Cerbral palsy: the Collet study

In 2001 the prestigious English medical journal, Lancet, published the only double-blind, randomized study of hyperbaric oxygen for the treatment of cerebral palsy ever performed.  In the ensuing eight years, no one has attempted to extend or even replicate the study, and I doubt that any more clinical research will be done for the foreseeable future.  What happened is a perfect example of, “My mind is made up, so don’t confuse me with facts.”

One of the coauthors of the Collet study, Dr. Pierre Marois, recently wrote a review article (http://www.jpands.org/vol12no4/marois.pdf ) on the subject of hyperbaric oxygen treatment of cerebral palsy that devoted a large segment to the controversy that still raises blood pressure at its very mention.  On its surface, the Collet study was straight forward:  It was an attempt to randomize children to hyperbaric oxygen treatment and compare them to children in a control group.  The problem, and the controversy, turned out to be the control group.

Because Dr. Marois’ report is freely available and the Collet study is old news anyway, I won’t go into great detail.  To make a valid comparison, both the researchers and patients in the Collet study could not know who was receiving hyperbaric oxygen. Consequently, both the oxygen and control groups had to be subjected to hyperbaric conditions–otherwise it would be easy for a patient to know if he were being treated simply by being able to feel the pressure or its absence.  The treatment group received 100% oxygen at 1.75 atmospheres of pressure and the control group received room air at 1.3 atmospheres of pressure.  In other words, the study compared treatment with hyperbaric oxygen to treatment with hyperbaric air, so it is inaccurate to call the hyperbaric air treatment a placebo.  The results showed that both the children treated with hyperbaric oxygen and the children treated with hyperbaric air showed considerable objective improvement compared to children who received no hyperbaric treatment at all.  But, there was no difference in outcome between the two hyperbaric treatment groups.

The coauthors began to squabble even before the study was published.  According to Dr. Marois, Dr. Collet and the group that funded the study wanted everyone to believe that the patients treated with hyperbaric air were treated with a placebo, so that they could conclude that hyperbaric oxygen treatment for cerebral palsy was no more effective than a placebo.  On the other hand, Dr. Marois pointed out that hyperbaric air is surely not a placebo, and in fact is in common use, with life-saving effect,  for treatment of acute mountain sickness.  Marois believes, as I do, that the Collet study plainly proves the efficacy of hyperbaric oxygen therapy for the treatment of cerebral palsy, although hyperbaric oxygen may not be more effective than hyperbaric air.

I’ve saved the best for last.  The Collet study was done in Canada and Canada has socialized medicine.  On the basis of the Collet study, the Canadian government does not pay for hyperbaric oxygen treatment of kids with cerebral palsy.  The Canadian government does not pay for hyperbaric air for these children either, though based on the Collet study, it seems like it should.  Does anyone think the proposed American socialized medicine scheme will pay for cerebral palsy kids to have hyperbaric oxygen or even hyperbaric air treatment?

Glenn L. Goodhart, M.D., J.D.

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About Public Protection Lawyer

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6 Responses to Cerbral palsy: the Collet study

  1. Jenny says:

    Pretty good post. I just found your site and wanted to say
    that I have really enjoyed reading your blog posts. In any case
    I’ll be subscribing to your feed and I hope you write again soon!

  2. The control group could have had inert gas added to the compressed air so that the fraction of oxygen in the inspired air corresponded to the FiO2 at sea level. A few percent nitrogen or helium mixed with the inspired air would have been hypoxic when the compression was begun or it could have been added as the pressure was increased to result in an iso-oxygen atmosphere and thus been a true control. Cerebral Palsy and other developmental neurobiological problems could be due to an abnormal cell wall protein or membrane that does not permit the oxygen to easily penetrate the blood brain barrier. Abnormal hyoo-oxy metabolism could switch a krebs cycle based metabolism to another pathway resulting in the manifestations of CP. Pure conjecture on my part. Pet scans have not been used in CP to my knowledge. This type of study could be an adjunct to objectively compare results to a metabolic marker, namely oxygen metabolism in a localized area of the brain. The site of the abnormality could be in the cortex which would lend itself to this type of study. Or it could be in the thalamus of the brain and/or in other subcortical nuclei.

  3. Ron Mills says:

    Thank you again, Dr Goodhart. I’ll be linking to you from O2.0, my HyperbaricLink.com blog. At last week’s UHMS scientific meeting in Las Vegas we were made to listen to the esteemed Prof Mike Bennett declare HBOT “disproven” for the treatment of cerebral palsy on this very same evidence. And not a heckler in the house. We’ll be in touch. Please keep up the good work.

    Ron Mills
    HyperbaricLink.com

  4. KonstantinMiller says:

    You know so many interesting infomation. You might be very wise. I like such people. Don’t top writing.

  5. DANA says:

    Well written article: Will come back.

  6. Conrad Mclaws says:

    I’ve been checking your blog for a while now, seems like everyday I learn something new 🙂 Thanks

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