刊登在8月2日《自然》杂志网络版上的一项研究报告称，一位脑部受伤达6年之久、只能微微移动眼球和稍动拇指的病人，在接受脑电极植入手术后，已能开口讲话。
这位38岁的男子在一次袭击中脑部受伤，6年来，他的肢体一直没有做出过任何有意义的动作，只是偶尔表现出有知觉的迹象，医学上称这种状况为“轻微知觉状态”。与昏迷和植物人状态有所不同，在后面两种情况下，病人不会表现出任何意识。
纽约市韦尔－康奈尔医学院的尼古拉斯·希夫博士领导的研究小组在该男子的脑中植入了数个电极，通过开、关电极来进行一种深度脑刺激治疗，这种方法在治疗帕金森病时经常使用。经过6个月治疗，他已经可以用短促但能听得见的声音讲话。新泽西州约翰逊康复研究所的约瑟夫·贾西诺介绍说，该病人不会主动与人交谈，但能回答别人的提问，通常是用1至3个单词。
该男子的部分运动功能也同时得以恢复。他重新获得了咀嚼和吞咽的能力，这让他可以通过汤勺喂食来获取营养，从而摆脱了对插管喂食的长期依赖。希夫说，他可以比划出像刷牙一类的动作，但他还不能真地完成这些动作。由于多年没有运动，他的肌腱已经萎缩了。实际上，他仍然是一名完全不能自理的伤残病人。
该男子的母亲认为，这种治疗方法对他儿子帮助很大。她说，“我儿子现在能吃饭，能表达，能让我知道他感到疼痛。他现在享受的生活质量是我原先做梦都想不到的。”
专家称，这项研究成果令人振奋，但必须经过更多的人体试验，才能正确评价其应用价值。
美国科学家近日通过向大脑中植入电极，成功地使一位因伤陷入最小意识状态（minimally conscious state）达六年之久的患者辨认出了指定物体，并能做出准确的手势。该项研究有望对处于最小意识状态的病患提供新的治疗方法。相关论文发表在8月2日的《自然》杂志上。
此次研究由美国威尔康奈尔医学院（Weill Cornell Medical College）的Nicholas Schiff领导完成。他和同事向一位因伤陷入最小意识状态达六年之久、只有微弱意识的男性脑中植入电极，然后用电流刺激中央丘脑，结果发现该男子能辨认出指定物体和做出准确手势，并且能够咀嚼食物，摆脱了食管的帮助。
严重的脑部伤害是很常见的问题，但是关于治疗方法的研究却很少见。一般认为，处于最小意识状态的病患如果在受伤后的最初12个月里没有好转的话，他们康复的希望就很小了。Schiff表示，此次研究的对象虽然大脑皮层受到了严重伤害，但是大脑的其它一些关键部位保存完好。这意味着这种电刺激法可能并不适用于其它种类的脑部伤害。
伦敦帝国学院的临床神经学家Paul Matthews认为，这种深度脑刺激法（DBS）虽然并不能治愈处于最小意识状态的病患，但它至少能在某些患者身上起作用。更为重要的是，它表明了患者在受伤很久后仍然能够得到好转。
原始出处:
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: nds2001@mail.med.cornell.edu).
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.
