Man in vegetative state for 15 years responds to new therapy

The 35-year-old is showing signs of consciousness after receiving nerve treatment

Images of a brain pre- and post-vagus nerve stimulation. Photograph: Corazzol et al/PA Wire

Images of a brain pre- and post-vagus nerve stimulation. Photograph: Corazzol et al/PA Wire

 

A 35-year-old man who had been in a vegetative state for 15 years is showing signs of consciousness after receiving a pioneering treatment based on nerve stimulation.

In the month since a vagus nerve stimulator was put into his chest, the man, who was injured in a car accident, has begun responding to simple orders, something which had been impossible before.

The findings, which are reported in Current Biology, may help to show that by stimulating the vagus nerve “it is possible to improve a patient’s presence in the world”, according to the project’s lead researcher, Angela Sirigu, of Institut des Sciences Cognitives Marc Jeannerod in Lyon, France.

The researchers said the findings may challenge the view that a vegetative state that lasts for more than 12 months is irreversible.

Other scientists have hailed the development as “a potentially very exciting finding” but have also urged caution.

After treatment, it was reported that the patient could follow an object with his eyes and turn his head on request. His mother also said he had an improved ability to stay awake when listening to his therapist reading a book.

The vagus nerve connects the brain to many other parts of the body, including the gut.

It is known to be important in waking, alertness, and many other essential functions.

The patient, who was chosen for the project because he had been lying in a vegetative state for more than a decade with no sign of improvement, also appeared to react to a “threat”.

Researchers spotted that he reacted with surprise by opening his eyes wide when an examiner’s head suddenly approached his face.

Changes in brain activity may show that the patient has shifted from being in a vegetative state to being in a state of minimal consciousness.

An important signal in distinguishing between these conditions had increased significantly in areas of the brain involved in movement, sensation, and awareness, according to the scientists.

Gains were also spotted in the brain’s functional connectivity and metabolic activity in both cortical and subcortical regions of the brain.

The researchers are now planning a large collaborative study.

‘Exciting indication’

Dr Tom Manly, of Cambridge University’s MRC Cognition and Brain Sciences Unit, described the development as a “potentially very exciting finding”.

He added: “It is very important to take into account that the patient moved from a vegetative to a minimally conscious state. That is, consciousness remains severely altered but, in contrast to the vegetative state, there is minimal but definite behavioural evidence of self or environmental awareness.

“The finding is therefore in my view an exciting preliminary indication that prolonged intervention could produce benefits that further work will no doubt address.

“In my view, it would be fair to say that this treatment could potentially restore consciousness in some patients in a vegetative state, rather than that it can.”

Roland Jones, professor in neuropharmacology at the University of Bath, said: “These results need to be repeated in other patients with long-term vegetative conditions to confirm the findings.

“If they can be, this treatment could complement a growing range of pharmacological approaches . . . that have been shown to partially reverse vegetative states and restore both motor and cognitive function in some cases.”

PA