Treatment restores signs of awareness in brain-injured man

Brain scan

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. But this is the first time that doctors attempted to treat a vegetative patient with the technique.

Because the vagus nerve connects so many critical brain areas thought to be heavily involved in consciousness, the researchers reckoned this would be a good place to start in order to help the man regain some of his cognitive functions.

Steven Laureys, who has worked extensively with people with impaired consciousness, at the University of Liege in Belgium, told New Scientist magazine that news of the study is encouraging.

"Brain plasticity and brain fix are still possible even when hope seems to have vanished", said researcher Angela Sirigu of Institut des Sciences Cognitives Marc Jeannerod in Lyon, France.

"Brain plasticity and brain fix are still possible even when hope seems to have vanished", Sirigu said in a statement accompanying publication of research describing the procedure.

To test the ability of VNS to restore consciousness, the researchers wanted to select a hard case to ensure that any improvements could not be explained by chance. Anyone who is in a vegetative state for more than a few weeks is said to be in a persistent vegetative state (PVS) and a paper in 2011 found people perceive those in PVS to have "less mental capacity than the dead".

The team of surgeons from the French National Centre for Scientific Research in Bron, lead by Angela Sirigu used a technique that required electrical nodes to be applied to the neck and send pulses via the vagus nerve.

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The team reports that the auto crash victim presented significant improvements in his brain activity, attention, and movements.

As the BBC writes, within a month a man could respond to simple commands, turn his head and follow an object with his eyes.

The patient, whose name has been withheld to preserve his privacy, suffered from severe traumatic brain injury (TBI) following the accident in 2002. Rather, he was classified as having moved from a vegetative state to a "state of minimal consciousness", according to brain scans that showed improvements in areas of the brain involved in movement, sensation and awareness. This persisted up to five months of stimulation, said Sirigu.

The research was published in the journal Current Biology.

The patient started showing signs of consciousness about a month after the implant was switched on.

However, a new study claims that this might not be so. Though involuntary, a vegetative state patient may move his limbs, grind the teeth, and make facial movements such as grimacing, yawning or smiling.

Other researchers working in the field agree that more research on a larger patient sample is needed to determine whether the approach could play a role in treating patients who are suffering from disorders of consciousness. The man remains paralyzed and unable to speak, and experts caution against drawing conclusions about the success of the intervention based on a case study of a single patient. There are a lot of different theories.

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