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