Doctors 'jump-start' man's brain - Patient had been minimally conscious
By Robert Mitchum
Copyright © 2007, Chicago Tribune
August 2, 2007
Doctors have succeeded in "jump-starting" the brain of a man who had been barely conscious for six years with electrical stimulation of the brain, making it possible for him to speak a little and take food by mouth, doctors reported Wednesday.
The 38-year-old man, whose identity was not released, had been in what is called a minimally conscious state for six years after suffering a brain injury during an assault. He retained some language capability but was unable to communicate reliably beyond brief gestures and silent mouthing of words. Usually, his eyes were closed, and he had no coordinated motor movements.
On Wednesday morning, the patient's mother tearfully described the improvements she has observed after electrodes were implanted in his brain.
"My son can now speak, watch a movie without falling asleep, drink from a cup," she said at a news conference. "He can express pain, can cry and laugh."
The authors of a case study published Thursday in the journal Nature and outside observers were quick to point out the therapy has been shown effective only in a single person. The technique is not likely to help people in a persistent vegetative state, they warned, and it is unknown to what extent the stimulation can help even other minimally conscious patients.
"It is way too early for us to know if this is actually going to be applicable to people who are in this situation," said Dr. Felise Zollman, medical director of the brain injury medicine and rehabilitation at the Rehabilitation Institute of Chicago, who was not involved in the study.
"We may find down the road that it adds to our toolbox in meaningful way and want to use it for a select group of folks, or we may find it has a very, very narrow application, and may not be relevant to many people at all."
Still, neurosurgeon Dr. Ali R. Rezai, a member of the research team from the Cleveland Clinic, called the achievement a new chapter in treating patients with brain injury. "Hopefully, we can reconnect people with loved ones," he said.
Deep brain stimulation involves the implantation of electrodes to inject electricity into select portions of the brain. The technique is already approved for the treatment of symptoms associated with Parkinson's disease and is in trials to test its effectiveness in treating epilepsy, obsessive-compulsive disorder and depression.
As with a pacemaker, the electrodes are implanted permanently and can be controlled remotely by doctors. The electrodes, placed in this case in a brain region called the thalamus, are turned on for 12 hours and off for 12 hours each day.
"Most likely we are activating areas of brain that were essentially depressed in activity as a result of this severe trauma," said Rezai. "In some ways we are jump-starting the brain, speaking simply."
"It's analogous to giving a drug that would cause arousal, waking one up from a drowsy or sleep cycle," said Dr. Richard Penn, a neurosurgeon at the University of Chicago not involved in the study, "though it's much more specific, as only a particular part of brain is being activated by it.
"But does it hold promise for lots of people? No one has any idea whatsoever," Penn added.
For the six years following the patient's injury, doctors said, he had shown no progress in his ability to communicate or orient toward objects in his environment consistently.
When the electrodes were implanted and activated in 2004, he immediately appeared more alert and moved his head toward people who were speaking. Since then, he has shown further improvement in speech, movement and the ability to swallow food.
"The most compelling change seen in the last six weeks is that he is able to say the first 16 words of the Pledge of Allegiance without prompting," said neurologist Dr. Joseph T. Giacino, an author of the study.
Now, the patient also is capable of coordinated movements such as bringing a cup to his mouth and brushing his hair, though some motor difficulties remain because of his long inactivity. He can chew and swallow food, whereas previously he had to be fed through a tube.
Even before his treatment, doctors described the patient as being in the "upper end" of minimal consciousness, very different from the more serious condition known as a permanent vegetative state.
"Someone who's in a vegetative state will open their eyes at certain times of day and look like they have a sleep/wake cycle, but have no interaction with environment," Zollman said. "They're awake, but not at all aware of their surroundings."
The amount of brain damage suffered in these patients and in many minimally conscious patients, is so severe that deep brain stimulation may not improve behavior, doctors said.
enn speculated that in addition to the fact that relatively few people may benefit from this technique, it is still at least several years away from being put into clinical practice.
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Deep brain stimulation involves surgical implantation of electrodes into a specific brain area, with the control box and battery placed in the chest. Side effects may include disrupted speech and emotional imbalance. It is approved by the FDA for treating these conditions:
*Dystonia (uncontrolled repetitive movements)
Ongoing clinical trials
are investigating its use