The news that a severely brain damaged man has “woken up” after being treated with electrical stimulation is good news.

A lot of people who seem to be unaware of their surroundings actually have some brain cortex (the thinking part of the brain) but injury to the lower parts of the brain that let you be conscious and that coordinate the upper parts.

Trying to wake people up by electronically stimulating the lower parts of the brain has been tried for years, (including to Terri Schiavo) with little success, but it is hoped that more exact placement of the electrodes will allow the electric current to stimulate the few undamaged cells to start working, and maybe even allow regrowth of this “integrating” or coordinating part of the brain.

The area of the brain that does the actual “thinking” and moving of your body is the cortex: think of it as the orange peel around the brain. However, in many cases of subtle brain injurty, these cells are intact but not “integrated” so that they work. Think of it as having computers but all the wires are messed up and a lot of them are broken. And it is the “lower” part of the brain that coordinates these things, supplies emotions, and lots of other subtle things that are only now starting to be understood thanks to PET scans and other things that allow the thinking brain to be studied.

The gentleman involved had something called “minimally conscious state”. This is now recognized because almost half of those diagnosed as “Persistent vegetative state” actually could respond to caretakers, but failed to respond when the diagnosing Neurologist came to visit.

Some definitions.

Brain dead means no circulation or living brain or living brain stem. Take people off the machine, and since the brain stem is gone, your lungs and heart quickly stop.

Comatose means you are sleeping all the time. You don’t wake up, but you might respond to pain.

PVS or “vegetative” state is a terrible choice of words, but essentially means the upper part of the brain is gone, but the lungs move, you wake up and sleep, you feel pain, but your responses are “reflexes” to pain or light. Some of these people can swallow and eat, but since it is easier to tube feed them, often they are placed on tube feeding for convenience of the family, and to prevent aspiration pneumonia.
The next step up is “minimally conscious state”, which is when you look like PVS, but when your mom comes in you smile, or you hum with the radio, or you recognize your caretaker. From a nursing standpoint, they are similar to PVS, but nicer to work with, since they sometimes are “there”.
A lot of things can make people look worse than they are, including illness (Hypothyroidism, hypothermia, even colds and urine infections), and medicine, especially seizure medicine that many of these people need to keep them alive.

When we work with the elderly, the first thing we do when they start forgetting things or getting senile is check all their medicines including “over the counter” medicines like cold pills and antacids and even aspirin.

A lot of ethical firestorms erupt about not giving full medical treatment to the elderly and handicapped, but this has to be balanced with the common sense of not overtreating someone and making them sicker.

So will electrical stimulation work? for a small percentage, maybe. But don’t get your hopes up, and remember: the treatment alone could make a lot of people worse than they are now.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket

and she writes medical essays on HeyDoc Xanga blog

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