Audio: How it works | Mum: ‘My boy came back’
Mother’s plea: `Don’t give up hope’
A man who spent six years unable to talk, eat or walk as a result of severe brain damage has made a remarkable recovery thanks to a revolutionary implant of electrodes deep in his brain.
|The American man can now use words and gestures
The 38-year-old had been written off by one doctor as a vegetable but he is now able to talk, laugh, drink, chew and carry out simple tasks such as brushing his teeth.
The man had been left in a “minimally conscious state” after being beaten up and robbed. He was unable to speak audibly and could only communicate by a nod, or tiny eye or finger movements.
He was also unable to chew or swallow, and had to be fed through a tube. His eyes mostly remained shut.
But after two electrodes delivered pulses of electricity to arouse his brain, he can now use words and gestures, respond reliably to requests, eat normally, drink from a cup, and carry out simple tasks such as brushing his hair, though his muscles have wasted and contracted so it is uncertain he will ever walk again.
The American patient’s family has requested that he not be identified, but speaking today his mother said: “I prayed for a miracle The most important part is that he can say ‘Mummy and pop, I love you’. God bless those wonderful doctors. I still cry every time I see my son, but it is tears of joy.”
She described him, the oldest of her three sons, as “an all around good kid” who loved to draw, collected comic books and worked with his father.
Then one night in 1999, while walking home, “he was assaulted, he was robbed, he was beaten, he was kicked about in his head. His skull was completely crushed in and he was left for dead”.
After emergency surgery, a doctor told her: “If your son pulls out of this, he will be a vegetable for the rest of his life.”
Eventually, she gave a “do not resuscitate order” to doctors because the prospect of change seemed hopeless.
Then in 2005, he had the chance to take part in the pioneering brain stimulation trial, the culmination of a decade’s work by a team at the JFK Johnson Rehabilitation Institute-Centre for Head Injuries, New Jersey; the Cleveland Clinic; and Weill Cornell Medical College, New York City, led by Dr Nicholas Schiff.
Today, he enjoys a quality of life his mother never thought possible.
The breakthrough in artificial arousal will raise hopes that up to 300,000 such patients worldwide, including around 2,500 in Britain, who are written off as untreatable.
Many could, in theory, be coaxed back to awareness in the wake of tomorrow’s report in Nature that could also shed light on consciousness.
However, this research will stir guilt among doctors and anger from relatives about what one ethicist describes as “therapeutic nihilism”, where the medical establishment has, in effect, held up treatments by dismissing these cases as hopeless and abandoning them in nursing homes.
Equally, the study will raise false hopes that all brain damaged patients could now be revived, when the possibilities depend on the extent of damage.
The minimally conscious state is distinct from a persistent vegetative state or coma, in that patients do show intermittent signs of awareness and may fleetingly attempt simple words or signals.
The new approach was developed when lead author Dr Schiff saw scanner studies that suggested language brain centres of patients were sometimes intact.
In such patients, his team wanted to arouse the central thalamus, the gateway between the brain stem that controls involuntary functions such as breathing and the cortex, where conscious is thought to reside.
They used deep brain stimulation, DBS, that, to date, has been used on around 40,000 patients worldwide in treating Parkinson’s, epilepsy, depression and other problems.
The hope that one millimetre electrodes could “jump start” brain areas though they admit exact how it works remains mysterious.
The electrodes, which are powered by a battery pack implanted in the chest, were moved in to position in the thalamus with millimetre precision in a 10-hour, two-stage operation by Prof Ali Rezai.
They saw the striking results of activation, when the patient’s eyes opened and focussed on those around him.
The implant was carried out in February 2005 and the brain continues to be stimulated by the electrodes.
Now the patient can manage the first 16 words of the US Pledge of Allegiance, without being helped, and the team expects to see further improvement, notably after surgery to improve his ability to move. The team hopes to carry out the operation on a dozen patients in a preliminary trial.
“If this achievement is replicated, its success could usher in a whole new era for the treatment of patients in MCS,” said co-author Dr Joseph Fins, Chief of the Division of Medical Ethics at Weill Cornell Medical College.
“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’.”
Dr Adrian Owen of the MRC Cognition and Brain Sciences Unit, Cambridge, who has done pioneering work with scanners to show that patients in this state can respond to spoken commands, said: “This study is a real landmark; patients in the so-called minimally conscious state following traumatic brain injury who remain in that condition for more than a year are widely considered to be completely untreatable.
“This study shows that may not be true in all cases. In the case reported here, deep brain stimulation promoted some late functional recovery years after the injury, allowing the patient to recover his ability to interact consistently with family members and even to play an active role in his own treatment.
“This type of treatment is extremely complex, not suitable for all patients in MCS and only possible in a limited number of centres in the world so it will be a while before we see it used widely. However, this is a major first step.”
The patient’s mother gave a message today to “all the mothers out there” with sons and daughters trapped in the same state: “Don’t give up – there is hope.”