Hyperbaric Oxygen Therapy for Cerebral Palsy: Definition and Principles

Hyperbaric oxygen therapy involves the inhalation of 100% oxygen inside a hyperbaric chamber pressurized to greater than 1 atmosphere (atm), which is atmospheric pressure at sea level. While there are a number of indications cleared by the FDA for hyperbaric oxygen therapy, it has been used off-label for patients with cerebral palsy, based on the theory that dormant neurons may respond to the treatment. Treatment approaches are not standardized, though generally children have been given a total of 20–40 sessions of 1 h each, with hyperbaric oxygen at 1.5–1.7 atm. While observational and nonrandomized studies suggested potential efficacy of hyperbaric oxygen therapy in children with cerebral palsy, most commonly on gross motor function, randomized controlled trials showed hyperbaric oxygen therapy not to be superior to placebo/ sham treatments. These trials have provoked controversy because of the choice of control groups. Middle ear complications are common, though more serious complications including seizures and pulmonary complications are less common. Current data are insufficient to support the use of hyperbaric oxygen therapy in children with cerebral palsy.