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.

In an accompanying commentary, Steven Laureys from the University of Liège writes, "Chronically unconscious or minimally conscious patients represent unique problems for diagnosis, prognosis, treatment, and everyday management. They are vulnerable to being denied potentially life-saving therapy….. This case shows that old dogmas need to be oppugned." While the researchers are careful to caution that this process of axonal re-growth may not be occurring in all MCS patients, similar future findings in other MCS patients could effect how these individuals are cared for and evaluated. The results reported here by Voss and coworkers will increase our understanding of severely brain-damaged patients and their "miracle" recovery of consciousness. The study suggests a method by which brain function in these individuals can be monitored and their potential recovery from MCS could be tracked.

Author contact:
Jonathan Weil
Office of Public Affairs, Cornell University, New York, New York, USA.
Phone: 212-821-0560; Fax: 212-821-0576; E-mail: jweil@med.cornell.edu.
View the PDF of this article at: https://www.the-jci.org/article.php?id=27021

Accompanying commentary
TITLE: Tracking the recovery of consciousness from coma

Author contact:
Steven Laureys
University of Liège, Liège, Belgium.
Phone: 32-4-366-23-16; Fax: 32-4-366-29-46; Email: steven.laureys@ulg.ac.be.
View the PDF of this article at: https://www.the-jci.org/article.php?id=29172

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