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Thursday, Aug 02, 2007
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Electrodes help him speak again

The man was in what doctors call a “minimally conscious state”
Man speaks in a breathy but audible voice, recovers some movement

NEW YORK: A brain-damaged man who could communicate only with slight eye or thumb movements for six years can speak again, after stimulating electrodes were placed in his brain, researchers report.

The 38-year-old also regained the ability to chew and swallow, which lets his attendants spoon-feed him rather than providing nourishment through a tube into his belly.

Injury during assault

The man suffered brain injury during an assault and spent six years with only occasional signs of consciousness and no useful movement of his limbs. In an experiment, researchers implanted electrodes in his brain for a procedure called deep brain stimulation, routinely done for Parkinson’s disease and some other illnesses.

They turned the electrodes on and off over six months to test their effect, and reported the results in Thursday’s issue of Nature. The man, who was not identified at his family’s request, now has them turned on all day.

Experts called the report exciting but cautioned that the approach must be tested in more people before its value can be known.

The researchers have already begun a study of additional patients.

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

No firm statistics

There are no firm statistics on how many Americans are in a minimally conscious state, but one estimate suggests 1,12,000 to 2,80,000. Doctors may try medications to improve their condition, but no drugs have been firmly established as helpful.

The man described in the journal speaks in a breathy but audible voice, said Dr. Joseph Giacino, a co-lead author. He does not initiate conversations but can reply to others, typically with one to three words, said Mr. Giacino, of the JFK Johnson Rehabilitation Institute in Edison, New Jersey.

The man also recovered some movement. He can demonstrate motions such as brushing his teeth, eating with a fork and drinking from a cup, said study lead author Dr. Nicholas Schiff of Weill Cornell Medical College in New York. “He is still totally dependent and severely disabled,” Mr. Schiff said.

But the treatment has helped him, the man’s mother said in a statement. “Now, my son can eat, express himself and let us know if he is in pain. He enjoys a quality of life we never thought was possible,” she said.

Dr. James Bernat, a professor of neurology at Dartmouth Medical School, who didn’t participate in the new work, called the Nature report exciting and important. Further study was needed to shed light on 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 case triggered national controversy before her death in 2005. That was the typical outcome for electrical brain stimulation in vegetative states, he said. Dr. Ross Zafonte of the University of Pittsburgh, also familiar with the study results, agreed that “we need to know more” and said the approach is “very interesting and holds great promise.” — AP

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