刊登在8月2日《自然》雜志網絡版上的一項研究報告稱,，一位腦部受傷達6年之久、只能微微移動眼球和稍動拇指的病人,，在接受腦電極植入手術后,，已能開口講話。
這位38歲的男子在一次襲擊中腦部受傷,，6年來,，他的肢體一直沒有做出過任何有意義的動作，只是偶爾表現出有知覺的跡象,，醫(yī)學上稱這種狀況為“輕微知覺狀態(tài)”,。與昏迷和植物人狀態(tài)有所不同,，在后面兩種情況下,，病人不會表現出任何意識,。
紐約市韋爾－康奈爾醫(yī)學院的尼古拉斯·希夫博士領導的研究小組在該男子的腦中植入了數個電極，通過開,、關電極來進行一種深度腦刺激治療,，這種方法在治療帕金森病時經常使用。經過6個月治療,，他已經可以用短促但能聽得見的聲音講話,。新澤西州約翰遜康復研究所的約瑟夫·賈西諾介紹說，該病人不會主動與人交談,，但能回答別人的提問,，通常是用1至3個單詞。
該男子的部分運動功能也同時得以恢復,。他重新獲得了咀嚼和吞咽的能力,，這讓他可以通過湯勺喂食來獲取營養(yǎng)，從而擺脫了對插管喂食的長期依賴,。希夫說,，他可以比劃出像刷牙一類的動作，但他還不能真地完成這些動作,。由于多年沒有運動,，他的肌腱已經萎縮了。實際上,，他仍然是一名完全不能自理的傷殘病人,。
該男子的母親認為，這種治療方法對他兒子幫助很大,。她說,，“我兒子現在能吃飯，能表達,，能讓我知道他感到疼痛,。他現在享受的生活質量是我原先做夢都想不到的。”
專家稱,，這項研究成果令人振奮,，但必須經過更多的人體試驗，才能正確評價其應用價值,。
美國科學家近日通過向大腦中植入電極,，成功地使一位因傷陷入最小意識狀態(tài)（minimally conscious state）達六年之久的患者辨認出了指定物體，并能做出準確的手勢,。該項研究有望對處于最小意識狀態(tài)的病患提供新的治療方法,。相關論文發(fā)表在8月2日的《自然》雜志上。
此次研究由美國威爾康奈爾醫(yī)學院（Weill Cornell Medical College）的Nicholas Schiff領導完成,。他和同事向一位因傷陷入最小意識狀態(tài)達六年之久,、只有微弱意識的男性腦中植入電極,，然后用電流刺激中央丘腦，結果發(fā)現該男子能辨認出指定物體和做出準確手勢,，并且能夠咀嚼食物,，擺脫了食管的幫助。
嚴重的腦部傷害是很常見的問題,，但是關于治療方法的研究卻很少見,。一般認為，處于最小意識狀態(tài)的病患如果在受傷后的最初12個月里沒有好轉的話,，他們康復的希望就很小了,。Schiff表示，此次研究的對象雖然大腦皮層受到了嚴重傷害,，但是大腦的其它一些關鍵部位保存完好,。這意味著這種電刺激法可能并不適用于其它種類的腦部傷害。
倫敦帝國學院的臨床神經學家Paul Matthews認為,，這種深度腦刺激法（DBS）雖然并不能治愈處于最小意識狀態(tài)的病患,，但它至少能在某些患者身上起作用。更為重要的是,，它表明了患者在受傷很久后仍然能夠得到好轉,。
原始出處:
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. Schiff1, J. T. Giacino2,3, K. Kalmar2, J. D. Victor1, K. Baker4, M. Gerber2, B. Fritz2, B. Eisenberg2, J. O'Connor2, E. J. Kobylarz1, S. Farris4, A. Machado4, C. McCagg2, F. Plum1, J. J. Fins5 & A. R. Rezai4
Department of Neurology & Neuroscience, Weill Cornell Medical College, New York, New York 10021, USA
JFK Johnson Rehabilitation Institute, Edison, New Jersey 08818, USA
New Jersey Neuroscience Institute, Edison, New Jersey 08818, USA
Center for Neurologic Restoration, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
Division of Medical Ethics, Weill Cornell Medical College, New York, New York 10021, USA
Correspondence to: Correspondence and requests for materials should be addressed to N.D.S. (Email: [email protected]).
Abstract
Widespread loss of cerebral connectivity is assumed to underlie the failure of brain mechanisms that support communication and goal-directed behaviour following severe traumatic brain injury. Disorders of consciousness that persist for longer than 12 months after severe traumatic brain injury are generally considered to be immutable; no treatment has been shown to accelerate recovery or improve functional outcome in such cases1, 2. Recent studies have shown unexpected preservation of large-scale cerebral networks in patients in the minimally conscious state (MCS)3, 4, a condition that is characterized by intermittent evidence of awareness of self or the environment5. These findings indicate that there might be residual functional capacity in some patients that could be supported by therapeutic interventions. We hypothesize that further recovery in some patients in the MCS is limited by chronic underactivation of potentially recruitable large-scale networks. Here, in a 6-month double-blind alternating crossover study, we show that bilateral deep brain electrical stimulation (DBS) of the central thalamus modulates behavioural responsiveness in a patient who remained in MCS for 6 yr following traumatic brain injury before the intervention. The frequency of specific cognitively mediated behaviours (primary outcome measures) and functional limb control and oral feeding (secondary outcome measures) increased during periods in which DBS was on as compared with periods in which it was off. Logistic regression modelling shows a statistical linkage between the observed functional improvements and recent stimulation history. We interpret the DBS effects as compensating for a loss of arousal regulation that is normally controlled by the frontal lobe in the intact brain. These findings provide evidence that DBS can promote significant late functional recovery from severe traumatic brain injury. Our observations, years after the injury occurred, challenge the existing practice of early treatment discontinuation for patients with only inconsistent interactive behaviours and motivate further research to develop therapeutic interventions.
