Treatment restores signs of awareness in brain-injured man

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Researchers say they plan to broaden their research to other patients in a vegetative or minimally conscious state. Brains aren't supposed to work that way.

Fifteen years ago, a 20-year-old man in France suffered traumatic brain injury in a auto collision and fell into a persistent state of unconsciousness known as a vegetative state.

After a month of daily vagal nerve stimulation, the man's dramatic improvements defied all expectations, the team reports this week in the journal Current Biology. This nerve is a key pathway in brain-body circuitry. Learn about the parts of the human brain, as well as its unique defenses, like the blood brain barrier.

"It is hard to know based on a single case how likely this treatment is to work in the general patient population".

This case may change conventional thinking about vegetative states. The tears might have been the result of the nerve stimulation, said Angela Sirigu of the Marc Jeannerod Institute of Cognitive Science in Lyon, France, which is affiliated with the National Center for Scientific Research.

With a coma, by contrast, the person's eyes are closed; it is possible to recover from a coma and regain full awareness.

The researchers are now planning a large collaborative study to confirm and extend the therapeutic potential of VNS for patients in a vegetative or minimally conscious state. Martin Pistorius, from South Africa, was in a vegetative state for 12 years, Terry Wallis of Arkansas woke from a 19-year coma in 2003 and Jan Grzebski, from Poland, woke from his 19-year coma in 2006.

No. It wasn't a scene from a daytime soap opera, but his progress was surprising.

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While the story is inspirational, it is important to bear in mind the statistical significance; many more patients need to be treated with vagus nerve stimulation before it can be described as a breakthrough.

Sirigu noted that "after VNS, the patient could respond to simple orders that were impossible before". His mother said he was more able to stay awake when his therapist read to him. For instance, when the examiner's head suddenly approached the patient's face, he reacted with surprise by opening his eyes wide. Nine months later, his level of consciousness didn't continue to improve, but it didn't slide back into a vegetative state, either. The surgery to implant the electrical stimulator, the frequent behavioral observations, and the moving in and out of brain scanners all could have contributed to the patient's improved state, says Andrew Cole, a neurologist at Harvard Medical School in Boston who studies consciousness. A PET scan, a type of imaging test, showed increases in metabolic activity in the brain, as well.

Probably not. The researchers specifically chose a patient whose condition was longstanding to rule out the possibility of a chance improvement. "I am emphatically in favour of this line of research", Samadani, an associate professor at the University of Minnesota Department of Neurosurgery, says via email.

In an attempt to restore his consciousness, scientists implanted an experimental stimulator on his man's chest.

The process involves using a chest implant to send pulses of electricity to the vagus nerve, which connects the brain to other major organs of the body. His family has declined to speak publicly about his progress.

"We've now known for a long time that we can do something for very severely injured brains, but the science has not been met with any kind of infrastructure to catch up with it", he said. "I would prefer to be aware, in any case".

The finding "suggests that some patients with disorders of consciousness might benefit from vagus nerve stimulation", he said.