Systematic review of hyperbaric oxygen therapy for cerebral palsy: the state of the evidence

Abstract

A systematic review of the evidence was conducted on the benefits and adverse effects of hyperbaric oxygen treatment (HBOT) for cerebral palsy (CP). Studies of any HBOT regimen in patients with CP were included except for case reports and case series. Electronic databases (e.g. MEDLINE, EMBASE), professional society databases, and reference lists were searched to identify studies. Study quality was assessed using predefined criteria relevant to the study design. Two randomized controlled trials and four observational studies were identified. Best evidence came from a randomized controlled trial which found that HBOT at 1.75 atmospheres (atm) and 1.3atm of room air resulted in similar improvements in motor function (5-6%). Other outcomes also indicated no difference between the HBOT and room air. Observational studies reported improvements in motor function to a similar degree. Other evidence was insufficient to clarify the benefits and/or adverse effects of HBOT for CP. Both HBOT and pressurized room air resulted in improvements in motor function compared with baseline. Similar improvements were seen in the observational studies. Children undergoing HBOT were reported to experience adverse events, including seizures and the need for ear pressure equalization tube placement, but the incidence was unclear. Future research is needed to determine the efficacy of pressurized room air or non-pressurized oxygen in equivalent amounts by mask, compared with standard treatments.Hyperbaric oxygen therapy (HBOT) is defined as the inhalation of 100% oxygen inside a hyperbaric chamber that is pressurized to greater than 1 atmosphere (atm). The use of HBOT to treat patients with cerebral palsy (CP) is based on the theory that among the damaged brain cells there are inactive cells that have the potential to recover. These cells constitute the ischemic penumbra, a transition area of dormant neurons between areas of dead tissue and unaffected healthy tissue. [1][2][3][4][5] The theory is that improving oxygen availability to these cells stimulates the dormant cells to function normally, reactivating them metabolically or electrically. Evidence of changes in metabolic or electrical activity following HBOT from animal brain injury models has motivated further research in humans.HBOT is approved by the US Food and Drug Administration (FDA) for use in a variety of indications, including certain wounds, carbon monoxide poisoning, and decompression sickness (the 'bends'). This list of indications is generally used by Medicaid and other payers in the US to determine HBOT treatments that are covered by the health insurance plan. However, its use to treat CP is controversial. Recent attempts in some US states to expand Medicaid coverage to include HBOT for CP, and the growing number of private facilities offering this therapy, indicate the strong interest in this treatment among some patients, caregivers, and health care providers. HBOT costs approximately US$400 per 90-minute session and an estimated US$12 000 per patient based on Medica...

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