Waking the Unconscious

The state of consciousness continue to puzzles neuroscientists worldwide. However, a team of neurologists and neurosurgeons have succeeded in increasing conscious control in an individual who had been in a minimally conscious state (MCS) for over six years.

A 38 year old male had suffered severe brain damage, slipped into in a deep coma, and a year after receded into a minimally conscious state. The patient was non verbal, was fed and kept alive through tubes in a long term care facility. Six years later, despite the large amount of damage to the cortex, imaging results showed that some parts of the brain were still functioning. This led a team of neurosurgeons to believe that they would be able to improve the patient’s state through manual stimulation of those undamaged parts of his brain. Upon examination at the time of enrollment, the patient was able to move his eyes sideways (but not up and down), and the rest of his body was out of conscious control.

The results were dramatic — within 48 hours post surgery the patient was able to respond to noise stimuli by turning his head towards the source of the voice. Further, he was able to keep his eyes open for a sustained period of time on his own, as well as move his limbs. Within 50 days with continued stimulation, he was able to bring a cup to his mouth, swallow food, thus becoming independent of his feeding tube.

The patient continued to improve after the experimental phase was over, and eventually was able to put together up to six words to express himself vocally. The cost of care for this patient has since reduced significantly, since he is no longer on a feeding tube and can feed himself manually three times a day.

This report is important for two reasons. For one, it challenges current practice of giving up on treating patients that are in a minimally conscious state, and simply turning them over to long term care facilities. Further, it increases the hope that stimulating certain regions after severe brain damage can still salvage some functional activity with potential for significant improvement.

Reference

Schiff N. D. et al. Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature 448, 600-603 (2 August 2007)