Preprint Hyperbaric oxygen therapy improves clinical symptoms and functional capacity and restores thalamic connectivity in ME/CFS, 2025, Kim, Scheibenbogen+.

SNT Gatchaman

SNT Gatchaman

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Hyperbaric oxygen therapy improves clinical symptoms and functional capacity and restores thalamic connectivity in ME/CFS
Laura Kim; Guido Cammà; Claudia Kedor Peters; Maron Mantwill; Oliver Müller; Nadège Leprêtre; Cornelia Heindrich; Rebekka Rust; Moritz Krill; Tim J Hartung; Lukas Reeß; Stephan Krohn; Christian von Heymann; Kirsten Wittke; Carsten Finke; Carmen Scheibenbogen

BACKGROUND
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disorder characterized by profound fatigue, cognitive impairment, autonomic dysfunction, and exertional intolerance with strongly impaired physical functioning. Hyperbaric oxygen therapy (HBOT) has been proposed as a potential treatment, but its effects on ME/CFS patients remain largely unexplored. This study aimed to evaluate the effectiveness and feasibility of HBOT in ME/CFS patients and to investigate its effects on functional brain changes.

METHODS
30 ME/CFS patients (mean age: 42.3 ± 11.7 years; seven males, 23 females) received 40 HBOT sessions each. Outcomes were assessed at baseline, during treatment, and four weeks post-treatment. The primary outcome was change in the Physical Functioning subscale of the Short Form-36 Health Survey (SF-36 PF). Secondary outcomes included severity of core symptoms assessed via questionnaires, exercise capacity, handgrip strength, cognitive performance, orthostatic intolerance, and brain MRI (volumetry and functional connectivity, (FC)). Thirty age-and sex-matched healthy controls (HCs) (mean age: 42.3 ± 11.3 years; seven males, 23 females) were included for MRI comparison.

FINDINGS
In the linear mixed model, SF-36 PF significantly improved during HBOT compared with baseline (g = 0.71, p = 0.006). SF36 pain (p = 0.002, g = 0.79) and CFQ fatigue showed clinically meaningful reductions (p < 0.001, g = -0.87) during HBOT. Exercise capacity (g = 0.66), muscle strength (g = 0.40), and information processing speed (g = 0.52), all improved significantly after HBOT compared to baseline (all p < 0.05). Treatment adherence was high, and tolerability was favorable, with no major side effects reported. Functional MRI analyses revealed increased thalamic FC in ME/CFS patients compared to HCs in bilateral sensorimotor (p < 0.001, t = 5.65, FDR-corrected) and visuo-occipital regions (p < 0.001, t = 5.4, FDR-corrected) at baseline. After HBOT, thalamic hyperconnectivity normalized. Responders (defined as a ≥ 10 point increase in SF-36 PF) showed greater reductions in thalamic hyperconnectivity than non-responders (p < 0.001, t = -4.34 to -5.18, FDR-corrected).

INTERPRETATION
HBOT was well-tolerated and was associated with significant improvements in physical functioning, fatigue, pain, and cognitive performance and provides the rationale for a controlled trial in ME/CFS to confirm therapeutic efficacy. The normalization of thalamic hyperconnectivity following HBOT and its association with clinical response highlights the role of thalamic FC in ME/CFS pathophysiology and underscores the need for larger, controlled trials in ME/CFS to confirm therapeutic efficacy.

FUNDING
Funded by The Federal Ministry of Education and Research (NKSG, 01EP2201), the Klinik Bavaria Kreischa, and the Weidenhammer Zoebele Research Foundation.

Web | PDF | Preprint: MedRxiv | Open Access
 
Utsikt said:
They also had to be healthy enough to complete 40 session in 8-16 weeks.
Click to expand...

You'd need to be healthy to do that many dives. It's very noisy and tiring, and as you're not usually in the chamber alone there's a bit of interaction too.

A friend with MS wanted to try it at a local centre, but didn't want to go on her own. I'm always up for novel experiences, so I said I'd go with her (they allowed people with ME/CFS to use the chamber). We did two dives a week until she felt okay about going without me.

The only effect it had on ME/CFS was to cause PEM. It wasn't too bad, but I can't imagine anyone with severe symptoms being able to tolerate it. The effect is similar to sitting in a cramped train carriage going through a tunnel for 40 minutes, while also breathing in a different way to usual—not horrible, but you're quite looking forward to getting out by the end.
 
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There isn't always a HBOT chamber close by. I live in a relatively high density population area and still, the nearest one is 20 miles away. It is heavily used by MS patients but they put my name as a patient with ME on their waiting list. I never heard further.

Now, that is too far because I can no longer travel independently and I would not be healthy enough to participate.
 
They excluded the 7/37 participants who dropped out
They do not compare results to a control group
The participants received 40 sessions, which seems quite a lot

And still the improvement was only 6.3 points on the SF-36 PF (a clinically meaningful improvement was defined as 10 points)

So it looks like the trial strongly showed that hyperbaric oxygen therapy probably doesn't work in ME/CFS.
 
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