Deep brain stimulation a miracle for man with severe brain injury

Aug 1 2007

In what must seem to his family to be a miracle, a man who had been in a near-vegetative state for six years has regained the ability to use words and gestures, chew and swallow and drink from a cup.

The 38-year-old was attacked and robbed in 1999, his skull completely crushed and he was left for dead.

Prior to his injury, the man loved to draw, collected comic books and enjoyed films about super heroes; following the attack the severe brain injuries he sustained left him unable to communicate beyond gestures indicating yes and no, and he was unable to feed himself.

The next five years were spent in a nursing home with no hope of recovery.

But in August 2005 experimental treatment using a brain pacemaker to deliver deep-brain stimulation was tried which sent impulses into the part of the brain regulating consciousness.

The researchers alternated periods of electrical stimulation with fake stimulation over a six month period to assess whether it was having an effect.

Within 48 hours the man became alert and able to move his head and to follow voices; though progress has been slow, several treatments have enabled him to drink from a cup, chew and swallow food, recall and speak 16 words, and watch films.

Rezai said he is now engaging with his family, playing cards with his mother and taking short trips outside the facility, but he may never walk because of years of immobility.

Dr. Ali Rezai, director of the Cleveland Clinic's Center for Neurological Restoration says although more research is needed the experiment could change the way people with severe brain injury are treated.

Dr. Rezai says patients with severe brain injuries, who are largely unresponsive but still have some level of consciousness are in many ways, forgotten and all too often are given little rehabilitation and a slim chance of recovery.

Rezai and a team of specialists from the JFK Johnson Rehabilitation Institute-Center for Head Injuries in Edison, New Jersey, and the Weill Cornell Medical College in New York used a device similar to a heart pacemaker.

The device is implanted in the chest under the skin and electrodes deliver stimulation to precisely targeted areas deep in the brain.

The researchers believe the electrical stimulation enhances the brain circuits that are still capable of functioning.

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

Experts believe about 100,000 to 300,000 patients with traumatic brain injury may be in a minimally conscious state where intermittent signs of awareness are seen and most do not receive active therapy.

Dr. Rezai and his colleagues say they are very encouraged regarding the potential of the technology to improve the function of such brain-injured patients.

Dr. Nicholas Schiff, an associate professor of neurology and neuroscience at Weill Cornell, and the study leader says the work challenges the existing practice of early treatment discontinuation and also changes the approach to assessment and evaluation.

Deep brain stimulation is already used in the treatment of tremors associated with Parkinson's disease.

The research is published in the journal Nature.