MS is a disease in which manifestations wax and wane, and which is not immediately fatal (and sometimes not at all), and proving or disproving the therapeutic worth of an intervention can be frustratingly difficult. The response of multiple sclerosis (MS) to hyperbaric oxygen (HBO2) therapy falls into this category. The letter of James and Perrins [see page 236] takes the pro- HBO2 point of view in direct opposition to a recent editorial by Dr. Jacoby in the Journal (1)

The dispute has unaccountably become both polarized and emotional, reminiscent of other medical debates, which were finally resolved by carefully designed outcome studies.

If, on the basis of current evidence, HBO2 therapy for MS can be neither accepted nor dismissed out of hand, there are two time-tested ways of approaching the truth. One is to perform comprehensive reviews of all available data, which has been done by Bennett and Heard (2). Although the authors failed to find an effect of HBO2, they left open the possibility that HBO2 might be effective for some subsets of patients, perhaps using prolonged treatment.

Presently, the studies are needed to establish which (if any) patients and useful treatment schedules are lacking. The answer to “why not?” might be available from those who directly care for patients with the disease, and should have the most interest in finding effective treatments. With respect to HBO2 and MS, little enthusiasm is evident among neurologists because no new human trials have been published in 15 years, and no studies of HBO2 using animal models have been published in a quarter of a century. However, neurologists have rarely expressed their opinions on HBO2 therapy in print. To redress this, along with Drs. James’ and Jacoby’s comments we have included remarks from clinical neurologist Dr. E. Wayne Massey. He brings to the table considerable clinical expertise with MS, as well as experience as a co-investigator in a randomized trial of HBO2 in MS (3).

In order for HBO2 therapy to be widely accepted as a useful treatment for MS, fresh data are needed. Clinical outcome studies in humans must be supplemented by new experiments to elucidate the mechanism of action of HBO2. The onus is on those who believe that HBO2 has a constructive role to generate those data.

Moon (2002). Mini-forum on multiple sclerosis (MS) and hyperbaric oxygen therapy. Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc, 2002 ;29(4):235-6. https://www.researchgate.net/publication/10715527_Mini-forum_on_multiple_sclerosis_MS_and_hyperbaric_oxygen_therapy