Hyperbaric oxygen therapy in cerebral palsy

Hyperbaric oxygen therapy (HBO) is the inhalation of 100% oxygen inside a hyperbaric chamber pressurized to greater than 1 atmosphere. This treatment has been approved for use in several indications including decompression sickness, carbon monoxide poisoning, severe burns, or chronic infections. HBO has been studied in cerebral palsy (CP), based primarily on the concept of improving oxygen availability to damaged brain cells with potential for recovery, even in after chronic injury. The evidence on HBO in CP is limited in precision, control groups, and methodological flaws. Three randomized controlled trials provide moderate strength of evidence that HBO does not improve gross motor function compared with slightly pressurized room air or wait-list controls, but these findings are controversial due to the nature of the control used (e.g., pressurized room air) and the limited number of patients studied. Observational before-after studies stimulate the interest in HBO for CP but are limited by methodological risk of bias. Adverse events of HBO include middle ear barotrauma, often requiring myringotomy and tube placement, and a potential increased risk of seizures. The use of HBO in CP remains controversial.