Dystonia & Hyperbaric Treatment
Hyperbaric oxygen therapy (HBOT) refers to a mode of treatment in which a patient enters a chamber with higher than normal air pressure and breathes oxygen. The combination of the oxygen and higher pressures increases oxygen concentrations throughout the body to promote healing of a wide variety of diseases. The therapy has been studied for its effects on cerebral palsy and associated dystonia, the uncontrolled, debilitating and disfiguring muscle contractions. The medical literature does not include studies of HBOT for other kinds of dystonia. The studies in cerebral palsy do not show a clear benefit of HBOT in regard to muscle control.
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How HBOT Works
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Pressure chambers used for HBOT may be big enough to hold several people or small enough for only one person. They may be portable or permanent and made of rigid or soft materials. A review of clinical studies of HBOT in chronic brain injury conducted by the Agency for Healthcare Research and Quality (AHRQ) notes that patients with cerebral palsy experience pressures up to 1.3 times normal while breathing pure oxygen with occasional breaks on normal air. The procedure achieves greater oxygenation of the blood, tissues and cerebrospinal and other fluids. Information at HBOTreatment.com indicates that the increased oxygenation facilitates healing in various diseases such as diabetic wounds and crush injuries.
Theory of Benefit for Dystonia in Cerebral Palsy
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According to HBOTreament.com, some experts believe that the affected areas of the brain in cerebral palsy have become dormant and can be reawakened by oxygenation through HBOT to improve dystonia. Others maintain that swelling in the brain has put pressure on the tissue, depriving it of oxygen and preventing proper formation of the nerve cells and causing dystonia; so oxygenation with HBOT would appear to be a valid approach.
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Studies in Cerebral Palsy
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The review of HBOT for chronic brain injury by AHRQ found that HBOT offered no benefit over control groups for cerebral palsy. Some studies used pressurized room air as the control, while others tracked a group of untreated patients instead. In these studies, the patients improved significantly compared to when they started treatment, including motor skills and dystonia, but those receiving HBOT did not improve significantly more than the control groups. The results do not show that if patients improved while receiving HBOT, that is was due to HBOT and not something else.
UHMS: Wait and See
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These studies, if they do not show a clear benefit of HBOT for dystonia due to cerebral palsy, show at least that HBOT has the potential for benefit. The Undersea and Hyperbaric Medical Society (UHMS) remains hopeful regarding future studies, but, as of 2003, did not recommend HBOT for cerebral palsy: "The weight of the currently available scientific literature is not felt to support an endorsement of HBO2 (HBOT) for chronic brain injury."
Side Effects
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HBOT has a risk of oxygen toxicity from breathing pure oxygen. Occasionally breathing normal air can prevent the seizures, disorientation, breathing difficulties and vision disturbances associated with oxygen toxicity. Prolonged overexposure to oxygen can damage the central nervous system---a particular consideration in patients with cerebral palsy---as well as the lungs and eyes. Brief exposures typically resolve robustly. In other respects, HBOT appears safe and painless, although it may cause ear popping associated with pressure changes, much as occurs in a plane.
Precautions
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The UHMS does not recommend home use of HBOT. For one thing, home administration often does not follow the rigorous procedures used in clinical studies and treatment centers to achieve the desired outcome. Moreover, home administration may fail to adhere to federal, state and local safety regulations. Pure oxygen is a fire hazard if used carelessly.
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