a brain tumor at the
base of my brain. My symptoms were not all due to a whiplash! When I asked about
treatments for each disease, he told me about my options and about the side effects of
the more invasive treatments. I asked him if there wasn't some non-invasive aid for
these disease, especially the Lupus and MS. He told my about hyperbaric oxygen. I
thanked him, left, set up an appointment for consultation at the Houston Hyperbaric
Center. I only began to regain my sight and to
have feeling in my legs after I began hyperbaric oxygen treatments. These treatments were
begun at the Hyperbaric Oxygen Center in Houston, Texas and seemed to restore my
vision after 10 sessions and feeling in my legs to the extent that I was able to begin walking
after 20 treatments. In fact, I began driving after about 35 of those treatments. The first
treatments with the hyperbaric oxygen were of one hour's duration, five days in a row,
skipping the weekends. However, after I got to where I could walk and I could see, I had
three treatments a week and have continued the routine since mid-April, 1985 until today.
On May 12, 1985 I was finally diagnosed to have multiple sclerosis. Since that time it seems
to have leveled out somewhat. My family and I have moved from Houston where the
climate seemed to bother me. I do not get to jog, jump rope or go skiing anymore, and I
have given up some of my practice as a psychologist. But I have added to my life daily
exercise - swimming, doing yoga or walking - and I meditate and/or rest in the middle of
the day every day.
I feel confident that I am coping with this disease in the best way possible for me, but I
know that without the hyperbaric oxygen I could not have improved the strength of my
mind and body."
J.L's story is not that unusual for an M.S. patient. The diagnosis is not always made early
at the onset. The history of her injuries is interesting. It very likely precipitated the onset of
M.S. This story also illustrates how the quest of a patient for better medical care can
eventually lead to optimal therapy which may have been otherwise denied to the patient.
J.L. subsequently had MRI scanning after HBO therapy. The lesion in the left temporal
lobe decreased while her brainstem lesions remained unchanged. SPECT scanning also
showed improvement in cerebral metabolism in the affected hemisphere of the brain. J.L.
was last seen by the authors in May, 1989 and continues to be active in her life.

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