Nervous system

Using modern techniques, the incidence of neurological complication is very low. In the cases of focal brain necrosis, corticosteroids can allow improvement. Sometimes the evacuation of necrotic focus is necessary. In adults, the use of HBO is reported in some contradictory case reports246,247. In children, Chuba248 reported 10 cases of brain necrosis treated with HBO. Patient age ranged from 4 to 23 years (median 12 years); all of them presented with new or increasing neurological deficits, associated with imaging changes. For 8 patients, necrosis was histologically proved. The 10 patients received 20 to 40 sessions (2-2.4 ata, 90 to 120 minutes). Initial improvement or stabilization occurred in all patients. For the 6 patients still alive (4 died of tumour progression) at follow-up (median 19 months), the benefit of HBO was durable. However the authors were unable to determine the relative effects of steroid therapy used in combination with HBO.

There is no curative treatment of peripheral nerve damage. Narcotics, corticosteroids and physiotherapy are used. Surgical procedures as neurolysis give uncertain results . Some cases reports of successfully treated

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patients with HBO have been published235,249. No randomised trial has shown the efficiency of HBO. A double blind randomised trial (34 patients) showed no evidence that HBO slows or reverses brachial plexopathy (12 months follow-up), in spite of improvements in sensory threshold250.

No treatment of myelitis has shown to be effective in the long term. The administration of corticosteroids allows a transient improvement of neurological symptoms. In animal, HBO showed no benefit in the treatment251, but should be interesting for prevention252. HBO has been used

in case report253 and retrospective trial227, but has not shown its interest in controlled trials.

The data from the literature concerning the efficacy of HBO in the treatment of neurological side effects in radiotherapy is scarce. The negative result of a randomised study does not therefore recommend its use in the treatment of plexopathy250. The level of evidence of efficacy in the treatment of complications of the central nervous system is very weak.

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