Multiple Sclerosis
Hyperbaric Oxygen Therapy for Multiple Sclerosis
Introduction
Hyperbaric Oxygen Therapy (HBOT) consists of breathing oxygen at a pressure higher than local atmospheric pressure for multiple sessions for the treatment or prevention of specific diseases. As per the European Code of Good Practice (Kot et al.), there is a general consensus that the term HBOT can only be applied when the partial pressure of oxygen in breathing mixture exceeds 1.5 absolute atmosphere (ATA) for a minimum period of 60 minutes (excluding compression and decompression).
HBOT has wide-ranging benefits for patients with some neurological disorders and may benefit patients with multiple sclerosis (MS). HBOT is associated with enhanced oxygen delivery, reduced inflammation and increased neuroplasticity and mitochondrial function. Although definitive evidence for the efficacy of HBOT as a treatment for MS is lacking, there is robust experimental and clinical evidence supporting HBOT as an adjunctive treatment for neurological conditions that share common symptoms and features with MS.
Mechanisms of Action
During HBOT, patients are treated with pure oxygen in a chamber in which the pressure is higher than atmospheric pressure (2 ATA) for 1.5 hours for multiple sessions. HBOT enhances oxygen delivery to tissues (Cannelotto et al., 2024), including the brain, and the potentially beneficial effects of HBOT for MS may theoretically involve several distinct mechanisms.
Reduced hypoxia: In MS, hypoxic regions in the brain may contribute to inflammatory, neurodegenerative, and vascular impairments (Soroush & Dunn, 2025). HBOT significantly increases the dissolved oxygen content in plasma, improving oxygen delivery to the brain (Nemoto & Betterman, 2007; Larsson et al., 2010; Hadanny & Efrati, 2022), potentially leading to neuroprotective and regenerative effects in patients with neurological conditions.
Modulation of the immune response: MS is driven by aberrant immune activity, particularly T-cell-mediated inflammation. Treatment of MS patients with HBOT may alter their immune phenotype (Nyland et al., 1989) while preclinical studies suggest HBOT can suppress pro-inflammatory cytokines while promoting anti-inflammatory cytokines in models of neuroinflammation (Shapira et al., 2018; Chiou et al., 2021).
Reduction of oxidative stress: MS development and progression involve oxidative stress (Pegoretti et al., 2020). HBOT has antioxidant activity (De Wolde et al., 2021), which may protect neurons and glial cells from oxidative injury, and theoretically, such activity could slow MS progression.
Remyelination and neural repair: Some evidence suggests that HBOT can stimulate oligodendrocyte precursor cell proliferation and enhance remyelination (Ahmadi & Khalatbary, 2021). In animal models of demyelination, HBOT increases myelin protein expression and improves neuronal survival (Kraitsy et al., 2014; Amatruda et al., 2023; Xue et al., 2023). These effects may help preserve or restore neurological function in patients with neurological conditions, potentially including MS.
Benefits of HBOT for Patients with Multiple Sclerosis
HBOT is generally well tolerated, and serious side effects are rare (Camporesi, 2014; Zhang et al., 2023). Patients with neurological conditions, potentially including MS, may experience a range of benefits from HBOT that can significantly improve their symptoms and quality of life.
Reduction in neurological symptoms: HBOT may ameliorate neurological symptoms, such as motor weakness (Khalil et al., 2023) and spasticity (McDonagh et al., 2007), in cerebral palsy patients. These symptoms are also common in MS, and some clinical trials (Perrins et al., 2005) and anecdotal data (Moore et al., 2020) suggest that HBOT may improve gait, muscle strength, coordination, and bladder function in MS patients.
Improvements in fatigue: Fatigue is one of the most debilitating symptoms of MS, affecting up to 80% of patients (Braley & Chervin, 2010). Reduced fatigue and enhanced mitochondrial function following HBOT have been shown in several neurological conditions (Ahmadi et al., 2021; Bin-Alamer et al., 2024) and similar mechanisms may contribute to reduced fatigue in MS.
Enhanced cognitive function: Cognitive impairment is common in MS, particularly deficits in attention, processing speed, and memory. HBOT’s neuroprotective and neurorestorative effects may support cognitive performance (Ahmadi et al., 2021; Bin-Alamer et al., 2024), although direct evidence in MS patients remains limited.
Slower disease progression: Inflammation and oxidative stress are key contributors to MS (Pegoretti et al., 2020). In several neurodegenerative diseases and models, HBOT slows disease progression by reducing oxidative stress and protecting against neuronal loss (Ahmadi & Khalatbary, 2021; Yang et al., 2023). By mitigating inflammation and oxidative stress (Cannellotto et al., 2024), HBOT may theoretically also slow MS progression.
Improved quality of life: By analogy with other neurological syndromes, HBOT may enhance MS patients’ quality of life. HBOT alleviates depression (Liang et al., 2020) and improves sleep and quality-of-life scores (Rosario et al., 2018; Zilberman-Itskovich et al. 2022) in neurological disorders. Anecdotal data suggest similar improvements may be seen in MS patients following HBOT (Moore et al., 2020).
Clinical Evidence of HBOT for Multiple Sclerosis
The clinical literature on HBOT for MS is mixed, with studies showing both positive effects and limited or no benefit (Bennett & Heard, 2004; Bennett & Heard, 2010). However, anecdotally, HBOT has been reported to be beneficial for MS patients (Moore et al., 2020), particularly for bladder symptoms and balance, but its benefits remain controversial (Neubauer et al., 2005).
Meta-analyses and reviews: A Cochrane systematic review (Bennett & Heard, 2004; Bennett & Heard, 2010) analysed randomised trials of HBOT in MS and concluded that there was no clinically significant benefit of HBOT for patients with MS. Similarly, a review by Kleijnen and Knipschild (1995) that included eight trials of HBOT (typically 1.75–2 ATA, 100% O2, 90 mins, 20 sessions) concluded that the majority of controlled trials did not show any positive effects of HBOT for the treatment of MS.
A clinical review of a small number of MS patients treated with HBOT showed marked improvements in locomotion and bladder function (Kochhar & Sangwan, 2014). There were no effects on cerebellar symptoms leading the authors to suggest that HBOT may not alter the disease process per se but may nevertheless have beneficial effects in the treatment of MS.
Clinical trials: Fischer et al. (1983) treated patients with chronic MS with HBOT (2 ATA, 100% O2, 90 mins, 20 sessions) and reported objective improvements in 12 of 17 patients (compared to 1/20 patients treated with placebo). Improvement was transient in seven of the HBOT-treated patients and long-lasting in five. Those with less severe forms of the disease had a more favourable and longer-lasting response.
Another study (Barnes et al., 1985) enrolled 120 MS patients who were randomised to HBOT (2.0 ATA, 100% O2, 90 mins, 20 sessions) or placebo-treated groups. A greater proportion of HBOT-treated than control patients (24% vs 6%, respectively) reported improvements on the subjective bowel/bladder parameter of the Kurtzke (1983) disability scale.
A large study at the Multiple Sclerosis National Therapy Centres in the UK, involving 703 patients, highlighted the potential effectiveness of HBOT (1.5–2 ATM, 100% O2, 60 mins, 5 or 25 daily sessions followed by weekly/fortnightly sessions) in slowing the progression of MS (Perrins & James., 2005). Patients who received about 300 hyperbaric oxygen treatments every fortnight for 10 to 13 years saw a notable slowing in the progression of their symptoms. Those who received treatments more frequently (approximately once a week) experienced greater benefits.
However, several other studies (e.g. Harpur et al., 1986; King et al., 1985) showed no clinical benefit of HBOT for the treatment of MS.
Conclusion
By improving oxygen delivery, modulating the immune response, reducing oxidative stress, and supporting neurological repair, HBOT may theoretically alleviate symptoms in MS patients. Clinical studies to date provide mixed evidence, with some suggesting modest benefits in symptom management but little consistent proof of slowed disease progression. However, HBOT may be beneficial for a number of MS symptoms, including sleep disturbances, pain, and fatigue, thus improving patients’ quality of life.
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