Medical Minute 10-28: Coming Around: Coma Breakthroughs

By: Andrew McIntosh Email
By: Andrew McIntosh Email

Six years ago -- a roll-over car accident left Josh in a coma-like state. But Josh has made big improvements since he enrolled in a clinical trial testing transcranial magnetic stimulation -- or TMS. After 15 sessions -- Josh could blink to communicate.

He could also hold his head up and has even spoken a few words. He couldn't do any of this before TMS.

Another therapy -- deep brain stimulation -- is being studied on some patients. It uses electrical pulses to stimulate parts of the brain. Doctors tried it on a patient who could not speak, chew or swallow for six years. After the procedure, he can eat, drink and even talk.

"Now, he can say 6 or 7 word sentences, can tell his mother he loves her," said Joseph Fins, M.D., Medical Ethics Professor Weill Cornell Medical College.

Other research has changed the way doctors think about coma patients. One study found even though some are diagnosed as vegetative -- they are able to respond to yes or no questions by changing their brain activity -- just like normally-functioning people. Suggesting patients may be able to hear and even feel what's going on around them.

Josh's mom is thankful for every improvement the clinical trial has brought.

"Very happy for what I got."

For more information on other series produced by Ivanhoe Broadcast News contact John Cherry at (407) 691-1500, jcherry@ivanhoe.com.

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MEDICAL BREAKTHROUGHS - RESEARCH SUMMARY:

COMAS: A coma is a state of prolonged unconsciousness that can be caused by several factors including traumatic head injury; stroke; brain tumor; drug or alcohol intoxication; or an underlying illness such as diabetes. A coma is considered a medical emergency. Doctors typically order several blood tests and a brain CT scan to determine what’s causing the coma. Comas typically last longer than several weeks. Symptoms of a coma may include closed eyes, depressed brainstem reflexes, no response of limbs, no response to painful stimuli, and irregular breathing. Several complications can develop during a coma, which include pressure sores, bladder infections and pneumonia.
(SOURCE: Mayo Clinic)

VEGETATIVE STATES: A persistent vegetative state occurs when, after a coma, patients lose cognition and can only perform certain, involuntary actions in their own. Most patients in a persistent vegetative state have no perception of and no ability to react to external stimuli. For them, any movement or response is purely spontaneous, unpredictable, and unconnected to events outside of physical impulse. Research shows patients who are labeled as being in a vegetative state are misdiagnosed about 40 percent of the time.
(SOURCE: www.brainandspinalcord.org)

MINIMALLY-CONSCIOUS: A minimally-conscious state is one in which a person has severe brain damage and is only able to produce subtle and intermittent signs of consciousness. Patients in a minimally-conscious state may be able to perceive minimal contact with their loved ones.
(SOURCE: www.sciencebasedmedicine.org)

NEW RESEARCH: Doctors are attempting to help patients in minimally-conscious states. Some promising approaches are:

• Deep Brain Stimulation: A study published in Nature found deep brain stimulation may be able to help patients in a minimally-conscious state. A man who could not speak, chew or swallow for six years can now do so after receiving the treatment, which involves using electrical pulses in specific parts of the brain. This procedure is the same one doctors use to treat Parkinson’s patients. The man in the study, who remains unidentified, was beaten up and left for dead while on his way home. His skull was severely crushed, and his brain was badly damaged. After the procedure, he could eat without a feeding tube, watch a movie without falling asleep, and express emotion.

• TMS: Transcranial magnetic stimulation (TMS) is another type of therapy being used on patients in minimally-conscious states. It involves using coils that create a magnetic field to stimulate the brain. The idea is to get neurons to activate and eventually descend down to the brain stem and then ascend back up to the cortex. One patient saw subtle, but important results after having the procedure. He was able to say a few words and hold his head up after 15 TMS sessions. Researchers plan to study four more patients over the next three years.

FOR MORE INFORMATION, PLEASE CONTACT:
Andrew Klein, Media Associate
Weill Cornell Medical College
(212) 821-0560


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