Article rank  CLEVELAND CLINIC 
 
Three-dimensional computer rendering depicts deep-brain stimulation electrodes
that U.S. researchers say helped a 38-year-old man, who had been unable to
communicate or feed himself for six years, emerge from a coma-like state. 

Implants awaken brain-injured man

NEURO 'PACEMAKER' Emerges from 6 years in coma- like state after new treatment

MARGARET MUNRO CANWEST NEWS SERVICE 
A 38-year-old U.S. man unable to communicate or feed himself for six years has
been reawakened from a coma-like state by tiny electrodes implanted deep in his
brain.


The man, incapacitated after an assault left him in a "minimally conscious
state," is interacting with family and friends, and gradually regaining more
control of his mind and body.


The family has requested anonymity, but the man's mother gave a tearful account
in a teleconference yesterday of how her son was declared a "vegetable" and
languished in a care facility after his skull was crushed and he was "left for
dead" following a robbery.


She thanked doctors for bringing back the eldest of her three sons, who had
loved music, drawing and comic books.


With the electrodes delivering weak electrical pulses to his brain for 12 hours
a day, she said he is once again connecting with the world. He can watch movies,
drink from a cup, cry, laugh, express pain and say: "I love you, mommy."


"I still cry every time I see him, but now it's tears of joy," she said.


The researchers, who describe the case in the journal Nature, say deep-brain
stimulation is opening the door to treatment of severe brain damage and might
eventually help thousands of families.


Dr. Ali Rezai, director of the Centre for Neurological Restoration at the
Cleveland Clinic, led the surgical team that implanted two electrodes in the
man's brain in 2005, wiring them to pacemaker batteries in his chest in a bid to
switch on undamaged regions of his brain. Rezai likens the result to a pacemaker
for the brain. The doctors charting the man's progress say the changes have been
"remarkable and sustained."


"He regularly uses words and gestures and responds to questions quickly," said
Dr. Joseph Giacino, co-leader of the study and associate director of the


Wired wonder: New Jersey Neuroscience Institute. The man, who lives in an East
Coast rehabilitation centre, no longer requires a feeding tube and can drink
from a cup and brush his hair. He routinely speaks in snatches of two and three
words and has been able to recite the first 16 words of the U.S. Pledge of
Allegiance.


While the man is good at engaging in the moment, the doctors say he has trouble
retaining new information and remembering what has happened from day to day.
Years of severe immobility also greatly limit his movements, and he is unable to
stand or walk, although the researchers are not ruling out the possibility that
he will be able to do so.


"His body now has to catch up with his brain," said Dr. Joseph Fins, chief of
medical ethics at New York's Weill Cornell Medical College, who is helping guide
the project.


The U.S. team plans to try the procedure on 11 more patients as part of a
government-approved trial. If successful, it could lead to re-evaluation of
countless people in the minimally conscious state. There is little reliable data
on how many people are in such a state, but the researchers said one study has
estimated there could be as many as 280,000 North Americans.


"It will force us to take a second look at each case and - for appropriate
patients - move away from the therapeutic nihilism that has so plagued this
population, most of whom are ignored, receiving what is euphemistically
described as 'custodial care,' " Fins said.


Observers caution that the procedure has so far only been shown to work in one
carefully selected patient and much more research is needed.


"It is impressive, but it is just the first step," said Dr. Elena Moro, the
neurologist in charge of deep-brain stimulation at Toronto Western Hospital.


The Toronto team, the largest group of its kind in Canada, implants deep-brain
stimulation electrodes in about 60 patients a year to treat movement disorders,
pain, epilepsy and, as part of a clinical trial, severe depression.


The probes target different regions of the brain depending on the disorder. Moro
said it is not clear how the electrical impulses work to reduce pain, restore
the ability to walk or, as appears to be the case with the U.S. man, to
reconnect individuals with the conscious world.


The U.S. researchers speculate that the electrical impulses are amplifying their
MCS patient's brain activity and are "bumping up" its efficiency.






 

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