A 38 year old man in Minimal Conscious State (MCS) for 6 years after closed head injury after an assault was implanted bilateral Deep Brain Stimulation electrodes in his head with the tips in the central thalamus. The electrodes were turned off and on at random during different periods of 30 days. The patient was assessed by a neuro-rehabilitation team ignorant of the stimulation schedule. The patient was more alert during the DBS-on periods, he could use his limbs after instruction, and he could chew and swallow food when it was placed on his tongue. The observed improvements in arousal, motor control and behavioural persistence were due to the DBS. It seems there is another indication for DBS coming: chronic Minimal Conscious State with widely preserved brain structure and clear evidence of interactive behaviour (command following, verbalisation and inconsistent communication).
Progression and long term outcome has to be assessed after this promising result.
DBS is already used for Parkinson’s disease when all other options failed and sporadically for depression, again when all other options have failed.
Nature 448, 600-603 (2 August 2007) | doi:10.1038/nature06041; Received 13 April 2007; Accepted 22 June 2007
Behavioural improvements with thalamic stimulation after severe traumatic brain injury
N. D. Schiff, J. T. Giacino, K. Kalmar, J. D. Victor, K. Baker, M. Gerber, B. Fritz, B. Eisenberg, J. O’Connor, E. J. Kobylarz, S. Farris, A. Machado, C. McCagg, F. Plum, J. J. Fins & A. R. Rezai