刊登在8月2日《自然》雜志網(wǎng)絡(luò)版上的一項(xiàng)研究報(bào)告稱,，一位腦部受傷達(dá)6年之久、只能微微移動(dòng)眼球和稍動(dòng)拇指的病人,，在接受腦電極植入手術(shù)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(dòng)作，只是偶爾表現(xiàn)出有知覺的跡象,，醫(yī)學(xué)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(huì)表現(xiàn)出任何意識(shí)。
紐約市韋爾－康奈爾醫(yī)學(xué)院的尼古拉斯·希夫博士領(lǐng)導(dǎo)的研究小組在該男子的腦中植入了數(shù)個(gè)電極,，通過開,、關(guān)電極來進(jìn)行一種深度腦刺激治療，這種方法在治療帕金森病時(shí)經(jīng)常使用,。經(jīng)過6個(gè)月治療,，他已經(jīng)可以用短促但能聽得見的聲音講話。新澤西州約翰遜康復(fù)研究所的約瑟夫·賈西諾介紹說,，該病人不會(huì)主動(dòng)與人交談,，但能回答別人的提問，通常是用1至3個(gè)單詞,。
該男子的部分運(yùn)動(dòng)功能也同時(shí)得以恢復(fù),。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(yíng)養(yǎng),，從而擺脫了對(duì)插管喂食的長(zhǎng)期依賴,。希夫說，他可以比劃出像刷牙一類的動(dòng)作,，但他還不能真地完成這些動(dòng)作,。由于多年沒有運(yùn)動(dòng)，他的肌腱已經(jīng)萎縮了,。實(shí)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(rèn)為，這種治療方法對(duì)他兒子幫助很大,。她說,，“我兒子現(xiàn)在能吃飯，能表達(dá),，能讓我知道他感到疼痛,。他現(xiàn)在享受的生活質(zhì)量是我原先做夢(mèng)都想不到的。”
專家稱,，這項(xiàng)研究成果令人振奮,，但必須經(jīng)過更多的人體試驗(yàn)，才能正確評(píng)價(jià)其應(yīng)用價(jià)值,。
美國(guó)科學(xué)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(shí)狀態(tài)（minimally conscious state）達(dá)六年之久的患者辨認(rèn)出了指定物體，并能做出準(zhǔn)確的手勢(shì),。該項(xiàng)研究有望對(duì)處于最小意識(shí)狀態(tài)的病患提供新的治療方法,。相關(guān)論文發(fā)表在8月2日的《自然》雜志上。
此次研究由美國(guó)威爾康奈爾醫(yī)學(xué)院（Weill Cornell Medical College）的Nicholas Schiff領(lǐng)導(dǎo)完成,。他和同事向一位因傷陷入最小意識(shí)狀態(tài)達(dá)六年之久,、只有微弱意識(shí)的男性腦中植入電極，然后用電流刺激中央丘腦,，結(jié)果發(fā)現(xiàn)該男子能辨認(rèn)出指定物體和做出準(zhǔn)確手勢(shì),，并且能夠咀嚼食物，擺脫了食管的幫助,。
嚴(yán)重的腦部傷害是很常見的問題,，但是關(guān)于治療方法的研究卻很少見。一般認(rèn)為,，處于最小意識(shí)狀態(tài)的病患如果在受傷后的最初12個(gè)月里沒有好轉(zhuǎn)的話,，他們康復(fù)的希望就很小了。Schiff表示,，此次研究的對(duì)象雖然大腦皮層受到了嚴(yán)重傷害,，但是大腦的其它一些關(guān)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(guó)學(xué)院的臨床神經(jīng)學(xué)家Paul Matthews認(rèn)為,，這種深度腦刺激法（DBS）雖然并不能治愈處于最小意識(shí)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(zhuǎn)。
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.
