For some, there is no hope ever of the brain rewiring.
Posted on 07/04/2006 5:29:33 AM PDT by srmorton
Doctors have their first proof that a man who was barely conscious for nearly 20 years regained speech and movement because his brain spontaneously rewired itself by growing tiny new nerve connections to replace the ones sheared apart in a car crash.
Terry Wallis, 42, is one of the few people known to have recovered so dramatically so long after a serious brain injury. He still needs help eating and cannot walk, but his speech continues to improve and he can count to 25 without interruption.
Wallis' sudden recovery happened three years ago at a rehabilitation center in Mountain View, Ark., but doctors said the same cannot be hoped for people in a persistent vegetative state, such as Terri Schiavo, the Florida woman who died last year after a fierce right-to-die court battle. Nor do they know how to make others with less serious damage, like Wallis, recover.
"Right now these cases are like winning the lottery," said Dr. Ross Zafonte, rehabilitation chief at the University of Pittsburgh Medical Center, who was not involved in the research. "I wouldn't want to overenthuse family members or folks who think now we have a cure for this."
Wallis has complete amnesia about the two decades he spent barely conscious, but remembers his life before the injury.
"He still thinks Ronald Reagan is president," his father, Jerry, said in a statement, adding that until recently his son insisted he was 20 years old.
The research on Wallis, published Monday in the Journal of Clinical Investigation, was led by imaging expert Henning Voss and neurologist Dr. Nicholas Schiff at the Weill Medical College of Cornell University in New York City and included doctors at JFK Medical Center in Edison, N.J.
Wallis was 19 when he suffered a traumatic brain injury that left him briefly in a coma and then in a minimally conscious state, in which he was awake but uncommunicative other than occasional nods and grunts, for more than 19 years.
"The nerve fibers from the cells were severed, but the cells themselves remained intact," unlike Schiavo, whose brain cells had died, said Dr. James Bernat, a neurologist at Dartmouth-Hitchcock Medical Center in New Hampshire, who is familiar with the research.
Nerve cells that have not died can form new connections; for example, nerves in the arms and legs can grow about an inch a month after they are severed or damaged. However, this happens far less often in the brain.
The new research suggests that instead of the sudden recovery Wallis seemed to make when he began speaking and moving three years ago, he actually may have been slowly recovering all along, as nerves in his brain formed new connections at a glacial pace until enough were present to make a network.
Researchers used a new type of brain imaging only available in research settings — not ordinary hospitals or rehabilitation centers — to establish the regrowth. It tracks the direction of water molecules in and around brain cells, an indicator of brain activity.
"It's a roadmap of how the connections are running," Schiff said.
Doctors compared Wallis' brain function to that of 20 healthy people and another minimally conscious patient who showed virtually no recovery for six years. All were imaged twice, 18 months apart.
In Wallis' brain, "what we first see is how overwhelmingly severe this injury was," with many abnormalities compared to the healthy people, Schiff said.
The second set of images showed changes from the first, strongly suggesting that new connections had formed. These correlated with areas of the brain that affect the ability to move and talk.
The other minimally conscious patient — a 24-year-old man who suffered a severe brain injury in a car accident when he was 18 — also had evidence of changes in nerve connections, but they were not organized in a way that made a difference in his ability to function.
"We'll have to understand more about why recovery occurred" in Wallis' case, Zafonte said. "The question is 'why?' It's not just 'wait.'"
Until that is known, imaging cannot be used to predict who will recover, or to help patients' brains rewire, he said.
The Charles A. Dana Foundation, which finances brain research, funded the scientific work. The lead author, Voss, also received money from the Cervical Spine Research Society, whose sponsors include companies that make spine care products. The British Discovery Channel and HBO paid to fly Wallis and family members to Cornell for tests.
"Most neurologists would have been willing to bet money that whatever the cause of it, if it hadn't changed in 19 years, wasn't going to change now," Bernat said. "So it's really extraordinary."
Wallis' father said his son is now able to make jokes. "That was something he wasn't able to do early in his recovery," Jerry Wallis said. "He now seems almost exactly like his old self. And he very often tells us how glad he is to be alive."
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On the Net: http://www.jci.org
It's the Catch-22 of the medical profession.
If you're "PVS", then there is no hope of recovery.
If your family doesn't let the doctors kill you, and 20 years later you wake up, then you weren't really "PVS".
Got it?
(This young man is lucky he got his voice back and can clearly state how GLAD he is to be alive, for there are many euthansia advocates who would assure us that "he wouldn't want to live this way")
I think the author is carefully drawing a distinction between a patient in a minimally conscious state ("in which he was awake but uncommunicative other than occasional nods and grunts") and a person who is in an irreversible PVS with their cerebral cortex consisting of liquified mush.
He woke up over 19 years ago following a coma, and was never diagnosed PVS.
"who would assure us that "he wouldn't want to live this way"
Which way was that?
"...and a person who is in an irreversible PVS with their cerebral cortex consisting of liquified mush."
As if that somehow gives us the freedom to kill them.
No it does not.
But if it is their expressed wish not to live like that, then they certainly have the freedom to be allowed to die. Don't you agree?
Didn't we do this yesterday?
See: http://www.freerepublic.com/focus/f-news/1659932/posts?page=104#104
Be sure and read the Polybius postings for the real scoop.
Or the day before.
Sorry! This was my first posting and I screwed up! I did search for his name, but the only articles that showed up were ones from three years ago when he first woke up. I devour FR every day, so I don't know how I missed seeing the previous posting.
For some, there is no hope ever of the brain rewiring.
I'm going to go with "No" here. We have no right to end our own lives: God alone knows our ends. If keeping me alive takes only food and water, and primary care - then I wish to stay alive. Anything other choice would be suicide.
*ping*
"Anything other choice would be suicide"
It would seem to me that a severly brain damaged or brain dead person has already died. The body is artificially being kept alive, only due to the advances in medical techniques. You still call it suicide?
There are many reasons Terri deserved to live, not the least of which is the fact her parents were very willing to fully take care of her every need. Michael could have been totally released of any responsibility. But then there's always money to be had....and in this case some sort of twisted vengeance for nothing.
Regarding the photo of Al Gore: I cannot imagine someone capable of that much anger in full public view being made president of our country.
Come to think of it I can't imagine the risk we'd be taking if Hillary responded to Vladimir Putin in one of her moments of anger either.....
George Bush, love him or hate him - at least he has excellent control of his emotions and acts like a mature adult.
Does this mean there is hope for screwed up liberals and their brains might eventually get right?
I wasn't aware Algore had a brain.......he certainly has no memory. He's been going around for years saying he won the 2000 race, yet he's totally fogotten that he conceded the race to GWB when he realized he couldn't win in the courts any more than he could win at the ballot box.....
How do the nerve cells know how to connect themselves?
If I was PVS, and somebody kept me alive FOR FIFTEEN YEARS,
if I awoke, I would kill them slowly.
Pure torture, on both parties.
Pooping in a diaper for fifteen years. That would be their sentence.
Food and water are among the few and simple things we owe to the medically dependent and disabled. In Terri Schiavo's case, the "advanced" medical technique consisted of a simple feeding tube. These were developed well before World War I ---in the late-19th century.
"You still call it suicide?"
Of course not. In Terri Schiavo's case, it was murder.
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