Multiple Sclerosis
I have been involved in the controversy over the use of more oxygen for MS patients since 1981 and all is not what it seems. It would be difficult to find a more convincing reason for increasing the oxygen dosage than in the disease process which underlies the formation of the scars. It begins as an acute swelling around veins in the nervous system and this process can be observed directly in many patients during acute attacks in the retina. The dispute over the etiology of the disease between the proponents of a vascular basis and the rest e.g. autoimmunity, goes back to the 1860's. (Rindfleisch and Charcot) but the evidence of blood vessel involvement is consistently ignored. Ian McDonald - who has just retired as Professor of Neurology at the National Hospital in London stated in 1986. "The occurrence of vascular lesions in an unmyelinated region (the retina) provides support for the view that the vascular changes in multiple sclerosis are primary and not as some have suggested secondary to myelin breakdown." Optic Neuritis. eds Hess RF, Plant GT. Cambridge University Press 1986 p47. ISBN 0 521 30247 1. Multiple and sclerosis describe the presence of scarring in the CNS - the end result of the attempts of the nervous system to heal. The trials of the use of oxygen at addtional pressure selected patients whose disease durations were typically 15 years.
This is nonsense as magnetic resonance spectroscopy has demonstrated lack of oxygen in the areas affected at the onset. (Lancet 1991;337:58). However if the patient has only one area affected then they do not have MULTIPLE areas of sclerosis and must wait a minimum of a month to qualify under the "diagnostic criteria" for multiple sclerosis. The neurologists response to the evidence from the controlled studies of oxygen therapy was less than enthusiastic, despite positive findings in patients with end stage disease. It is necessary to study history to understand the powerful factors that shape medical opinion and there is no better starting point than the story of Semmelweiss and the controlled trial related to the etiology of childbed fever in Vienna. I will be posting an article about the Fischer trial from the New England journal of Medicine on the list soon, but if you want an object lesson in medical prejudice read the isssue of the journal that carried the results - Jan 27 1983 vol 308 and the editorials.
Dr. Philip James, Wolfson Hyperbaric Medicine Unit
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