Cerebral palsy and hyperbaric oxygen therapy (HBOT)
Cerebral palsy and hyperbaric oxygen therapy (HBOT)
Hyperbaric oxygen therapy for children with cerebral palsy is unproven and has potential hazards - we do not recommend it.
Key points to remember
- hyperbaric oxygen therapy is an established treatment for some serious conditions such as carbon monoxide poisoning, decompression sickness (the 'bends') and some wounds
- use of hyperbaric oxygen therapy in a range of conditions including cerebral palsy is based on the theory that there are inactive cells in the damaged brain that have the potential to recover
- hyperbaric oxygen therapy for children with cerebral palsy is unproven and has potential hazards - we do not recommend it
- if parents are planning to use this option for their child, they should carefully consider the points in the section ‘What should parents do?’
Parents who have a child with a disability, especially a severe disability that significantly limits function and/or quality of life may want to consider any therapy that offers hope of cure or significant improvement.
What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy is the inhalation of 100 percent oxygen inside a hyperbaric chamber. A hyperbaric chamber is a sealed room where oxygen or air is pressurised to 25 – 75 percent above normal air pressure at sea level. The child and a caregiver spend time (usually one hour) in the chamber.
Cerebral palsy (CP)
Cerebral palsy is a permanent physical condition that affects movement and posture and can cause a range of other problems. It is caused by damage to, or lack of development in a part of the brain that controls movement. Cerebral palsy is the most common physical disability in childhood occurring in 1 in every 500 babies. Cerebral palsy is often called ‘CP’ for short. For more information, see the cerebral palsy page on this website.
Could hyperbaric oxygen therapy help children with cerebral palsy?
The theory underlying the use of hyperbaric oxygen therapy in cerebral palsy is that there are cells within the damaged brain that are living but are not active and are not functioning as they should. The hope is that providing an increase in the supply of oxygen to these cells will switch them on again and start them functioning and so improve the child’s function. Studies in animals have shown that there are changes in the electrical or metabolic activity of brain cells.
There have been very few studies in children with cerebral palsy, and no new studies have been published for more than 10 years. The best study showed no significant difference between children given hyperbaric oxygen therapy and children given room air at a similar pressure.
There is no evidence that hyperbaric oxygen therapy is helpful for children with cerebral palsy.
What happens in hyperbaric oxygen therapy for a child with cerebral palsy?
First, an assessment is necessary to look for problems that could happen to the child during hyperbaric oxygen therapy - see the next section 'Can anything go wrong?'
Children who have ear problems may need to have an operation to insert grommets (also called ventilation tubes) before treatment. Grommets prevent ear pain or a burst ear drum in the hyperbaric chamber. The operation involves a general anaesthetic with the associated risks.
An adult must be with the child while they are in the chamber. The adult is there to give help in an emergency such as an epileptic seizure or vomiting. Once the child and their caregiver are in the chamber, the chamber is closed and the pressure raised to the level selected for the treatment.
Can anything go wrong?
Yes, things can go wrong.
Changes in pressure can result in pain or in damage to the ear drum. In the published studies, ear problems were relatively common and in one study over half the children needed an operation to insert grommets.
If a child vomits in the chamber there is a higher risk of choking on the vomit (aspiration). The high pressure tends to force the vomit back into the airway.
In the published studies up to 12 percent of the children had seizures during treatment. There is the possibility of breathing in vomit if the child vomits during a seizure.
Does it work?
The evidence from the studies published in the peer reviewed literature is that hyperbaric oxygen therapy is not effective for children with cerebral palsy. A recent analysis of 64 different treatments for cerebral palsy gave a red light grading to hyperbaric oxygen therapy. This grade indicated that the treatment should be discontinued as it is ineffective and has potentially serious harmful effects. Only 5 of the 64 treatments received this grade.
What should parents do?
Our advice is that hyperbaric oxygen therapy for children with cerebral palsy is unproven and has potential dangers. We do not recommend it.
If parents are planning to use this option for their child, they should carefully consider the following points:
- Does my child have seizures (epileptic convulsions)? If yes, does my child sometimes vomit during seizures?
- Does my child have a tendency to vomit at other times?
- Has my child had ear problems? If my child needs to have an operation to insert grommets before having hyperbaric oxygen therapy am I fully informed about the risk of a general anaesthetic?
If you answered yes to any of these questions, ask yourself whether it worth risking your child's life for this unproven treatment.
Some other questions to consider
- How will the treatment be given?
- How much will this treatment cost? Remember that there is always more than a dollar cost. Think about the disruption to the rest of the family as a result of travelling overseas, the safety of the destination, loss of earnings.
- What qualifications do the people giving the treatment have?
- What follow-up and treatment evaluation will they offer?