Hyperbaric Oxygen Treatment & MS

Background: 

Magnetic resonance spectroscopyhas shown that lactate, the hallmark of hypoxia (low tissue oxygen) is present in acute lesions. 

Blood–brain barrier disturbance precedes the symptoms and is involved in migration of auto-reactive T-cells into the nervous system. Hyperbaric oxygen has been shown to improve BBB integrity.

Naturally, the oxygen rich environment is favorable for Myelin repair especially when appropriate building blocks are given such as Vitamin K, B12, Phospholipids/Citicholine, Methyl-Folate, Pregenolone and Essential fatty acids.

CCSVI phenomenon has a the very least demonstrated that in some MS patients blood flow (and therefore oxygenation) is absolutely a crucial element of proper brain function in MS patients.  

The edema that is seen in MS brain lesions increases the diffusion distance for oxygen to pass and provides rationale for increasing oxygen transfer by delivering oxygen under hyperbaric conditions.

Furthermore, in addition to increasing oxygen passage through areas of edema, HBOT treatment has been shown to effectively reduce cerebral edema (for instance in brain injury). The effect of Hyperbaric treatment on the edema associated with MS has been demonstrated by MRI by Neubauer in 1986. 

Hyperbaric treatment allows for resumption of normal aerobic metabolism in acute areas affected by the disease process. In addition to this, increasing cellular oxygen availability during hypoxia reduces inflammation by down-regulating HIF-1α (hypoxia-inducible factor 1α) - falling oxygen levels usually increase HIF-1. 

Stem Cells likely contribute to the repair of areas of damage in the nervous system. A recent study has shown that course of 20 sessions at 2.0 ATA increased circulating stem cells by 800%.   

Hyperbaric Oxygen therapy ameliorated symptoms in Experimental Allergic Encephalomyelitis (EAE) the animal model of multiple sclerosis in numerous studies in the 1970s in part because HBOT has been found to be immunosuppressive in mice as well as reduction of edema as explained above. There is also animal data to suggest that use of Hyperbaric treatment in acute episodes would beneficial. 
 

Human Data:

In 1980, Richard A. Neubauer, M.D, published his observations on 262 patients with MS using Hyperbaric Oxygen Therapy - his clinical impression was that "patients who received the therapy and continued with occasional follow-up treatments did not progress as far or as rapidly as those who never received the therapy."

Fischer (1983) studied 40 patients with advanced chronic multiple sclerosis who were randomly divided into two groups and treated at 2.0 ATA for 90 minutes for twenty treatments.

The experimental group received pure oxygen, and the placebo group received 10 per cent oxygen and 90 per cent nitrogen.

Objective improvement (mobility, fatigue, balance and bladder function) occurred in 12 of 17 patients treated with hyperbaric oxygen and in 1 of 20 patients treated with placebo. Improvement was transient in seven and long-lasting in five. Those with less severe forms of the disease had a more favorable and lasting response. At one year of follow-up, deterioration was noticed in 2 patients (12 per cent) in the oxygen group, neither of whom had had an initial response, and in 11 patients (55 per cent) in the placebo group. 

A major criticism of the study was no continuation treatment was provided. Naturally some maitenance treatments would be needed and possibly more than 20 would have been beneficial. As mentioned elsewhere 20 treatments is often considered the  beginning of new blood vessel formation. Another issue is that 2.0 ATA might actually be too high of a pressure. For instance, according to Holbach et al. 1977 the optimal pressure in stroke patients is about 1.75 ATA. 

Barnes 1985 that used similar parameters to Fischer (90 minutes, 2.0 ATA and 20 treatments) found improvements in bladder function in 12 of 51 patients in the hyperbaric oxygen group. The bladder improvement was present after 1 month of treatment and was maintained for 6 months without additional treatment.

Once again, the same criticisms are applied to this study - chiefly that 20 might not be enough treatments and 2.0 ATA might be too high. However, in the experience of our Naturopathic doctors in our Edmonton patients, bladder urgency is a difficult to treat issue naturally therefore we welcome the idea that Hyperbaric oxygen can be used for this. 

Oriani et al (1990) studied 44 MS patients - 22 in the 100% oxygen group and 22 in the compressed normal air group both receiving 2.5 ATA for 90 minutes initially for 1 month then multiple "booster" treatments over a 1 year period. 

In the Hyperbaric group, 14/22 reported benefits, 4 reported no change and 4 declined. However, versus 2 in the Hyperbaric air group reporting benefit. What is extremely interesting was that after 6 months no major changes were noted, which indicates that numerous other studies may have been far too short and that MS patients might need long term exposures.  8/14 patients experienced a 2 point drop in their EDSS score which is massive as some of the EDSS measurements dropped in half. 

With regards to RRMS, and affecting the disease course, Pallota et al. (1986) followed 22 MS patients for 8 years. All MS patients had an initial course of 20 Hyperbaric Oxygen Treatments, and 11 were treated thereafter with two Hyperbaric treatments every 3 weeks. The frequency of relapses decreased dramatically in the long term treatment group whereas they increased in the group which received the initial treatment. We like this study because its reasonable to have treatment every 3 weeks for a patient for long term treatment. 

Hyperbaric Oxygen in Edmonton

United Kingdom Data

In the United Kingdom a charity called "The MS National Therapy Centres" installed Hyperbaric facilities across the UK. Since 1982 over 25,000 MS patients were treated with more than 3,000,000 individual Hyperbaric treatments (without a significant incident). 

Seven hundred and three patients were followed in detail since first receiving their treatment. The study was predominantly females (66%) with Chronic progressive MS. 

UK MS Therapy Centres Protocol

Five daily treatments of 1 hour were given at 1.25 or 1.5 ATA.

If two or more symptoms improved, a course of 20 treatments in 4 weeks was completed at this pressure.

or pressure was raised in weekly increments of 0.25 ATA until a response seen 

After twenty treatments, 70 % of patients obtained relief of two or more symptoms.

In general, the response was better in patients with less advanced disease.

Further assessments were made between 2 and 4 years, and again between 6 and 8 years after the initial course. They suggested that the initial improvements were being maintained by regular treatment.  

A third survey was conducted between 10 and 14 years, out of 446 patients, 103 (23 %) were no worse after regular treatment for 10–14 years and 30 patients (7 %) actually improved

An analysis suggested that one treatment every 2 weeks was required to retard the progression of relapsing/remitting state where as once weekly was even more effective. 

Improvement after initial 20 treatments

Specific abilities also improved after the initial course such as Brushing teeth, doing up buttons, holding a cup, brushing hair. With many of these maintained after four years.  

Hyperbaric Oxygen and MS

The Naturopathic Approach to MS: 

Dr. Muradov focuses on many areas in his MS patients but there are a few key areas often considered: Gut Integrity & Dietary Augmentation, Infectious Triggers, Toxic Triggers. In his experience among Edmonton patients, the two former seem to dominate the latter.

Dietary strategies we consider: Swank, Dairy and Gluten Free, Paleo, AIP, Low Lectin, Ketogenic, Wahls and Carnivore in addition to understanding an individuals idiosyncratic triggers through IgG testing.

We dive deeper into gut health, with comprehensive stool cultures with PCR to identify pathogenic inflammation driving agents affecting our Edmonton patients. 

Infectious Triggers are screened for: Candida, Mycoplasma, Chlamydia, HHV-6 and EBV. 

In Dr. Muradov's experience, Viral triggers seem to dominate in young Edmonton patients with Autoimmune diseases, MS included. 

Screening for Lyme disease in MS patients is occasionally fruitful as misdiagnosis between the two is possible albeit rare in our experience. 

Off Label considerations such as LDN or Valacyclovir are often recommended through referrals to local prescribers in Edmonton. 

IV Treatment can frequently be helpful for our Edmonton MS patients. IV Glutathione is an effective option for acute inflammation. IV Therapy with B Vitamins can be helpful for energy and mood. NAD+ IV is a newer promising option for energy in MS. IM AMP is an "old school" treatment we use that can help with walking strength in patients. 

Low Dose Lithium is an interesting Naturopathic option as data exists for it both as a way to activate myelin producing oligodendrocytes as well as inhibit inflammation causing microglia. 

Of course mainstays such as Vitamin D, Curcumin, Green Tea, Fish Oil, CoQ10 and Lipoic Acid are all well known evidence based interventions we use in our Edmonton patients for relapse reduction and inflammation management. 

Ultimately, our Naturopaths will construct a unique evidence based protocol to meet the needs of your particular MS.

Because of Dr. Muradov's interest in MS, our Edmonton Clinic also deals with numerous other autoimmune issues. Our Naturopathic doctors have experience with RA, SLE, Crohn's, Ulcerative Colitis, Psoriasis and Hashimoto's & Graves'. 

Want to know more?

Get in touch (780) 757 8378