Implant Aids Man With Brain Injury
Deep Brain Stimulation Helps Patient in Minimally Conscious State to Talk, Eat Again
Aug. 1, 2007 -- Tomorrow's edition of the journal Nature includes
what doctors call the "remarkable" case of a brain-injured man helped
by deep brain stimulation.
The 38-year-old man had been in a "minimally conscious state" for
six years after suffering a severe traumatic brain injury in an assault. After
getting deep brain stimulation, he is now able to talk and eat on his own. His
family has requested that his name not be released.
A minimally conscious state is different from a coma or a persistent
vegetative state. Patients in a minimally conscious state occasionally show
signs of arousal and organized behavior, but they have a "profound deficit
in consciousness," states an editorial published in Nature.
Despite rehabilitation therapy, the man was nonverbal and couldn't swallow
or communicate reliably.
"He infrequently mouthed single words when prompted but could not
communicate yes/no responses reliably," write the researchers, who included
Nicholas Schiff, MD, of New York's Weill Cornell Medical College.
But the man's brain scans showed that while he had severe brain damage, some
of the networks within his brain were still intact.
Based on those brain scans, Schiff's team asked the man's family to let the
man try deep brain stimulation.
Patient Improves With Deep Brain Stimulation
The doctors surgically implanted electrodes in the man's brain, targeting a
brain area called the thalamus. Two days after surgery, the doctors turned the
electrodes on as an initial test of deep brain stimulation.
When they did that, the man was able to keep his eyes open longer than
before the surgery, and he was able to turn his head when someone spoke.
Over the next six months, the doctors gradually gave the man deep brain
stimulation. He gained the ability to chew and swallow food and to talk more,
even occasionally saying sentences up to six words long.
The man's improvements didn't disappear on days when he didn't get deep
brain stimulation, and his ongoing rehabilitation therapy didn't appear to
explain his progress, note the researchers.
Schiff and colleagues caution that other patients with severe traumatic
brain injuries may not respond the same way to deep brain stimulation.
They call for further studies on deep brain stimulation for patients
with severe traumatic brain injury.
Patient's Mother Speaks
In a Weill Cornell Medical College news release, the patient's mother
states, "My son, as well as the entire family, had little hope of further
recovery. If it were not for the deep brain stimulation surgery and
rehabilitation, we would be no further along than we were in 1999. Now my son
can eat, express himself, and let us know if he is in pain. He enjoys a quality
of life we never thought possible."
The results "raise hope," but "not all patients with disorders
of consciousness will benefit from thalamic stimulation," states the
editorial in Nature.
"Neuroscience is beginning to stitch together the neurologist's and the
philosopher's ideas of consciousness. It is wonderful to see the fruits of this
research help one patient. We hope that further studies will advance our
knowledge and help more patients,' write the editorialists.
They included Michael Shadlen, MD, PhD, a professor of physiology and
biophysics at the University of Washington in Seattle.