Brain Stimulation Rouses Minimally Conscious Man

Aug. 1, 2007— -- For six years, the patient lay silent -- unable to move, eat or speak after suffering a traumatic brain injury from a blow he received to his head during a robbery.

When conventional attempts to rouse him from his minimally conscious state proved unsuccessful, doctors tried a novel and experimental approach. They inserted long, thin electrodes deep into the patient's brain.

Almost immediately after the first day of treatment, the 36-year-old man became more alert, shifting his eyes around the room to follow the movements of doctors and his loved ones.

Gradually, over the six-month course of the treatment known as deep brain stimulation, other improvements followed.

The patient was able to sit up and eat food that was fed to him. He could respond consistently to questions by mouthing yes or no. He could drink out of a cup. And, best of all, he began to speak, telling his mother and father that he loved them.

"After the procedure was over with, he can watch a movie without falling asleep. He can drink, he can laugh and cry," said the patient's mother during a teleconference Wednesday morning. Neither she nor her son was identified to the press. "I still cry every time I see my son, but now it's tears of joy."

The science behind this stunning recovery was published Wednesday in the journal Nature.

Researchers implanted tiny electrodes controlled by an external brain pacemaker into the brain of the patient, which functions like a pacemaker for the heart.

The electrodes were turned on for 12 hours a day, and shut off for the other 12 hours.

Before this experiment, the therapy had been used in patients with severe Parkinson's disease, as well as for people with anxiety disorders or who suffered a loss of hearing. But this was the first time that deep brain stimulation had helped someone in a minimally conscious state.

"Minimally conscious patients cannot communicate," said lead study author Nicholas Schiff of the Weill Cornell Medical College department of neurology and neuroscience during the teleconference. "One of the reasons we thought patients in this state would benefit from DBS is that they showed that the intrinsic systems may still be there, and could be restored."

In contrast to patients in a persistent vegetative state, minimally conscious patients show signs of arousal and knowledge of their environments but only in a limited way.

The researchers estimate that 112,000 to 280,000 such patients are in the United States. These patients with little hope of recovery are often relegated to nursing homes.

"This work is really about the patients with traumatic brain injuries," said Dr. Ali R. Rezai, the Cleveland Clinic neurosurgeon who performed the operation to implant the electrodes. "This group of patients are often young people, forgotten about by everyone except their families and caregivers. It is our responsibility to continue to explore all the ways of treating them."

Demystifying Deep Brain Stimulation

Deep brain stimulation has already been used in 35,000 to 40,000 patients to treat a variety of neurological problems, from Parkinson's to hearing loss. Doctors who use the technique say that it makes sense that the electrical stimulation would work to help patients in a minimally conscious state.

"DBS masks certain pathological patterns of electrical activity in the brain and replaces them with more regular patterns," said Warren M. Grill, associate professor of biomedical engineering at Duke University. He said that deep brain stimulation often works better than drugs in patients with neurological disorders.

"It's similar to having bad information in the circuits, and we replace it with no information -- and the symptoms are relieved."

Other researchers agree that the results published today are promising.

"It's encouraging if over the six-year course of his illness, he didn't improve at all, and during the treatment he improved dramatically," said Dr. Ben Greenberg, associate professor of psychology at Brown University and Butler Hospital.

The researchers emphasized that their results with this patient are preliminary and that his full cognitive functions have not yet been tested. This is just the first patient, they said, adding that they had chosen 11 other minimally conscious patients to treat with deep brain stimulation.

The researchers hope that the patient continues to improve. During a recent checkup, he recited the first 16 words of the Pledge of Allegiance, showing that his long-term memory is still somewhat intact. Generally, the patient doesn't initiate conversations, but can reply to others, giving short answers.

For the patient's mother, the treatment has given her family another chance at life.

"I will never forget the day the surgeons told us that our son would be a vegetable for the rest of his life," she said, referring to the the time right after her son was assaulted and beaten.

"I would like to tell the other families out there, don't give up hope."