Health Care

Consciousness 'restored' using nerve stimulation

Consciousness 'restored' using nerve stimulation”

The expert of the University of Tübingen said this new research shows sufficient evidence to affirm that paralyzed patients are not hopeless after 12 months. This nerve is a key pathway in brain-body circuitry.

The team of researchers wanted to choose a very complicated case to attribute the results exclusively to the treatment, which is why they selected a patient who had been in a vegetative state for 15 years.

Co-lead investigator Dr. Angela Sirigu, of the Institut des Sciences Cognitives Marc Jeannerod in Lyon, France, comments that their results show that "it is possible to improve a patient's presence in the world" by stimulating the vagus nerve.

He also reacted to a "threat" - reacting with surprise by opening his eyes wide when the examiner's head suddenly approached his face. It plays a central role in a number of essential functions, including waking and alertness.

After many years in a vegetative state, he had entered a state of minimal consciousness, the researchers said.

The team next plans to test whether the vagus nerve implant could help restore consciousness in other patients in a vegetative state.

Noting that vagus nerve stimulation has always been used as a treatment for both epilepsy and depression, the French team chose to see whether it might also be deployed to help bring a patient out of a vegetative state into a minimally conscious state.

After six months, supported by significant changes in the man's brain activity in the thalamus, researchers determined that their intervention helped propel the man from a vegetative state-showing no signs of communication or attention-to a minimally conscious state, in which people are aware of the world around them but just barely able to express that fact. The researchers made sure to record his brain activity to prove that the electrical communication between brain regions had really increased, specifically those linked to sensation and awareness.

What this shows is that "brain plasticity and brain fix are still possible even when hope seems to have vanished", Sirigu added.

Those who remain in a persistent vegetative state do remain "wakeful".

So the investigators focused on "a patient with the worst outcome", meaning someone who had always been in a vegetative state with no signs of improvement, to eliminate the possibility of chance.

Similarly, Dr. David McGonigle, a neuroscientist at Cardiff University, recommends a "full randomized controlled clinical trial" to perform a deeper evaluation of the effectiveness of electrical stimulation of the vagal nerve in patients in a vegetative state. Vagus stimulation tends to increase metabolism in the forebrain, which is crucial for consciousness.

"[But] more research is needed to determine which patients in vegetative or minimally conscious state might plausibly respond to this treatment, such as this patient did", Bernat added.

But although there is reason to be optimistic about the study's potential, Brent Vogt, a research professor at Boston University, cautions that this report focuses on the case of a single person.

The Western Journal of Medicine has more on the vegetative versus minimally conscious state.

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