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NO ADVANTAGE OF HIGH-PRESSURE OXYGEN FOR TREATING CHILDREN WITH CEREBRAL PALSY (p 582)

February 21, 2001

Children with cerebral palsy are unlikely to benefit from treatment with high-pressure oxygen, conclude authors of a study in this week's issue of THE LANCET.

Cerebral palsy is characterised by disorders of movement and posture caused by a non-progressive injury to the immature brain; there is no known cure. Hyperbaric (high-pressure) oxygen has been used by several centres in the USA, UK, and Canada to treat children with cerebral palsy. Reports of successful treatment have circulated among the families of children with this condition, who have asked for hyperbaric oxygen treatment despite the lack of scientific evidence of efficacy and possible side-effects.

Jean-Paul Collet and colleagues from McGill University, Montreal, Canada, did a randomised trial to assess the efficacy and side-effects of this form of therapy for children with cerebral palsy. 111 children aged 3-12 years were randomly assigned hyperbaric oxygen (57 children) or slightly pressurised room air (54 children). All children received 40 treatments over 2 months. Hyperbaric oxygen treatment was one hour spent in a chamber with 100% oxygen at 1.75 atmospheres absolute (ATA); children on slightly pressurised air received air at 1.3 ATA (the lowest pressure at which pressure can be felt; this ensured experimental masking). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech.

Both groups improved in all outcome measures over the course of the study, but there were no differences between the two treatments. Ear problems occurred in 27 children treated with hyperbaric oxygen, compared with 15 treated with hyperbaric air.

Jean-Paul Collet comments: "This trial shows that hyperbaric oxygen treatment has no advantages over treatment with slightly pressurised air in children with cerebral palsy. The global improvements seen in both treatments during the course of the study might be related to the context of the intervention and the selection of very motivated parents. A possible effect of increased pressure cannot be ruled out because of the slight increase in alveolar partial pressure of oxygen; nevertheless, the same increase in blood oxygen can be reached by masked administration of 28% fractional inspiration of oxygen without increased pressure-a treatment that needs to be assessed before it can be recommended".

Contact: Dr Jean-Paul Collet, Randomized Clinical Trial Unit, SMBD Jewish Ceneral Hospital, 3755 Côte-St-Catherine Suite A132, Montreal, Quebec H3T 1E2, Canada; T)+1 514 340 7587; F) +1 514 340 7564; E) jpcollet@epid.jgh.mcgill.ca

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