To Be Carefully Evaluated

How the technology would synchronize with the brain’s complex function, which is poorly understood, is a critical question. A ventriculoperitoneal drain, a last resort measure to improve coma, assumes widening of the ventricles is the main culprit, and it’s always unsuccessful. It has been studied for traumatic brain injury. Unfortunately, adding more oxygen to the body isn’t helpful if a cell is injured to the point that it can’t absorb oxygen. Therefore, benefits and risks of the therapy need to be carefully evaluated. In clinical research, the earliest treatment is given six hours after an injury. A more aggressive treatment involves placing an electrode deep inside the brain to stimulate the thalamus. Whether the cells that rev up a person’s alertness can be electrically stimulated remains an open question, although we know that neurons fire after triggering by electrical currents and chemical signals. Electrode implantation is tantamount to adding more battery power to a defective computer and not the equivalent of a soldering iron. Also, focusing on just one aspect of brain activity isn’t enough because many parts need to function together to produce wakefulness. Magnetic and transcranial ultrasound stimulation are other therapies that have been suggested. We don’t know whether either would help patients or cause additional damage.

Enough Is Enough

Spinal stimulation and transcranial magnetic stimulation are also questionable. One study involved placing wires in the spinal cords of 200 patients in a vegetative state to stimulate their spines. A randomized, controlled trial of dorsal column stimulation was proposed but hasn’t been performed. Transcranial magnetic stimulation produced similar results in another study. While all these preliminary clinical results have been called intriguing and encouraging, they are nothing more than that. On it we can see how brain regions are connected in networks and identify the regions potentially most important to an individual’s recovery. It’s deceptive to claim that very slow activity indicates a nonfunctional brain when someone is in a dreamless sleep and under anesthesia. We just don’t know if that’s the case. Generally, however, increased activity in one region that’s associated with activity in another region doesn’t mean that any sort of communication or direct connection is occurring between those areas. However, the regions could be critical for consciousness full recovery. The number of comatose patients in whom it’s been studied can be counted on two hands. And once we have the results, what do we do with them? Does the person’s mind simply go blank, or is an inner life present that the person is unable to communicate again? Patients coming out of a coma don’t remember anything.

Deadly Sins

Those who claim they do weren’t comatose in the first place. Meanwhile, technology continues to evolve, and its role in diagnosis and treatment continues to be explored. The mechanisms of action for such a treatment are mostly hypothetical. Grafted stem cells must be compatible with the new host environment or they’ll die. Stem cells can either be injected into the arteries leading to the brain or directly implanted into the brain with a neurosurgical probe. In animal studies, stem cell treatment has restored injured tissues, but its use is still experimental. In theory, the treatment might be more successful in adolescents than in adults because younger brains are better able to regenerate lost neurons. Areas of concern include a lack of data showing that stem cell transplantation provides meaningful benefits for humans. The bottom line is it’s just too soon to even consider such a therapy for acute brain injury. In the 1960s, brain transplants were performed on monkeys, but the experiments went nowhere. This piece of medical history is a cautionary tale and an egregious aberration. The data gained didn’t pave the way for transplantation, but it vividly demonstrated how rapidly a brain declines following separation from a body.

Life Is A Battlefield

The experiments showed that a brain simply can’t tolerate being without blood for the time it takes to remove it from the donor and reattach it to major vessels in the recipient. Recently, the topic of brain transplantation came up again in relation to experiments in mice and a new protocol described in the media and even in medical literature. Clearly, there’s still a misunderstanding about whether a brain can be transplanted into an otherwise healthy body. Actually, the opposite seems more likely, although it’s more in the realm of a horror movie than medical science. The aim would be to remove the head from the recipient and detach the body from the donor and, ultimately, transplant the recipient’s head onto the healthy donor body. Head transplantation is impossible. The scientific community greeted news of this experiment with major skepticism because even attempting the procedure on deceased donors raises so many surgical, ethical and psychosocial issues. The procedure should logically be called a body transplant, but I don’t believe for a minute that anyone has the knowledge needed to connect the head from one person to the body of another person. Many different acute and chronic diseases and conditions can cause a coma. So, it’s fruitless to think that one therapy could help every individual who is comatose. Scientists wouldn’t do research on interventions for pain without knowing what led to the discomfort, and the same is true for coma. Rather than searching for a single therapy, research on treatments for acute coma that produces awakening and good brain function must proceed differently. Reduce early complications, such as increased brain pressure, shock and poor oxygenation Recognize that some individuals will get worse quickly unless we take preventive steps Include a neurosurgeon on the care team, because the timing of surgery matters Get the little things right and avoid treatments that can harm patients Standardize major interventions rather than taking a scattershot approach, with one neurorehabilitation center doing one thing while the another does something else Greater access to a neurorehabilitation center may improve the chances of survival in a patient in a prolonged coma. Drug therapy to stimulate brain function is prioritized in neurorehabilitation centers, but its benefit remains questionable at best.