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Doctors: Comatose man's brain rewires
By MARILYNN MARCHIONE, AP Medical WriterTue Jul 4, 5:29 AM ET
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."
jillian said:Interesting article. If it's accurate, it's certainly an argument for intensified stem cell research, because as far as anyone has known til now, brain cells don't regenerate. They do say that he was only partially comatose, so I'm not sure how that differs from a persistent vegetative state.
One case among how many hundreds of thousands/millions certainly wouldn't change my mind on the other issues. I still think we're kinder to our pets than to people.
Glad to know that you were against government involving itself in the Schiavo matter. I agree. And just to distinguish her case from this.... her brain was liquified and wasn't partially anything.
GunnyL said:Yeah, and good thing it turned out that way after the fact. I'd like to see which of you libs was going to resurrect her had the guesswork been wrong.
Whoops, we screwed up.
jillian said:Ahhhhhhhh...as usual, you take the most extreme position possible. There was no "guesswork", there was "science"...you know, medicine practiced by the doctors who TREATED her. You like when people say things you want to hear and create issues where there are none so you can say there is "disagreement". But there was no disagreement from anyone who knew anything.
Or should we have believed Dr. Bill "I saw a video" Frist?
Will the docs that want to stop feeding/fluids read this?
BTW, for those not around here long, I was AGAINST the FEDERAL government getting involved with Schiavo...
Yeah, and good thing it turned out that way after the fact. I'd like to see which of you libs was going to resurrect her had the guesswork been wrong.
Whoops, we screwed up.
1549 said:Terry Schiavo was suffering in more ways than the people in this article.
I have no hard feeling on the Schiavo case. My family faced a similar, though somewhat more black and white decision. I bring that up only because it is easy to say you support a viewpoint, but reality makes things a lot more difficult. The laws favored Terry's scumbag husband...it is just too bad the family was not able to have a mutual decision, one way or the other.
There actually was not much guesswork involved. Terry Schiavo's condition is about as rare as an apple, thousands of people with similar ailments lay in hospitals as we speak. Not one of them will wake up tomorrow and say "what is for breakfast?".
It is unfortunate and I hope one day a scientific miracle will be able to rescue people from such tragic states...but if her condition had been different, it would have been like finding a pretzel in a bag of potato chips. Ultimately it is probably not impossible, the pretzels and chips could be made in the same factory, but it is not going to happen.
GunnyL said:To clarify my position, I have no real problem a decision made by a person that they desire to not be kept alive on a machine. Had that been in writing, I wouldn't have bothered to learn to spell "Schaivo."
My problem with the issue is that her life was terminated based on the hearsay of her husband, who stood to gain by her demise. Now, had they been in DIVORCE court, do you think they would take the uncorroborated statement of her husband as evidence of anything if he stood to gain? I seriously doubt it.
It is my opinion that in circumstances as happened in this case, we as a society should err on the side of caution rather than death. We did not, and I consider the decision rendered to be the wrong one.
I think a person has a right to not be kept alive artificially if there is no chance of recovery, and/or they will be just a living shell at best afterward. BUT, I think that person should be the one to make that choice, and not have it made based on someone else's word.
1549 said:My bad with schiavo/schaivo.
I agree with a lot of what you are saying, but I do have a few disagreements. In the 'final wishes' trial, 18 witnesses provided testimony about Terri's wish to or not to be kept alive. The media has portrayed it as strictly the husband vs. the parents. Considering the husband's sketchy character and the possibility of alterior motives, I can not help but believe that the testimony of the 18 witnesses was legitimate to the point that the judge felt the husband was not lying.
I find it hard to believe that she would tell 18 people that if she was living on a tube, pull the plug. At any rate, I am speaking of legal documentation signed by the individual and properly witnessed and notarized.. IIRC, those people that testified for the husband came out of the woodwork.
That leads to the parent's defense that she was not in a permanent vegetative state. Doctors know what they are looking at. As I said before, this is not a rare injury. With modern MRI and past cases, I am sure the doctors had no doubts that this women would never recover.
I would disagree with your opinion of doctors. Some are good and some aren't so good. And some will say she was a veg, and others said she was not.
Either way, I did not and do not support the parent's argument other than the fact that they were willing to take care of their daughter and absolve Michael Schaivo of any responsibility.
To back track to the original post in this thread, the article was about people who are in a coma. Schaivo was in a coma for 10 weeks, and then came out of it in a vegetative state. That is why articles like this should not cast doubt on the court's decision.
GunnyL said:I STILL disagree with the court's decision.
Abbey Normal said:Hey 1549, I suppose I am the only person who didn't didn't know that Dylan was a born-again Christian. Do you think that it lost him some fans?
From Wikipedia:
"Dylan's work in the late 1970s and early 1980s was dominated by his becoming, in 1979, a born-again Christian. He released two albums of exclusively religious material and a third that seemed mostly so; of these, the first, Slow Train Coming (1979), is generally regarded as the most accomplished, winning him a Grammy for best male vocalist. The second album, Saved (1980), was not so well-received. When touring from the fall of 1979 through the spring of 1980 Dylan refused to play secular music and delivered sermonettes on stage, such as:
Years ago they used ..., said I was a prophet. I used to say, "No I'm not a prophet" they say "Yes you are, you're a prophet." I said, "No it's not me." They used to say "You sure are a prophet." They used to convince me I was a prophet. Now I come out and say Jesus Christ is the answer. They say, "Bob Dylan's no prophet." They just can't handle it. (January 25, 1980, Omaha) [5]"
.
1549 said:It probably did. Well I do believe in a secular government, I am indifferent to a person's personal faith. I am glad Dylan found religion and I like the music from all parts of his career. I have not read his book Tarantula though...maybe one day I'll get to that.
Dylan is a very interesting guy. Grew up in a small town, became famous in the big city. I think his detractors need to realize that Dylan and his art stand for what is right: equality, peace, and justice--and hey, everybody must get stoned
jillian said:Ahhhhhhhh...as usual, you take the most extreme position possible. There was no "guesswork", there was "science"...you know, medicine practiced by the doctors who TREATED her. You like when people say things you want to hear and create issues where there are none so you can say there is "disagreement". But there was no disagreement from anyone who knew anything.
Or should we have believed Dr. Bill "I saw a video" Frist?
GunnyL said:"Science." Right. The doctors that treat her took a guess, but only the autopsy proved them correct. Guess it worked out for them and the rest of you that support state-sanctioned murder. Would've sucked to be them if it hadn't.
Bullypulpit said:It is painfully clear that the primacy of reason over faith given us by the Enlightenment, which began in the 18th century, has passed by many here.
No guesswork involved. MRI and CT scans provide detailed 3D maps of of tissues within the human body, incluyding the human brain. Terry Schiavo's autopsy only provided another confirmation of what was already known.
And, golly, "state sanctioned murder" wasn't the case at all. It was a decisoin by Michael Schiavo to, resonably and as was his right under law, to withdraw medical treatment that was futile. It became an issue only when Terri's parent's made an issue of it, never mind that Terri's father pulled the plug on his mother. An of course, once the religious right-wing nuts got ahold of the issue they turned it into a three-ring circus which politicians eagerly, and cheerfully, leaped into. Notable among these political crap-sacks was Tom DeLay, who pulled the plug on his father a few years earlier. Right wing hypocrisy and religious fundamentalism walking hand-in-hand for purely political ends.
