August 2, 2007

Altered States

Filed under: — mlazoff

The current issue of Nature published a Letter by Nicholas Schiff, MD and colleagues from the Weill Cornell Medical College in New York, which documents the use of a relatively new technology, deep brain stimulation (DBS), to treat a patient with a disorder of consciousness. Behavioral improvement with thalamic stimulation after severe traumatic brain injury and accompanying news articles describe the case of a 38 yo patient with minimally conscious state (MCS), a condition similar to coma but with intermittent periods of arousal. The patient was chosen for DBS study because while he sustained traumatic cerebral cortex damage six years earlier, his other brain functions were thought to be relatively intact. Electrodes were implanted in the intralaminar nuclei of the central thalamus with the goal to stimulate the undamaged areas of the cortex. Within 2 days of stimulation the patient, who had been in MCS for six years, demonstrated increased arousal. After 2 months of post-op recovery without further stimulation, the patient was subjected to a six month, double blind alternating crossover study to study the effect of DBS on several primary and secondary outcome measures (including motor, communication, arousal, and feeding skills). When stimulated, the patient was able to name objects, make precise hand gestures on request, and chew food. Some functions demonstrated a carryover effect even after DBS was turned off, while other functions required continual stimulation.

DBS has been used experimentally in the past to treat Parkinson’s Disease and other movement disorders, epilepsy, obsessive-compulsive disorder and other psychiatric conditions. Last year, DBS was the subject of a Time Magazine article, How Deep Brain Stimulation Works

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