A coma, or a persistent vegetative state, is a condition in which a patient is alive however is in a deep state of unconsciousness that prevents them from moving or responding to any outside stimuli. They are unable to speak or respond to commands, and are unaware of their surroundings, however, they are not clinically brain-dead, still retaining their non-cognitive functions. Their body will continue to function as necessary, with their circulatory and respiratory systems continuing to operate as normal.
Doctors have long believed that when a patient slips into this state, triggered by injuries, such as a head trauma, or some sort of complication by an underlying condition, that they are now powerless to wake the patient focusing instead on maintaining their physical health while waiting to see if they come to. Working to prevent bedsores and pneumonia, doctors have had to break the news to the family that there is nothing more that they can do.
But that may all be changing with the latest case.
A 35-year-old man had been in a vegetative state for a total of 15 years following a car accident when a Vagus Nerve Stimulation (VNS).tried a therapy called
The procedure sends electrical energy in mild pulses at regular intervals to the brain along the vagus nerve. This is achieved by implanting a stimulator device in the chest of the patient, commonly referred to as a ‘pacemaker for the brain.’ The device is often used to prevent seizures; however, this was the first time it had been used in the treatment of a coma.
After being fit with the device the man started to show signs of consciousness including opening his eyes wide in surprise responding to sudden, shocking movements by the examiner and tracking objects with his eyes. He was even able to respond to basic requests such as the request to turn his head, although there was a delay in his reaction. Angela Sirigu, the researcher who led the project explained, “He is still paralyzed, he cannot talk, but he can respond. Now he is more aware.”
The surgery to implant the stimulator device lasted approximately 20 minutes. The device itself was located in the chest, however, it was connected to the vagus nerve in the patient’s neck which is what allowed it to send the electrical pulses. The treatment took time to take effect, however, after approximately 1-month researchers began to notice changes in his attention span, movements, and brain activity. At this point, he had made the change from vegetative to minimal consciousness. Brain scans reflected an increased level of brain activity including an increase in communication between different regions of the brain, and more activity in the areas associated with sensation, awareness, and movement.
The research team is hoping that they can take their findings from this case and apply it to patients with various levels of brain injuries. They explained that if it works on those that have a significantly less serious brain injury they may even be able to see substantially higher levels of improvement. Sirigu is hopeful, saying, “Brian plasticity and brain repair are still possible even when hope seems to have vanished.”
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