Brain electrodes help man speak again

WORLD / Health

Brain electrodes help man speak again

(Agencies)
Updated: 2007-08-02 09:37

New York - He was beaten and left for dead one night in a robbery while
walking home in 1999. His skull was crushed and his brain severely
damaged. The doctor said if he pulled through at all, he'd be a vegetable
for the rest of his life.

For six years, the man could not speak or eat.

On occasion he showed signs of awareness, and he moved his eyes or a
thumb to communicate. His arms were useless. He was fed through a tube.

But researchers chose him for an experimental attempt to rev up his brain
by placing electrodes in it. And here's how his mother describes the
change in her son, now 38:

"My son can now eat, speak, watch a movie without falling asleep," she
said Wednesday while choking back tears during a telephone news
conference. "He can drink from a cup. He can express pain. He can cry and
he can laugh.

"The most important part is he can say, `Mommy' and `Pop.' He can say, `I
love you, Mommy' ... I still cry every time I see my son, but it's tears
of joy."

The progress of the patient, who remains unidentified at the family's
request, is described more formally in a report in Thursday's issue of
the journal Nature.

Experts called the results encouraging but cautioned that the
experimental treatment must be tried in more patients before its value
can be assessed. The researchers are already proceeding with a larger
study.

Before the electrodes were implanted, the man was in what doctors call a
"minimally conscious state." That means he showed only occasional
awareness of himself and his environment. In a coma or vegetative state,
by contrast, patients show no outward signs of awareness.

There are no reliable statistics on how many Americans are in a minimally
conscious state, but one estimate suggests 112,000 to 280,000. Doctors
may try medications to improve their condition but no drugs have been
firmly established as helpful.

The experimental treatment is called deep brain stimulation. It has been
used for years in treating Parkinson's disease, although in this case the
electrodes were implanted in slightly different places. The goal of the
stimulation was to provide "drive" to areas of the brain that are
critical for specific skills like speaking.

Similar stories of partial recovery from brain damage occasionally grab
headlines, whether the improvement came from treatment or just out of the
blue.

Terry Wallis of Arkansas lingered in a minimally conscious state for
almost 20 years before he suddenly regained some ability to speak and
move in 2003. In 2005, a former firefighter in Buffalo, N.Y., turned from
being barely aware and almost mute for nearly a decade into a virtual
chatterbox for 14 hours. His doctor had been trying a cocktail of drugs.

The man described in the Nature paper, despite his improvements, remains
severely disabled in a rehabilitation facility for brain injury on the
East Coast. (To preserve the man's anonymity, the researchers would not
identify the facility or even reveal which state it is in).

He can't walk. While he has regained the ability to chew and swallow, he
must be spoon-fed. He can demonstrate the motion of brushing his teeth,
for example, but he can't actually do it. That's because tendons in his
arms contracted after years of immobility, said study lead author Dr.
Nicholas Schiff of Weill Cornell Medical College in New York.

The man doesn't initiate conversation but can reply to others, generally
with one to three words, said Dr. Joseph Giacino, a co-lead author of the
Nature study.

Several weeks ago, he recited the first half of the Pledge of Allegiance
without assistance, said Giacino, of the JFK Johnson Rehabilitation
Institute in Edison, N.J.

The man's electrodes are left on for 12 hours a day. He has continued to
improve since the experiment formally ended in February 2006, the doctors
said.

After the research was over, doctors started giving him the drug
amantadine, which has shown some potential for treating people in a
minimally conscious state. It's not clear whether amantadine can boost
the effects of deep brain stimulation or vice versa, Giacino said.

Dr. James Bernat, a professor of neurology at Dartmouth Medical School
who didn't participate in the new research, called the Nature report
exciting and important. Further study is needed to sort out how many
patients would respond and how to identify the minimally conscious
patients with the best chance of being helped, he said.

He noted that a similar treatment did not help Terri Schiavo, the Florida
woman in a vegetative state whose care triggered national controversy
before her death in 2005. That's the typical outcome for electrical brain
stimulation in vegetative states, he said.

Dr. Ross Zafonte of the University of Pittsburgh, who also was familiar
with the study results, agreed that "we need to know more." He said the
approach is "very interesting and holds great promise."

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