"Long before it's in the papers"
June 04, 2013


Brain stimulation “awakens” near-unconscious patient

Aug. 1, 2007
Courtesy Nature
and World Science staff

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

“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.

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