Monday, August 06, 2007

Neurotechnology Awakenings

In a recent article in Nature, researchers report that deep brain stimulation techniques quite dramatically enhanced the brain function and behavior of a patient who had suffered traumatic brain injury and considered minimally-conscious for 6 years.

From the accompanying AP article:

For six years, the man could not speak or feed himself. 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."

Should certainly revitalize the debates on the definition of brain death and the clinical ethics therein.


[Editor's note, added August 16, 2007 : An article from Reuters August 13, 2007 also sheds some interesting new light on the subject: Scans have shown near-normal brain activity in a second patient who is in a vegetative state -- British researchers reported on Monday in a study that may show a way to predict who is likely to recover from the usually hopeless condition. Access the full text here.]


Stephen Drake said...

I'm confused why you are saying this should spark any discussion on "brain death." The person in question had a label of "minimally conscious state."

I would agree that it should spark discussion, though. In the past couple years the cases of Haleigh Puoutre and Jesse Ramirez have made many people wonder how many clinicians are engaging in a "rush to judgement" in the case of people with severe brain injury. Both Ramirez and Poutre were the subject of court battles revolving around removal of feeding tubes - initiated a short time post-injury. Both regained consciousness, but only as a result of the court delays.

Just last year, ASBH honored Ronald Cranford, who was very clear in his wish to make it easier for families to end the lives of people in minimally conscious state.

Yeah, there's a lot to talk about. But I don't see too many bioethicists wanting to enter this particular territory.

Linda MacDonald Glenn said...

It's a good point you make, Stephen -- it is very important to distinguish between coma, minimally conscious state, persistent vegetative state, and brain death -- all of these have very specific neurological criteria and each diagnosis warrants a different approach. Considering how little we know about the brain currently and how much are learning through fMRI's and new technology, I imagine(and hope)that diagnoses, prognoses, and treatments will continue to change as we learn more.