Man emerges from 19 years in minimally conscious state as brain repairs itself

July 03, 2006

Three years ago, 39-year-old Terry Wallis who had persisted in a minimally conscious state (MCS) for 19 years after a traumatic brain injury resulting from a motor-vehicle accident, recovered basic motor function and the power of speech. Using state-of-the-art structural and functional neuroimaging techniques, Henning Voss and colleagues from Cornell University have now examined Terry's brain in order to gain some insight into what caused his "miracle" recovery. In their study, which appears in the July issue of the Journal of Clinical Investigation, they show that neuronal cells in the relatively undamaged areas of Terry's brain have slowly grown new and important connections over a period of years in a process known as axonal re-growth.

Voss et al. compared Terry's post-recovery brain structure and function with that of 20 healthy individuals and another MCS patient that had not shown any recovery after 6 years. The authors suggest that the axonal re-growth may be the result of Terry's brain trying to re-establish connections that would allow for functions like motor control and speech to resume after injury.

In the aftermath of the political, ethical, medical, and legal controversies that surrounded the highly publicized right-to-live versus right-to-die case of Terry Schiavo there has been much debate about the outcome for patients with disorders of consciousness. Unlike patients in a persistent vegetative state like Schiavo, MCS patients will show more than purely reflex or automatic behavior, but they will nevertheless be unable to communicate their thoughts or feelings in more than a limited or intermittent capacity. Our minimal understanding of why some patients recover from these disorders has limited our ability to predict emergence from MCS and optimize the health care options for these individuals.

In an accompanying commentary, Steven Laureys from the University of Liège writes, "Chronically unconscious or minimally conscious patients represent unique problems for diagnosis, prognosis, treatment, and everyday management. They are vulnerable to being denied potentially life-saving therapy..... This case shows that old dogmas need to be oppugned." While the researchers are careful to caution that this process of axonal re-growth may not be occurring in all MCS patients, similar future findings in other MCS patients could effect how these individuals are cared for and evaluated. The results reported here by Voss and coworkers will increase our understanding of severely brain-damaged patients and their "miracle" recovery of consciousness. The study suggests a method by which brain function in these individuals can be monitored and their potential recovery from MCS could be tracked.
-end-
Author contact:
Jonathan Weil
Office of Public Affairs, Cornell University, New York, New York, USA.
Phone: 212-821-0560; Fax: 212-821-0576; E-mail: jweil@med.cornell.edu.
View the PDF of this article at: https://www.the-jci.org/article.php?id=27021

Accompanying commentary
TITLE: Tracking the recovery of consciousness from coma

Author contact:
Steven Laureys
University of Liège, Liège, Belgium.
Phone: 32-4-366-23-16; Fax: 32-4-366-29-46; Email: steven.laureys@ulg.ac.be.
View the PDF of this article at: https://www.the-jci.org/article.php?id=29172

JCI Journals

Related Brain Articles from Brightsurf:

Glioblastoma nanomedicine crosses into brain in mice, eradicates recurring brain cancer
A new synthetic protein nanoparticle capable of slipping past the nearly impermeable blood-brain barrier in mice could deliver cancer-killing drugs directly to malignant brain tumors, new research from the University of Michigan shows.

Children with asymptomatic brain bleeds as newborns show normal brain development at age 2
A study by UNC researchers finds that neurodevelopmental scores and gray matter volumes at age two years did not differ between children who had MRI-confirmed asymptomatic subdural hemorrhages when they were neonates, compared to children with no history of subdural hemorrhage.

New model of human brain 'conversations' could inform research on brain disease, cognition
A team of Indiana University neuroscientists has built a new model of human brain networks that sheds light on how the brain functions.

Human brain size gene triggers bigger brain in monkeys
Dresden and Japanese researchers show that a human-specific gene causes a larger neocortex in the common marmoset, a non-human primate.

Unique insight into development of the human brain: Model of the early embryonic brain
Stem cell researchers from the University of Copenhagen have designed a model of an early embryonic brain.

An optical brain-to-brain interface supports information exchange for locomotion control
Chinese researchers established an optical BtBI that supports rapid information transmission for precise locomotion control, thus providing a proof-of-principle demonstration of fast BtBI for real-time behavioral control.

Transplanting human nerve cells into a mouse brain reveals how they wire into brain circuits
A team of researchers led by Pierre Vanderhaeghen and Vincent Bonin (VIB-KU Leuven, Université libre de Bruxelles and NERF) showed how human nerve cells can develop at their own pace, and form highly precise connections with the surrounding mouse brain cells.

Brain scans reveal how the human brain compensates when one hemisphere is removed
Researchers studying six adults who had one of their brain hemispheres removed during childhood to reduce epileptic seizures found that the remaining half of the brain formed unusually strong connections between different functional brain networks, which potentially help the body to function as if the brain were intact.

Alcohol byproduct contributes to brain chemistry changes in specific brain regions
Study of mouse models provides clear implications for new targets to treat alcohol use disorder and fetal alcohol syndrome.

Scientists predict the areas of the brain to stimulate transitions between different brain states
Using a computer model of the brain, Gustavo Deco, director of the Center for Brain and Cognition, and Josephine Cruzat, a member of his team, together with a group of international collaborators, have developed an innovative method published in Proceedings of the National Academy of Sciences on Sept.

Read More: Brain News and Brain Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.