Author: Raja Harish
Date: August 2007
Deep brain stimulation (DBS) may help patients with severe brain injuries who are in the minimally conscious state (MCS). This comes after a team of researchers led by Dr. Nicholas Schiff of Cornell University and Joseph T. Giacino of the JFK Johnson Rehabilitation Institute and the New Jersey Neuroscience Institute, in conjunction with a team from The Cleveland Clinic Foundation, achieved dramatic results with the technique. They reported their work in last week's issue of Nature.
DBS, a procedure where wires are surgically implanted to stimulate specific areas of the brain, is not new to medicine; in fact, physicians have long used the implant surgery to treat Parkinson's disease. Unfortunately, traditional attempts with DBS to help patients with profoundly damaged brains have yielded little success to date. However, the new study acknowledges that patients in the MCS may indeed benefit from stimulation treatment. MCS is differentiated from coma and vegetative state in that the patient retains partial awareness of the surrounding and self.
The study involved a 38-year-old man who, during a 1999 street mugging in which he was repeatedly kicked in the head, suffered severe brain injury. At the time of intervention, the patient, who had been confined to bed in a long-term care facility, was unable to communicate, followed verbal commands inconsistently, infrequently mouthed incoherent words, had increased reflexes, and spasticity in all limbs and had no spontaneous voluntary movements.
So far, the surgery's results have been promising. During an initial therapy session, the patient became more responsive. His eyes opened and, over several months, he has displayed a gradual but consistent improvement in speech and movement when the machine is activated relative to when it is turned off.
"We really see this as a first step, but it should open doors that have not been open before for patients like this," said Giacino, acknowledging that the technique is promising but still in its infancy.
Although scientists are optimistic about the surgery, there are still potential concerns. For instance, experts point out that the study relies on the results of only one participant so the results cannot be generalized. Furthermore, there are ethical questions that could arise regarding how to treat patients who are unable to give consent.
Even still, the surgery is uplifting news for the estimated 100,000 to 300,000 Americans who live in partial consciousness everyday because of severe brain injuries. For them, there is finally hope.
Concerning the 38-year-old man, "he has regained his personhood, his personal agency," said Dr. Joseph Fins of Cornell University, speaking of the study's patient.
By: Harish Raja