By Dr. Rohan Ramakrishna
Researchers from the University of Munich recently reported that they were able to awaken an 82-year-old woman who’d been in a persistent vegetative state by using injections of her own immune cells.
The woman, who had suffered a stroke, had been cared for at home by her family and a home health nurse -- for nine long years.
Then her doctors proposed an experimental new treatment, offering to give the octogenarian intramuscular injections of her own immune cells, specially activated in the laboratory to produce substances thought to modulate brain activity.
Remarkably, after starting the weekly injections, the patient began to respond to commands and even regain some movement in previously weakened limbs. She opened her eyes and turned toward people entering the room, grabbed the hands of her grandchildren (with both hands) and looked at them, and would voluntarily move her tongue when her teeth were brushed.
Although she’d been on a feeding tube for years, her swallowing reflex even began to return.
The implications of her awakening are truly astounding.
As a neurosurgeon who treats patients with traumatic brain injuries and serious strokes on a daily basis, I'm too often presented with a patient, who despite our team's best efforts, fails to awaken from a coma.
Sometimes the combination of time, patience and a tireless family results in a patient who wakes up six months after their injury. Other times, though, they don't -- primarily because no treatments are available to change the outcome for patients in persistent coma. But perhaps this new research will change that.
According to the article, published in a recent issue of the Journal of Medical Case Reports, the doctors manipulated the patient’s own cells to somehow restore some brain function nine years after a devastating stroke, a claim few physicians can make.
Their results also suggest that injections of these sorts of cells might even be effective in patients who have recently suffered brain injury.
This news is especially significant since, despite decades of research in neuroscience and behavioral medicine, no therapies have emerged in the last 50 years that systematically reverse coma in patients that have suffered significant strokes or traumatic brain injuries. However, the last decade of neuroscientific research has produced a wealth of data regarding neural responses to injury and potential routes to neuronal rehabilitation and even restoration.
Modern medicine is quite good at rehabilitating patients who are awake but disabled from their brain injury. Specifically, physicians and physiatrists in the field of rehabilitation medicine do a superb job at retraining the mind to rewire around injury and compensate for functions that have been lost. However, modern medicine still has yet to come up with a solution for patients who do not wake up. That’s why this research is so intriguing.
But these new findings also bring up a host of questions:
Could anything else have possibly explained the patient’s improvement? Were there side effects or potential complications to the treatment? Are there plans to test this treatment in a randomized fashion with a large number of patients?
All of these questions need to be considered before an experimental treatment can be considered for wider use. Until then, this research most certainly qualifies as fringe medicine.
It also reopens the debate regarding the care of patients in coma.
For example, is a person really alive if they are unable to meaningfully interact or comprehend the outside world? How you answer that question is a topic of much controversy, as it brings in religion, politics, medicine and culture (the Terri Schiavo case is a perfect example of how complicated -- and heated -- this issue can become).
Another pertinent question: Is being alive the same thing as being human, a sentient being? If it isn’t, how do you reconcile the societal cost of medical care for persons who are alive but no longer awake? How do you reconcile the human cost? Does your answer to these questions change if there is a treatment that offers a tiny chance of improving the patient’s comatose condition?
In reality, the vast majority of patients in long-term deep coma or persistent vegetative state do not get better despite treatment. Even the 82-year-old woman who was "reawakened" by the use immune cells injections later died after aspirating her food and developing pneumonia.
However, research aimed at protecting or even restoring brain tissue from permanent damage after injury is always welcomed. It may demand further study, but for now, it offers a glimmer of hope to patients and their families.
Dr. Rohan Ramakrishna is a chief resident in neurological surgery at the University of Washington in Seattle.
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