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Brain-injured man 'jump started' awake

brain electrodes

These electrodes delivered electrical impluses deep into the brain, effectively 'jump starting' existing circuits (Image: Cleveland Clinic)



The man's awakening may change the way doctors think about people with severe brain injuries, who are largely unresponsive but still have some level of consciousness.

These patients typically spend the rest of their lives in nursing homes, with little efforts at rehabilitation and slim chance of recovery.

"This is a group of patients that are really, in many ways, forgotten about," says Dr Ali Rezai, director of the Cleveland Clinic's Center for Neurological Restoration.

"We have to do more research, obviously, but I think down the line it will change the way we are treating or even looking at people with severe brain injury."

Rezai and a team of specialists from the JFK Johnson Rehabilitation Institute in New Jersey and the Weill Cornell Medical College in New York detail the patient's progress in the journal Nature.

The doctors used computer-generated maps, image-guided navigation and 3D mapping of the brain to manoeuvre electrodes to areas deep in the brain.

They targeted the central thalamus, a region that helps adjust brain activity to match cognitive demands.

They then connect the leads to programmable pacemaker batteries, implanted in the chest.

Boosting existing brain function

People in a minimally conscious state show occasional signs of awareness and may even attempt, fleetingly, to communicate using simple sounds or signals.

Such activity points to the existence of a still-functioning brain network in which, in theory, the thalamus would play a key regulatory role.

"Our theory was that electrical impulses targeted to this area would help amplify the existing low level of activity that we thought was already there," says Dr Joseph Giacino, a neuropsychologist at JFK Johnson Rehabilitation Institute and the New Jersey Neuroscience Institute.

"In other words, we assume that the signals that help drive speech and movement are still present in the brain; we're just 'bumping up' their efficiency and function, to help get them working better."

Before his injury, the man loved to draw, collected comic books and fancied movies about superheroes.

But after he was attacked and robbed in 1999, he spent the next five years in a nursing home with no hope of recovery.

He would occasionally mouth the word 'yes' or 'no', but could not communicate reliably or eat on his own.

His parents agreed to try the experimental treatment in August 2005, and doctors saw immediate results.

He was alert and could move his head to follow voices. He can now drink from a cup, recall and speak 16 words, and watch a movie.

Rezai says he is engaged with his family, playing cards with his mother and taking short trips outside the facility.

Because of years of immobility, he may never walk.

"He still has got a long way to go, but given where he was, he is dramatically improved," Rezai says.

The man is the first of 12 patients who will undergo the treatment as part of a pilot study approved by the US Food and Drug Administration.

The authors stress they do not know whether other minimally conscious patients will respond to such deep-brain stimulation as they may have different types of brain injury and levels of responsiveness.

Deep-brain stimulation is routinely used to improve symptoms in people with Parkinson's disease, and trials are under way in the US for using it to treat epilepsy, obsessive-compulsive disorder and depression.

Tags: health, science-and-technology, biology, neuroscience