Remember ME - You Me and Dementia

Friday, January 11, 2008

Brain stimulation “awakens” near-unconscious patient

A new brain stimula­t­ion treat­ment awak­ened a pa­tient from a near-veg­e­ta­tive state, re­search­ers re­ported.

“The pre­vi­ously non-verbal pa­tient be­came ca­pa­ble of nam­ing ob­jects and us­ing ob­jects with his hands — for ex­am­ple, bring­ing a cup to his mouth,” wrote Mi­chael N. Shadlen and Roozbeh Kiani of the Un­ivers­ity of Wash­ing­ton Med­i­cal School in Se­at­tle, Wash. in the Aug. 2 is­sue of the re­search jour­nal Na­ture. “More­o­ver, he could swal­low food and take meals by mouth,” re­mov­ing his de­pend­en­cy on a feed­ing tube.

Shadlen and Kiani have fol­lowed the case but were not in­volved in the treat­ment, which was per­formed by Nich­o­las Schiff of Weill Cor­nell Med­i­cal Col­lege in New York and col­leagues.

Peo­ple in a min­i­mally con­scious state are those who, be­cause of se­vere brain dam­age, can’t in­ter­act with oth­ers, be­yond some­times fol­low­ing sim­ple com­mands, such as re­quests to blink their eyes or raise a hand. No ef­fec­tive treat­ments are known to date.

Schiff and col­leagues im­planted elec­trodes in­to the brain of a 38-year-old ma­le, six years af­ter he suf­fered a se­vere brain in­ju­ry that re­sulted in a min­i­mally con­scious state. The elec­trodes were used to stim­u­late an ar­ea known as the thal­a­mus, on both sides of the brain, which has been sug­gested to have a role in arous­al.

Schif­f’s team surmised that the pa­tient’s prob­lem might be due to an “im­pair­ment of the arous­al sys­tem it­self,” and the treat­ment was aimed at im­prov­ing this, Shad­len and Ki­ani wrote. The team’s find­ings were pub­lished in the same is­sue of the re­search jour­nal.

Schiff and col­leagues cau­tioned that it’s un­known to what ex­tent their re­sults might apply to oth­er pa­tients, who might have dif­fer­ent types of in­ju­ries. But the find­ings should mo­ti­vate fur­ther re­search in­to the mech­a­nisms of re­cov­ery, they wrote.

De­bates over the amount of con­sciousness pre­s­ent in var­y­ing de­grees of veg­e­ta­tive states fed into the contro­versy over Ter­ry Schi­avo, a brain-dam­aged Flor­i­da wom­an who died when doc­tors dis­con­nect­ed her feed­ing tube in 2005. Schi­avo’s of­fi­cial di­ag­no­sis was per­sist­ent veg­e­ta­tive state. But her par­ents—who had fought a le­gal bat­tle to keep her alive ar­ti­fi­cial­ly—and their sup­port­ers ar­gued that she was in a min­i­mally con­scious state.


Forget yourself for others, and others will never forget you.

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