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Author Topic: New Findings on brain Damage and Recovery
Dagonee
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From New Scientist

quote:
A study of the "miraculous" recovery of a man who spent 19 years in a minimally conscious state has revealed the likely cause of his regained consciousness.

The findings suggest the human brain shows far greater potential for recovery and regeneration then ever suspected. It may also help doctors predict their patients’ chances of improvement. But the studies also highlight gross inadequacies in the system for diagnosing and caring for patients in vegetative or minimally conscious states.

In 1984, 19-year-old Terry Wallis was thrown from his pick-up truck during an accident near his home in Massachusetts, US. He was found 24 hours later in a coma with massive brain injuries.

Within a few weeks he had stabilised in a minimally conscious state, which his doctors thought would last indefinitely. It did indeed persist for 19 years. Then, in 2003, he started to speak.

Over a three day period, Wallis regained the ability to move and communicate, and started getting to know his now 20 year old daughter – a difficult process considering he believed himself to be 19, and that Ronald Reagan was still president.

[scientific details omitted]

Krish Sathian, a neurologist and specialist in brain rehabilitation at Emory University School of Medicine in Atlanta, US, describes it as an amazing finding. “The bounds on the possible extent of neural plasticity just keep on shifting,” he says. “Classical teaching would not have predicted any of these changes.”

Knowing the mechanism will be important for identifying whether a particular unconscious patient could improve, says Schiff, potentially allowing doctors to target their rehabilitation efforts.

Family appeals

But improvements in the care of patients could be made without putting every patient into a brain scanner, says Schiff. There is currently no system for even a bedside re-examination from 8 weeks after an initial diagnosis, despite the fact that “their whole prognosis might change”, he says.

Wallis was frequently classified as being in a permanent vegetative state. Though his family fought for a re-evaluation after seeing many promising signs that he was trying to communicate, their requests were turned down.

“A careful bedside examination at 6 months [after the accident] would have unequivocally said he was not in a vegetative state,” says Schiff. There is a much greater chance of a late recovery from a minimally conscious state, he adds, although such recoveries are still rare. “The Wallis case will force the issue,” he believes.

Amazing stuff that hopefully, over time, will lead to new procedures and new treatments.
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imogen
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quote:
In 1984, 19-year-old Terry Wallis was thrown from his pick-up truck during an accident near his home in Massachusetts, US. He was found 24 hours later in a coma with massive brain injuries.

Within a few weeks he had stabilised in a minimally conscious state, which his doctors thought would last indefinitely. It did indeed persist for 19 years. Then, in 2003, he started to speak.

Over a three day period, Wallis regained the ability to move and communicate, and started getting to know his now 20 year old daughter – a difficult process considering he believed himself to be 19, and that Ronald Reagan was still president.

I saw an episode of Gray's Anatomy last week that featured a very similar scenario. Guess the screenwriters must have based the plot on this incident.
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Dagonee
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Sounds like the Law and Order of the medical genre. "Ripped from the headlines." [Smile]
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Bob_Scopatz
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This is so cool. The part where they explain that his brain built completely novel structures to rewire around the broken areas. Amazing.

I bet the other thing that we'll learn, eventually, is how to speed things up so that in the future we don't have to wait 20 years to have people recover.

Thanks for the story! [Big Grin]

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Dagonee
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quote:
I bet the other thing that we'll learn, eventually, is how to speed things up so that in the future we don't have to wait 20 years to have people recover.
Yep. I bet some of it is rehab - exercising the brain if you will - and part medicinal - providing proper nutrients or drugs that stimulate such growth.

I'm reminded of things some people (maybe you) posted about schizophrenia being less severe and easier to recover from in certain social settings. Speculation was that the interaction with the supporting social structure caused the brain to "rewire" itself (in a less specific sense than used here).

Similar process? I have no idea, but it sounds plausible and I'm sure smarter people are working on it.

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Bokonon
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I also wonder how much has to do with his age at the accident... I'd guess that while we all retain some plasticity, someone in their teens will have more of it, and therefore more propensity to rewire itself than someone older...

-Bok

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Elizabeth
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I had my appointment with the neurologist yesterday.
He was surprised that I was still showing signs of healing. He thinks I will lose all fatigue and other weirdnesses from the illness. At first, they had told me that after a year, I would be where I was going to be, neurologically.

And I definitely notice that I can retrain my brain for certain things. I am playing tennis, and at first, like playing squash, it was really awkward. Now, I am almost back to where I was.

To think that almost two years ago I could not walk, talk, or see, it is pretty amazing.

He did these weird tests on my feet, and said my toes still curl up, but that one has improved dramatically. I can;t remember the test, but I am sure the docs know it.

He also had me stand with my feet together, eyes closed, arms out. I swayed, which indicated spinal cord damage. I said I was sure it indicated drinking too much wine the night before, but he laughed and said no. I still don;t believe him, though, and plan to test everyone I know to see who DOESN'T sway with their eyes closed.

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Glenn Arnold
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quote:
Yep. I bet some of it is rehab - exercising the brain if you will - and part medicinal - providing proper nutrients or drugs that stimulate such growth.
Also stem cells.
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quidscribis
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My father had four brain aneurisms back in 1980. He was 45 years old. When he came home from work - before we knew what was going on - he didn't know who he was, who we were, where he was, or pretty much anything. We still don't know how he actually managed to drive himself to his own house. He couldn't speak coherently at all. There was no recognition, no intelligence, nothing - it was autopilot, nothing more. The doc at the hospital misdiagnosed him, so he wasn't diagnosed properly until two weeks later. Meanwhile, his head swelled up to unbelievable size and turned black and blue, then eventually green from the bruising.

Three were operated on (behind one temple, on top of the skull, in the back of the head, operations done over a period of the next month or so). The first operation wasn't for a couple of weeks after he was brought to the second hospital - they had to wait for the swelling in his head to go down and it took that long. The other was left alone because it was too deep in the brain for surgery. He went into a coma and was not supposed to live - had less than a 5% chance of survival. Then he lived anyway, and he had zero chance of recovery. Doctors said he would be in a persistent vegetative state for the rest of his short life.

He lived and started to recover anyway.

He lost everything - all learned skills and abilities were gone. After six months or so, he started learning how to talk, walk, use the toilet, read, do simple math, and so on. Everything - no exceptions - had to be taught to him again like he was a newborn.

Something like half his memories are completely gone, and he didn't completely recover. Nevertheless, he relearned enough that he can function. Not to the point of working, but to the point of otherwise taking care of himself.

According to all the doctors, this was not supposed to be possible given the amount of damage done by the exploding blood vessels. If it had been one aneurism, maybe, but with four? Completely unheard of at the time. He was actually written up in medical journals because of his survival and because his brain rewired itself.

Weird things happen.

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Shawshank
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A few years ago I came home from school one day (I have all these memories by third parties) and didn't know who I was, who my best friend was, who my parents were, where I lived, how to count.

My parents rushed me to the ER of the best hosptial in my city and I was drifting between regular slightly confused consciousness and then being off in "la-la" land. I tore an IV out of my hand in the ER trying to look for my mother at one point. Eventually we had to stay and we got a new room, an actual real one on a different wing. I got my wing put under lockdown for trying to get into other people's rooms. And as we were doing a head MRI I crawled out of the tube for being confused.

After a couple of days I was diagnosed with Absent Seizures and what had happened was I had like several hundred right in a row- so when I was having a seizure I had no memory and when I wasn't having a seizure my brain was so screwed up I was confused anyways.

This kind of report makes me happy.

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Tante Shvester
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quote:
Originally posted by Elizabeth:
He did these weird tests on my feet, and said my toes still curl up, but that one has improved dramatically. I can;t remember the test, but I am sure the docs know it.

Babinski.
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Theca
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And the swaying test, that's the Romberg's test.
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CoriSCapnSkip
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For what it's worth, I know a guy who suffered a traumatic brain injury at the same age. He regained consciousness but had to learn everything again from square one. He was told that whatever a brain injury patient didn't learn in ten years, they wouldn't. Twenty years later, he is still learning.
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Katarain
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This drastically affects my decision on whether or not to stay on life support...

(I hadn't decided before, but I'm really leaning toward staying on it now.)

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Kwea
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More research needed, of course, but it shows a lot of promise. [Big Grin]
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kwsni
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This makes me happy, since the story I'm half working on hinges on something similar happening.

Ni!

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Bob_Scopatz
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quote:
This drastically affects my decision on whether or not to stay on life support...

(I hadn't decided before, but I'm really leaning toward staying on it now.)

Yeah, what's the opposite of a DNR order? I want the entire GNP of the Western World dedicated to my eventual recovery.
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ketchupqueen
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Well, a living will can specify the conditions under which you want life support terminated, right? You could write a living will that specified that you don't want it terminated, ever...
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Dagonee
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More new insights into brain damage.

quote:
According to all the tests, the young woman was deep in a "vegetative state" -- completely unresponsive and unaware of her surroundings. But then a team of scientists decided to do an unprecedented experiment, employing sophisticated technology to try to peer behind the veil of her brain injury for any signs of conscious awareness.

Without any hint that she might have a sense of what was happening, the researchers put the woman in a scanner that detects brain activity and told her that in a few minutes they would say the word "tennis," signaling her to imagine she was serving, volleying and chasing down balls. When they did, the neurologists were shocked to see her brain "light up" exactly as an uninjured person's would. It happened again and again. And the doctors got the same result when they repeatedly cued her to picture herself wandering, room to room, through her own home.

"I was absolutely stunned," said Adrian M. Owen, a British neurologist who led the team reporting the case in today's issue of the journal Science. "We had no idea whether she would understand our instructions. But this showed that she is aware."

While cautioning that the study involved just one patient who had been in a vegetative state for a relatively short time, the researchers said it could force a rethinking of how medicine evaluates brain-damaged patients.


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Sharpie
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quote:
Originally posted by Bob_Scopatz:
quote:
This drastically affects my decision on whether or not to stay on life support...

(I hadn't decided before, but I'm really leaning toward staying on it now.)

Yeah, what's the opposite of a DNR order? I want the entire GNP of the Western World dedicated to my eventual recovery.
People think I'm kidding when I tell them this.
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quidscribis
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Dags, thanks for posting that. It's very interesting. Very very interesting.

In some ways, I'm not surprised - I've heard about how people under anaesthesia can hear what's being said, and I've also heard claims by some that coma patients can hear as well - but now there's actual proof. Okay, one person, but it always starts with one person. [Smile]

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katharina
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I completely agree with Bob. NO ONE pulls the plug. Give me a chance.
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sndrake
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Dag,

Thanks for posting this. It supports other studies done with greater numbers of individuals. There have also been studies relying on low-tech, labor-intensive evaluations
with people with the PVS labels that resulted in the decision that as many as 43% of the subjects were misdiagnosed. What that means is that with
the sustained intervention and evaluation of a multidisciplinary team, almost half the subjects in several studies were found to be awake, aware and capable of communicating with some form of assistance.

Oddly enough, the *last* of these studies was published in 1996. It's available here:

Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit

There hasn't been a rush to replicate these studies - it's *expensive* to invest the efforts of a skilled team at re-evaluating the capacities of people. Right now - people with a PVS diagnosis are mostly either warehoused or "allowed to die" through removal of a feeding tube. The discovery that many thousands of people need rehabilitation rather than warehousing or death would mean a significant investment of resources.

Therefore, I suspect the predominant reaction we'll see from the bioethics community is the one quoted here (from the Washington Post article):

quote:
"We have to be exquisitely cautious. We don't want to raise false hopes. This is very new technology," said Kenneth W. Goodman, a University of Miami bioethicist. "We don't really know what parts of your brain lighting up really mean."

I'm thinking maybe this would be a good time for a "we told you so" press release, though. Just to remind people of this press release from 2005:

Disability Activists Call for Moratorium on Starvation and Dehydration

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BlackBlade
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Very interesting thread Dag, though I suppose thats why you posted it eh?

I used to be quite pro pulling the plug, but I am not so sure anymore. I do think this warrants ALOT of study into the layers of conciousness.

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MyrddinFyre
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Wow, that's amazing stuff. I hope they can now figure out more about what actually happens when someone is in a coma or "semi-veegetative" state.
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The Pixiest
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I think persistant vegitative is worse than full blown coma...

I don't know what you can remember if you ever wake up from that.. I don't know what you can feel while you're in it...

But imagine being aware, feeling and completely paralyzed. Imagine not being able to tell someone that you would really prefer anesthetic before they cut you open to put that feeding tube in or that "Please, treat my bedsores. They hurt like the dickens" or even "Scratch my nose, for GODS SAKE SCRATCH MY NOSE!!"

I'm sure.. or at least... I hope.. this is nightmarish paranoia....

Pix

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sndrake
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Pix,

You're conflating the two scenarios of being aware while under surgery and being conscious while being labeled "PVS". So that *is* a little paranoid.

But I've encountered mainstream bioethicists suggest that death may be the best thing for people labeled "PVS" *especially* if the diagnosis is wrong. So this weird kind of projective paranoia is not limited to you - but at least you recognize it for what it is - a personal nightmare instead of an "objective analysis."

I have not been able to track down the study, but there was a tantalizing reference to a study in France of people with "locked-in syndrome" in this article:

Blink and You Live

quote:
When surveyed, only four of the 300 members of the French Association of Locked-In Syndrome (ALIS) said they would opt for euthanasia. The rest, like the Belgian woman who was misdiagnosed, desperately wanted to live.


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Phanto
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Letting someone starve to death sounds to me like a really cruel thing to do. If they really aren't counscious and so on, why not just, well, kill them straight off? Letting the world do the killing for you does not strike me as being any more morally counsciable when it is a helpless person under your charge.
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MightyCow
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Tough call. If there was a chance that I would recover, I would want to be given that chance. On the other hand, if I was going to be brain-dead forever, I would hate to drain the life savings of my family and cause them to waste years waiting for me to "wake up" when I was already gone.

I hope doctors learn more about how to determine the actual state of a person with severe brain damage, and how to better treat those who can recover.

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Storm Saxon
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I agree with MightyCow. If I'm in a vegetative state/coma/whatever, I think I would give it a year, max. There's no way I'm going to go with the certainty of destroying my family's future if doctors say that there's little chance for recovery.
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