Breathing life back into Doran

Brain-injured children may benefit from treatment in an oxygen chamber. So why isn't it available on the NHS? By Rita Carter

Twice a week 16-year-old Doran Scotson is sealed into a tank resembling a small submarine. This is then pumped full of air until it reaches nearly twice the normal atmospheric pressure. Inside the tank, Doran dons a mask and breathes pure oxygen for up to an hour at a time. According to Doran's mother, Linda, this bizarre ritual is doing for him something most doctors say is impossible: reversing severe congenital brain injury.

Children like Doran are generally regarded as beyond medical help. He is severely physically and mentally disabled, probably because he suffered oxygen deprivation at birth. But Linda Scotson claims the high-pressure oxygen treatment, known as Hyperbaric Oxygen Therapy (HOT) has produced a near-miraculous improvement in her son. She is so convinced it works that she has installed a hyperbaric chamber in her home and is using it to treat Doran and a few other brain-injured children who cannot get treatment elsewhere.

Before he began the treatment nearly two years ago, Doran's condition made it almost impossible for him to interact with the outside world, Mrs Scotson says. "He couldn't see clearly because he couldn't keep his eyes steady or focused; he couldn't stop his hands shaking and his speech was terrible because he couldn't control his breathing or get his tongue around words. Now he has so much control over his hands that his favourite hobby is taking apart and rebuilding cameras.

"He even phoned me up the other day. A year ago the idea that he would ever punch out a seven-digit number then make himself understood down a phone line would have been pure fantasy."

HOT has existed as a treatment since the 19th century and is a proven method of treating carbon monoxide poisoning, skin wounds, some multiple sclerosis symptoms and the divers' disease the bends. It is not available on the NHS for treating brain injuries because doctors say there is no evidence that it is effective. However, Richard A Neubauer, an American doctor working with stroke patients in Fort Lauderdale, Florida, claims that HOT can revive seemingly "dead" brain tissue and may even restore some brain-injured people to near normality. He backs his claim with a video that shows before and after shots of several patients - stroke and head injury victims as well as children with cerebral palsy - who appear to have benefited hugely from the treatment. His video includes scans of the patients' brains, which appear to show that dead areas of brain have come back to life. In one case, a stroke victim who has had the treatment is shown walking after 14 years in a wheelchair.

Dr Neubauer offers a plausible explanation for these apparently startling recoveries. HOT is thought to work by forcing extra oxygen into the blood, pushing toxic gases out of the system. Under high pressure, the capillaries become more porous, improving circulation around damaged cells such as wounds and skin ulcers, encouraging them to heal. British doctors say that extra oxygen cannot help dead brain tissue to mend because, unlike other parts of the body, brain cells cannot regenerate. But in many brain injury cases, says Dr Neubauer, the damaged cells may actually just be "sleeping" and, by using HOT to bathe them in oxygen, he claims they can be brought back to life.

"In normal atmospheric pressure, these cells get enough oxygen to survive and to tick over but not enough to fire and function as nerve cells," he explains. "HOT triggers them to start working again."

Dr Martin Hamilton-Farrel, who runs the hyperbaric unit for carbon monoxide poisoning and skin conditions at Whipps Cross hospital in north London, is sceptical. "I would dearly love to think that this treatment could work for brain-injured children, but I am very doubtful. I am also worried that desperate families might hear about these claims and spend a great deal of money on private HOT treatment that could do more harm than good. It can be risky, too. People sometimes panic in the chambers because they tend to get claustrophobic, and there are cases of epileptic fits being triggered in susceptible people."

Dr Philip James, a senior lecturer in occupational medicine at Dundee University, who has wide experience in treating divers with HOT and who trained Linda Scotson to operate the tank, dismisses any safety concerns. "HOT has been around for decades and it has probably been used more throughout the world than just about any medical treatment, bar aspirin," he says. "It is as simple and straightforward as washing your hands."

What they agree on is the need for a large-scale clinical trial to see if HOT really works for brain injuries. But this is unlikely ever to happen, least of all here. Hot is widely used in China, Russia and some European countries, but in Britain it is largely ignored even for those conditions for which it is known to work. For example, each year some 1,400 people die in the UK from accidental carbon monoxide poisoning and many of them might be saved if the emergency services were allowed to take them directly to HOT chambers, as happens in France.

As it is, even when poison victims do get taken to a chamber it is usually only after a long delay, which makes the treatment less effective. There is also a shortage of individual chambers. One family of four, who were discovered unconscious in their home after fumes escaped from their gas boiler, were duly taken to an NHS HOT unit (there are only five in the whole country) but then had to queue to get into the chamber.

So the prospect of a trial for HOT seems remote. Linda Scotson's enthusiasm, however, verges on the evangelical. She has spent years trekking around specialists who had little to offer in the way of effective treatment for her son. Like many such parents, she responded to the doctors' helplessness by making herself an expert on her child's condition in the hope of discovering something that orthodox medicine had overlooked.

She is so convinced HOT works that she has set up a charity, the Hyperbaric Oxygen Trust, aimed at making it easily and cheaply available to other brain-injured children. The trust, whose medical adviser is Philip James, plans to open its first clinic later this year in Dormansland, East Sussex.

"The more I read, the more I became convinced that the main problem with children like Doran is simple lack of oxygen," she says. "They all have this pinched, half-starved look. When I heard about hyperbaric oxygen I knew at once that I had to give it a go.

"You could see the difference from the very first treatment. When he came out of the chamber that first time he looked as though he had been filled out - pink and shining and glowing with health. It was as though, for the first time ever, he had been given what he needed - enough air."

For details of the Hyperbaric Oxygen Trust, send an sae to Linda Scotson, Ryton House, Primrose Lane, Forest Row, East Sussex RH18 5LT.