HBOT (Hyperbaric Oxygen Therapy)
It's no secret that many DAN! doctors (and probably non-DAN! doctors as well) are already recommending and selling low-pressure hyperbaric oxygen therapy as a potential autism treatment. Here's an example of one such physician (not a board-certified developmental pediatrician, pediatrician, or neurologist for that matter) here in Phoenix. Before you jump on the "Children With Oxygen-Deprived Brains" bandwagon and chase the claimed "healing power" of oxygen, there's a lot worth looking into here -- the underlying science, several clinical aspects, the marketing of HBOT.
There's another “hyperbaric therapy as a treatment for autism” study underway. It appears to be headed up by Dr. Rossignol, and has three clinical locations supervised by Doctors Liz Mumper (Virginia), Cindy Schneider (Arizona) and Jeff Bradstreet (Florida) - none of which appear (according to a search at ABMS) to have board certification in Developmental-Behavioral Pediatrics, Child Neurology, Neurodevelopmental Disabilities or Undersea & Hyperbaric Medicine... For the moment, set aside anything you may know about the role of hemoglobin in oxygen transport and how the minute increases (probably around 3-4%) in total blood oxygen content afforded by this kind of hyperbaric therapy, or simple O2 therapy, are likely to be insignificant.
Readers may remember that I originally asked the journal Medical Hypotheses to consider contacting the study authors of "Hyperbaric oxygen therapy may improve symptoms in autistic children" and publishing an erratum about the overstated treatment pressure. That didn't go far with Medical Hypothesis (they don't do peer review). I subsequently sent the request to the study authors.
In my last post, a new paper hypothesizing hyperbaric therapy as a treatment for autism was barely introduced. I will be going into much more detail, but wanted correction of what appears to be significant factual error in the paper first. You can read the details about the likely error and my request to Medical Hypotheses for publication of an erratum in my last post. To make a long story short, it appears that the journal, Medical Hypostheses could not care less about my communication. The editor did respond, but suggested that I contact the study authors myself. In fact, their peer-review and publication policies are outlined quite clearly on their website.
"If there is a treatment for autism, the approach would probably depend on the underlying problem, and we don't know what the cause of autism is," said Dr. Jonathan Mink, associate professor of neurology and pediatrics and chief of child neurology at the University of Rochester. "There is little or no evidence that hyperbaric oxygen is helpful for established brain injury." His skepticism is widely echoed. "As far as what exactly it does in brain, based on everything we know about autism, I do not believe (HBOT) could possibly help," said Dr. Leonid Topper, a pediatric neurologist with Pediatric Neurology Associates in Morristown.
It's only marginally scientifically plausible that HO would be good for autism. In fact, some evidence in the literature suggests that increased oxidative stress may have relevance to the pathophysiology autism. If that is actually true, then HO might potentially even be harmful to autistics. (Certainly the known possibility of neurotoxicity from HO should give any parent contemplating this therapy for autism pause.) However, there are also studies that suggest decreases in regional cerebral bloodflow in autistics, but the significance of these findings are unclear. Even if these results are consistent and confirmed, it does not necessarily follow that hyperbaric oxygen will do anything to reverse the pathophysiology. In any case, my team looked and looked and couldn't find one trial, one scientific paper, or one bit of convincing evidence that it does anything. Only testimonials. A PubMed search on "hyperbaric oxygen" and "autism" fails to turn up a single hit. They also couldn't find any evidence that HO can reduce the effects of aging, either.
Autism is a neurodevelopmental disorder currently affecting as many as 1 out of 166 children in the United States. Numerous studies of autistic individuals have revealed evidence of cerebral hypoperfusion, neuroinflammation and gastrointestinal inflammation, immune dysregulation, oxidative stress, relative mitochondrial dysfunction, neurotransmitter abnormalities, impaired detoxification of toxins, dysbiosis, and impaired production of porphyrins. Many of these findings have been correlated with core autistic symptoms. For example, cerebral hypoperfusion in autistic children has been correlated with repetitive, self-stimulatory and stereotypical behaviors, and impairments in communication, sensory perception, and social interaction. Hyperbaric oxygen therapy (HBOT) might be able to improve each of these problems in autistic individuals. Specifically, HBOT has been used with clinical success in several cerebral hypoperfusion conditions and can compensate for decreased blood flow by increasing the oxygen content of plasma and body tissues. HBOT has been reported to possess strong anti-inflammatory properties and has been shown to improve immune function. There is evidence that oxidative stress can be reduced with HBOT through the upregulation of antioxidant enzymes. HBOT can also increase the function and production of mitochondria and improve neurotransmitter abnormalities. In addition, HBOT upregulates enzymes that can help with detoxification problems specifically found in autistic children. Dysbiosis is common in autistic children and HBOT can improve this. Impaired production of porphyrins in autistic children might affect the production of heme, and HBOT might help overcome the effects of this problem. Finally, HBOT has been shown to mobilize stem cells from the bone marrow to the systemic circulation. Recent studies in humans have shown that stem cells can enter the brain and form new neurons, astrocytes, and microglia. It is expected that amelioration of these underlying pathophysiological problems through the use of HBOT will lead to improvements in autistic symptoms. Several studies on the use of HBOT in autistic children are currently underway and early results are promising.
The International Hyperbarics Association, Inc. is an educational and charitable organization focusing on the needs of the hyperbaric community. Members come to us from all facets of the medical field, ranging from medical centers treating the hyperbaric needs of their patients, to individual hyperbaric chamber users, to corporate chamber manufacturers.
Multiple studies have found that autism is characterized by cerebral hypoperfusion which correlates with many core features including repetitive, self-stimulatory, and stereotypical behaviors, and impairments in communication, sensory perception, and social interaction. Hyperbaric oxygen therapy (HBOT) can help overcome cerebral hypoperfusion by providing more oxygen to the brain.
The shame of it is that the message parents are getting from the affluent west is that money buys a cure. So they pay for expensive "therapies" like HBOT and chelation while AFA struggles to find the money for its education programme, which is much cheaper and, more to the point, actually works.
To determine if HBOT improves symptoms in autistic children, a double-blind placebo controlled study is needed.
One of the most appalling ideas to come out of autism quackery is so-called, "hyperbaric oxygen therapy," also known as HBOT or mHBOT, the "m" standing for "mild." True hyperbaric oxygen therapy (also known as High Dose Oxygen Therapy) is known to be useful in a few conditions, but it's a dangerous thing in the hands of untrained personnel. Some of the real HBOT chambers are like rooms and can accomodate several people inside. Here's a good way of telling if a hyperbaric oxygen chamber is the real kind or not: real hyperbaric oxygen chambers don't have zippers.
Public discussion on HBOT. Includes DAN! Doctor James Neubrander's defense of HBOT.
Opinions expressed by the authors of pages to which this site links do not necessarily reflect this site developer's opinions.
In other words: Sublime or ridiculous? You decide!
Copyright © 2004-2008, Kathleen Seidel. All rights reserved.
This page was last updated on 5 November 2008, 3:48 pm
Hosted by TextDrive