September 13, 2007

Man Awakens After Six-Year Coma

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After being severely beaten during a mugging in 1999, a man spent six years in a minimally conscious state, virtually unable to communicate with others and eating through a feeding tube. Now 38, that man is not only able respond to commands and feed himself, but has also regained some characteristics of his personal identity after having his brain stimulated by electric currents.
“His speech has improved, he is regaining aspects his personhood and he is beginning to regain aspects of his personality,” said Prof. Joseph Fins, medicine, who collaborated with several doctors on the study. “He can eat three meals a day by mouth, say short sentences and recite the first 16 words of the pledge of allegiance.”
In the procedure, two electrodes were inserted on both sides of the man’s brain and were then used to stimulate the thalamus. A pacemaker was also inserted in his body to provide the electric current, which continues to stimulate the thalamus for 12 hours a day.
The results indicate that the frequency of specific cognitively mediated behaviors, functional limb control and oral feeding increased during periods in which the brain was being stimulated as compared to when it was not, according to the article, “Behavioral improvements with thalamic stimulation after severe traumatic brain injury” published by the researchers in the journal Nature on Aug. 2nd.
“We interpret the [deep brain stimulation] effects as compensating for a loss of arousal regulation that is normally controlled by the frontal lobe in the intact brain,” the article stated.
The therapy, known as deep brain stimulation, is typically used to treat patients with drug-resistant Parkinson’s, according to Fins.
The man was selected based on the condition of his brain and the type of brain injury he had. He had a traumatic brain injury as opposed to one caused by oxygen deprivation.
“We didn’t choose a particular patient, the key point is that he fit the criteria, which is based on the notion of inactivated intact neural circuits. We wanted to activate them,” Fin said.
The man is the first of 12 patients to participate in the trial study of deep brain stimulation on patients who live in a minimally conscious state. MCS is characterized by intermittent evidence of awareness of self or the environment, according to the article in Nature.
About 100,000 to 300,000 Americans subsist in states of partial consciousness, according to the Associated Press.
“This study is a promissory note for classifications that had been marginalized and unmitigated. We have to pay more attention to these populations and fund more research so we can progress and determine how to predict who will respond and how they will respond,” Fins said.
However, researchers stress that although the results show promise, the study has only been conducted on one patient thus far.
“It is not a therapy [for MCS patients] and the trial has to be repeated. I am delighted with the results, but it is still the beginning of the investigation,” Fins said.
The study also raises ethical questions about whether such a procedure should be conducted on a patient who is unable to make that decision.
“I don’t think that there is an ethical dilemma. Because he was in a minimally conscious state he would have had to have someone in his family serve as a proxy, and the doctors would have explained the procedure,” explained Ugo Ihekweazu ’08, editor in chief of the Ivy Journal of Ethics. “In any procedure the doctors have to disclose the risks involved and what side effects can come from it.”
Fins worked with Prof. Schiff, neurology, who served as principal investigator; Joseph Giacino, associate director of neuropsychology at JFK Johnson Rehabilitation Institute and the New Jersey Neuroscience Institute; and Dr. Ali Rezai director of the Center for Neurological Restoration, Cleveland Clinic on the research.