The use of hyperbaric oxygen for treatment of multiple sclerosis has a long but questionable history. I don’t even recall the last time someone called us at Atlanta Hyperbaric to inquire about hyperbaric oxygen treatment of multiple sclerosis and I know we haven’t treated anyone with it. The Undersea and Hyperbaric Medical Society has taken a look at various research reports on the treatment of multiple sclerosis with hyperbaric oxygen and issued a position paper that concluded “there is some case for further investigation of possible therapeutic effects in selected sub-groups of [multiple sclerosis] patients (well-characterised [sic] and preferably early in the disease course) and for the response to prolonged courses of [hyperbaric oxygen therapy,] this case is not strong.”
Despite the usually disappointing results of hyperbaric oxygen for treatment of multiple sclerosis, a new theory has come up implicating the brain’s blood supply in this disease. Dr. Paolo Zamboni of the University of Ferrara in Italy, has published information that implicates inadequate venous blood drainage of the brain. Specifically, abnormal flow through the azygous and jugular venous systems results in a build-up of iron in the brain. The excess iron damages blood vessels and allows the metal, as well as other substances, to cross the blood-brain barrier. Dr. Zamboni studied 65 patients with multiple sclerosis and 235 controls using high resolution transcranial Doppler and found that the multiple sclerosis patients were 43 times more likely to have the abnormality. The clinical implications of Dr. Zamboni’s idea are important because a relatively simple surgical procedure, percutaneous transluminal angioplasty, corrects the problem. During the 18 months following surgery, Zamboni is reporting that half of the patients with the remitting-relapsing form of multiple sclerosis had no attacks. The corresponding rate before surgery was 27%.
Dr. Zamboni’s theory is pretty interesting stuff and, if it continues to hold true over time, perhaps it explains why the results with hyperbaric oxygen have been so variable. It may turn out that hyperbaric oxygen will have a therapeutic role when combined with percutaneous transluminal angioplasty.