6 ms·

Brain zap rouses people from years of vegetative state

53 points by tjaerv 13y ago

whoopiecush 13y ago
I hate to be a skeptic, but a sample size of 15 people is far from conclusive. And just when I thought electric shock therapy was almost dead...
- beejiu 13y ago
  The sample size was 55. 15 showed sign of response. I don't know the probabilities, but that's probably greater than the probability of response without treatment, with statistical significance. Obviously, you'd have to know the exact details to gauge its significance -- I'm sure those will be in the paper.
  - asfapifb 13y ago
    It depends on what the prior probability of them waking up without intervention was as to its significance. Statistical significance is a function of both frequency of effect and magnitude of effect.
- frandroid 13y ago
  It's not dead, and it won't die. It's used more discriminately now, especially in the case of deeply depressed people, with good results.
- Cushman 13y ago
  Just so we're clear: when you say "electric shock therapy" you're talking about electroconvulsive therapy, which uses a strong shock to induce a seizure (under anaesthesia). It's actually the seizure itself which is therapeutic, which should give you an idea of the severity of the conditions it's used to treat: ECT is a last-resort treatment which can be lifesaving for severe depression, schizophrenia, or catatonia which are unresponsive to medication. There are less extreme alternatives being studied, but as of today ECT is still the magic bullet in some severe cases. Anyway, this article is not about ECT, but transcranial direct current stimulation. tCDS is a completely different concept that uses much lower voltage, applied continuously in the direction of neuron activation, to promote activity and possibly growth. It's been used by healthy individuals to try to boost cognition, and it's certainly exciting to hear it may have real therapeutic indications as well.
tjaerv 13y ago
Fascinating research suggesting how consciousness as an emergent phenomenon needs to cross an activation threshold to boot up.
- cristianpascu 13y ago
  IF consciousness is an emergent phenomenon. :)
  - pohl 13y ago
    What's a real, possible alternative? If consciousness is not something that arises out of a multiplicity of relatively simple interactions, then is the alternative that consciousness is unrelated to the multiplicity of relatively simple interactions but by sheer coincidence vanishes when those interactions are disrupted?
    - mgkimsal 13y ago
      maybe just the ability for the consciousness to express itself in a way humans can understand vanishes. ??
      - pohl 13y ago
        I kind of like that idea. Sort of like how Tomb Raider's ability to express itself vanishes when you turn off the Playstation. Laura continues to proceed through the dungeon, but we just can't see her.
    - cristianpascu 13y ago
      First, I don't know which is the difference/connection between real and possible alternatives. By real you mean plausible? Secondly, consciousness goes away even though those many _relatively simple_ interactions are still there. So, I'd say, that we don't really know for sure that consciousness is not there when worms are eating our brains. Consciousness is a subjective phenomenon. That's what makes it impossible to study directly, without relying on reports. And that's what separates it from those _relatively simple_ interactions which we can model and study experimentally.
rcthompson 13y ago
Bizarre. What if we can fully rouse patients with this treatment, but only temporarily? Imagine being dependent on a daily morning tCDS treatment to wake up every day. Maybe this will be incorporated into an implantable device, like a pacemaker for the brain (not in the sense of providing periodic pulses, but rather in the sense of being required for normal functionality).
- Jtsummers 13y ago
  There's actually precedent for that. [1] Uses there include epilepsy, Parkinson's and depression treatment. But extending beyond that, my search also found this [2], for Alzheimer's treatment. [1] http://en.wikipedia.org/wiki/Brain_pacemaker http://en.wikipedia.org/wiki/Brain_pacemaker [2] http://medicalcenter.osu.edu/mediaroom/releases/Pages/Ohio-State-Implants-First-Brain-Pacemaker-To-Treat-Alzheimer's.aspx http://medicalcenter.osu.edu/mediaroom/releases/Pages/Ohio-S...
  - byoogle 13y ago
    Also encephalitis lethargica, the treatment of which even got turned into a movie (and book and play): http://en.wikipedia.org/wiki/Awakenings http://en.wikipedia.org/wiki/Awakenings. (Spoiler: The patients, unfortunately, developed a tolerance for the treatment within a few months.)
  - rcthompson 13y ago
    Yes, I vaguely remember hearing about "brain pacemakers" before, thank you for reminding me. But I'm using the term a little more metaphorically: just like a patient's heart might just stop without a pacemaker, in this case the patient would lose consciousness if the "brain pacemaker" was deactivated. To put it more bluntly, imagine that you were revived from a vegetative state, but your consciousness now effectively has an on/off switch. http://i.imgur.com/lSjkmNj.gif http://i.imgur.com/lSjkmNj.gif
  - caycep 13y ago
    Well, the Parkinson's thing isn't all that complicated - simple wire w/ ~ 1.5mm electrode sending out a 130Hz square wave at ~ 3 volts. It's been FDA approved for over a decade now, and ~100k implants have been done worldwide. The interesting part is that no one knows why it works as well as it has. tDCS, and TMS, on the other hand, have barely measurable effects or widely variable effects, and no one has really figured out how to make them practical. Useful for all sorts of psych papers and hypothesis generation, though.
timdiggerm 13y ago
This is a great argument against "pulling the plug" on folks in vegetative states.
- daeken 13y ago
  You don't pull the plug on those in a vegetative state. They have brain activity and a functioning brain stem -- generally they're just on a feeding tube.
  - cstavish 13y ago
    I certainly could be wrong here, but wasn't Terry Schiavo in a persistent vegetative state?
    - wnevets 13y ago
      http://www.nbcnews.com/id/8225637/ns/us_news/t/schiavo-autopsyshows-irreversiblebrain-damage/ http://www.nbcnews.com/id/8225637/ns/us_news/t/schiavo-autop... > An autopsy on Terri Schiavo backed her husband’s contention that she was in a persistent vegetative state, finding that she had massive and irreversible brain damage and was blind
      - caycep 13y ago
        Someone published the CT scan of the brain, IIRC, there certainly wasn't a lot left. Not by volume, at least...
  - caycep 13y ago
    Ideally there would be some sort of advanced directive, living will, etc. Being on a breathing machine and feeding tube is pretty terrible...a lot of people would beg to pull the plug...
- jtheory 13y ago
  It's certainly a great reminder that I should (as should everyone) make a living will. If you ever end up in a persistent vegetative state, it's grueling for your family & loved ones. We now have the tech to keep you sort-of alive for many years, but it's not cheap, of course. There have been ridiculous controversies in the US (see http://en.wikipedia.org/wiki/Terri_Schiavo_case http://en.wikipedia.org/wiki/Terri_Schiavo_case for a good example) about families that have decided (with the support of medical professionals) to pull the plug after years of suffering... and there may be protests from the devout (because to some people, any action or explicit inaction that causes a life to end is murder), political interference all the way up to high levels, etc.. It's also somewhat sad that if it's time to give up on restoring a person to working order, the ways of doing that may be limited to somewhat slow & cruel methods (like removing a feeding tube) rather than more humane methods, due to the legal terrain. There's a certain level of brain damage from which it's not possible to recover a functional person; it's hard to draw that line (see OP for emphasis on that), but it's a line that people in real life are obligated to draw on a regular basis. If you make a living will that specifies that you do not wish to be kept on life support if your brain activity is below X for Y time (a bit of research required here), you can save the people you leave behind a great deal of heartache by not foisting the decision on them.
grannyg00se 13y ago
Interesting. I wonder what people typically describe after suddenly becoming communicative after months or years of vegetative state.
mybbor 13y ago
I can't help but wonder if this is a devastating headline for anyone who has had to take a loved one off of life support.
gagege 13y ago
At first I thought some guy named Brian Zap was doing this.
- aantix 13y ago
  Oh the irony, "Dr. Zap" applies mild electric stimulation to wake up his vegetative patients. :)
caycep 13y ago
The problem is the outcome measures for these sort of things are always kind of murky. "Signs of Responsiveness Not Previously Seen Before Intervention" might mean more eye twitching than average, etc. These aren't people who suddenly wake up and start talking after tDCS
- rcthompson 13y ago
  I guess the next step is to set up blind studies, where one doctor sets up the apparatus for either a real or sham treatment, and then leaves the room, then another doctor comes in with the family and runs the treatment without knowing which treatment is being administered. Alternatively, the treatment is administered (or not) by a second doctor in another room who can't communicate with those in the room.
- tjaerv 13y ago
  > These aren't people who suddenly wake up and start talking after tDCS Did you actually read the article? "Some recovered the ability to communicate"
md224 13y ago
Those of you fascinated by electrical manipulation of consciousness may find this interesting: http://blogs.discovermagazine.com/neuroskeptic/2014/02/23/disconnecting-consciousness-external-environment/ http://blogs.discovermagazine.com/neuroskeptic/2014/02/23/di... > Guillaume Herbet and colleagues describe the case of a 45 year old man in whom electrical stimulation of a particular spot in the brain “induced a dramatic alteration of conscious experience in a highly reproducible manner.” Basically, when they zapped a certain point in his brain, it sent him into some kind of dream state. Very interesting.
- jhvh1134 13y ago
  And this is how Total Recall became a reality
LukeShu 13y ago
mybbor: You appear to be shadow banned. All of your comments since December 2010 are "[dead]". https://news.ycombinator.com/item?id=7320083 https://news.ycombinator.com/item?id=7320083
pessimizer 13y ago
That 'facilitated communication' isn't mentioned in this article is worrying. How were the vegetative people communicating, how was it observed and recorded, and how conscious were the experimenters of (possibly subconscious) mistakes in the past related to the interpretation of slight movements from the disabled or vegetative as communication? edit: http://theness.com/neurologicablog/index.php/man-in-coma-23-years-is-he-really-conscious/ http://theness.com/neurologicablog/index.php/man-in-coma-23-... http://www.skepdic.com/cleverlinda.html http://www.skepdic.com/cleverlinda.html
- Luc 13y ago
  Yup, this is the same researcher from a few years back: https://www.google.com/search?q=facilitated+communication+Steven+Laureys https://www.google.com/search?q=facilitated+communication+St... It's shameful, really. See also this article (about the 2010 'revelation'): http://www.csicop.org/si/show/fabricating_communication/ http://www.csicop.org/si/show/fabricating_communication/ "At the beginning and at the end of our trials, we tried to make normal conversation with Houben, and the FC seemed to work perfectly fine, producing intelligible and sometimes even elaborate sentences. In one test, we asked the facilitator to leave the room while we showed Houben a large printed word, which we read aloud to him several times. The facilitator was then allowed to return and assist Mr. Houben in giving the word back to us. Although a well-formed word, the resulting answer was completely wrong. We tried the same test with a large and simple drawing, which yielded identical results. In another test, we shielded the keyboard from the facilitator’s view in the midst of an answer. Immediately, the typing changed into gibberish and soon halted completely"
  - pessimizer 13y ago
    Awful. I didn't even catch that. As a journalist, writing up this story without reference to Houben must be some sort of malpractice. http://scienceblogs.com/insolence/2009/11/28/coma-man-dr-steven-laureys-just-doesnt-g/ http://scienceblogs.com/insolence/2009/11/28/coma-man-dr-ste... http://www.psychologytoday.com/blog/adventures-in-old-age/201002/gullible-science-where-is-clever-hans-when-we-need-him http://www.psychologytoday.com/blog/adventures-in-old-age/20...
muraiki 13y ago
I found it interesting that the article mentions amantadine. I suffered a mild traumatic brain injury with post-concussion syndrome whose effects were persisting for quite a long time. While vestibular therapy made a big difference, once that treatment plateaued I started taking amantadine -- it had been suggested by my doctor before, but I'm a stubborn person. The difference that amantadine made in terms of my concussion was significant. My migraines almost completely vanished, but more importantly I had the cognitive energy to do things that had been impossible for many months, such as programming and playing my musical instruments. I had to take it slow at first, but the difference amantadine made was truly remarkable. It's not fully understood how this drug works, especially considering that it was originally used as an anti-flu medicine. Furthermore, my understanding is that it was no longer used in treating Parkinsons. But it's one of the few drugs that seems to have an effect in people suffering from post-concussion syndrome. A cousin of mine who also suffered from pretty serious post-concussion syndrome likewise had good results with amantadine. It should be noted that the use of amantadine is controversial in concussion treatment. From what I've heard, some patients don't get much benefit, and the effects tend to wear off over time. Also, it caused me to have problems with insomnia, which were mostly addressed through sleep hygiene and melatonin. But I thought that I'd share my experience here, as this experience helped me to understand just how physical our mind is, and how there are likely a variety of avenues for helping the brain when it is damaged.

53 points by tjaerv 13y ago

I hate to be a skeptic, but a sample size of 15 people is far from conclusive. And just when I thought electric shock therapy was almost dead...

beejiu 13y ago
The sample size was 55. 15 showed sign of response. I don't know the probabilities, but that's probably greater than the probability of response without treatment, with statistical significance. Obviously, you'd have to know the exact details to gauge its significance -- I'm sure those will be in the paper.
- asfapifb 13y ago
  It depends on what the prior probability of them waking up without intervention was as to its significance. Statistical significance is a function of both frequency of effect and magnitude of effect.
frandroid 13y ago
It's not dead, and it won't die. It's used more discriminately now, especially in the case of deeply depressed people, with good results.
Cushman 13y ago
Just so we're clear: when you say "electric shock therapy" you're talking about electroconvulsive therapy, which uses a strong shock to induce a seizure (under anaesthesia). It's actually the seizure itself which is therapeutic, which should give you an idea of the severity of the conditions it's used to treat: ECT is a last-resort treatment which can be lifesaving for severe depression, schizophrenia, or catatonia which are unresponsive to medication. There are less extreme alternatives being studied, but as of today ECT is still the magic bullet in some severe cases. Anyway, this article is not about ECT, but transcranial direct current stimulation. tCDS is a completely different concept that uses much lower voltage, applied continuously in the direction of neuron activation, to promote activity and possibly growth. It's been used by healthy individuals to try to boost cognition, and it's certainly exciting to hear it may have real therapeutic indications as well.

tjaerv 13y ago

Fascinating research suggesting how consciousness as an emergent phenomenon needs to cross an activation threshold to boot up.

cristianpascu 13y ago
IF consciousness is an emergent phenomenon. :)
- pohl 13y ago
  What's a real, possible alternative? If consciousness is not something that arises out of a multiplicity of relatively simple interactions, then is the alternative that consciousness is unrelated to the multiplicity of relatively simple interactions but by sheer coincidence vanishes when those interactions are disrupted?
  - mgkimsal 13y ago
    maybe just the ability for the consciousness to express itself in a way humans can understand vanishes. ??
    - pohl 13y ago
      I kind of like that idea. Sort of like how Tomb Raider's ability to express itself vanishes when you turn off the Playstation. Laura continues to proceed through the dungeon, but we just can't see her.
  - cristianpascu 13y ago
    First, I don't know which is the difference/connection between real and possible alternatives. By real you mean plausible? Secondly, consciousness goes away even though those many _relatively simple_ interactions are still there. So, I'd say, that we don't really know for sure that consciousness is not there when worms are eating our brains. Consciousness is a subjective phenomenon. That's what makes it impossible to study directly, without relying on reports. And that's what separates it from those _relatively simple_ interactions which we can model and study experimentally.

rcthompson 13y ago

Bizarre. What if we can fully rouse patients with this treatment, but only temporarily? Imagine being dependent on a daily morning tCDS treatment to wake up every day. Maybe this will be incorporated into an implantable device, like a pacemaker for the brain (not in the sense of providing periodic pulses, but rather in the sense of being required for normal functionality).

Jtsummers 13y ago
There's actually precedent for that. [1] Uses there include epilepsy, Parkinson's and depression treatment. But extending beyond that, my search also found this [2], for Alzheimer's treatment. [1] http://en.wikipedia.org/wiki/Brain_pacemaker http://en.wikipedia.org/wiki/Brain_pacemaker [2] http://medicalcenter.osu.edu/mediaroom/releases/Pages/Ohio-State-Implants-First-Brain-Pacemaker-To-Treat-Alzheimer's.aspx http://medicalcenter.osu.edu/mediaroom/releases/Pages/Ohio-S...
- byoogle 13y ago
  Also encephalitis lethargica, the treatment of which even got turned into a movie (and book and play): http://en.wikipedia.org/wiki/Awakenings http://en.wikipedia.org/wiki/Awakenings. (Spoiler: The patients, unfortunately, developed a tolerance for the treatment within a few months.)
- rcthompson 13y ago
  Yes, I vaguely remember hearing about "brain pacemakers" before, thank you for reminding me. But I'm using the term a little more metaphorically: just like a patient's heart might just stop without a pacemaker, in this case the patient would lose consciousness if the "brain pacemaker" was deactivated. To put it more bluntly, imagine that you were revived from a vegetative state, but your consciousness now effectively has an on/off switch. http://i.imgur.com/lSjkmNj.gif http://i.imgur.com/lSjkmNj.gif
- caycep 13y ago
  Well, the Parkinson's thing isn't all that complicated - simple wire w/ ~ 1.5mm electrode sending out a 130Hz square wave at ~ 3 volts. It's been FDA approved for over a decade now, and ~100k implants have been done worldwide. The interesting part is that no one knows why it works as well as it has. tDCS, and TMS, on the other hand, have barely measurable effects or widely variable effects, and no one has really figured out how to make them practical. Useful for all sorts of psych papers and hypothesis generation, though.

timdiggerm 13y ago

This is a great argument against "pulling the plug" on folks in vegetative states.

daeken 13y ago
You don't pull the plug on those in a vegetative state. They have brain activity and a functioning brain stem -- generally they're just on a feeding tube.
- cstavish 13y ago
  I certainly could be wrong here, but wasn't Terry Schiavo in a persistent vegetative state?
  - wnevets 13y ago
    http://www.nbcnews.com/id/8225637/ns/us_news/t/schiavo-autopsyshows-irreversiblebrain-damage/ http://www.nbcnews.com/id/8225637/ns/us_news/t/schiavo-autop... > An autopsy on Terri Schiavo backed her husband’s contention that she was in a persistent vegetative state, finding that she had massive and irreversible brain damage and was blind
    - caycep 13y ago
      Someone published the CT scan of the brain, IIRC, there certainly wasn't a lot left. Not by volume, at least...
- caycep 13y ago
  Ideally there would be some sort of advanced directive, living will, etc. Being on a breathing machine and feeding tube is pretty terrible...a lot of people would beg to pull the plug...
jtheory 13y ago
It's certainly a great reminder that I should (as should everyone) make a living will. If you ever end up in a persistent vegetative state, it's grueling for your family & loved ones. We now have the tech to keep you sort-of alive for many years, but it's not cheap, of course. There have been ridiculous controversies in the US (see http://en.wikipedia.org/wiki/Terri_Schiavo_case http://en.wikipedia.org/wiki/Terri_Schiavo_case for a good example) about families that have decided (with the support of medical professionals) to pull the plug after years of suffering... and there may be protests from the devout (because to some people, any action or explicit inaction that causes a life to end is murder), political interference all the way up to high levels, etc.. It's also somewhat sad that if it's time to give up on restoring a person to working order, the ways of doing that may be limited to somewhat slow & cruel methods (like removing a feeding tube) rather than more humane methods, due to the legal terrain. There's a certain level of brain damage from which it's not possible to recover a functional person; it's hard to draw that line (see OP for emphasis on that), but it's a line that people in real life are obligated to draw on a regular basis. If you make a living will that specifies that you do not wish to be kept on life support if your brain activity is below X for Y time (a bit of research required here), you can save the people you leave behind a great deal of heartache by not foisting the decision on them.

grannyg00se 13y ago

Interesting. I wonder what people typically describe after suddenly becoming communicative after months or years of vegetative state.

mybbor 13y ago

I can't help but wonder if this is a devastating headline for anyone who has had to take a loved one off of life support.

gagege 13y ago

At first I thought some guy named Brian Zap was doing this.

aantix 13y ago
Oh the irony, "Dr. Zap" applies mild electric stimulation to wake up his vegetative patients. :)

caycep 13y ago

The problem is the outcome measures for these sort of things are always kind of murky. "Signs of Responsiveness Not Previously Seen Before Intervention" might mean more eye twitching than average, etc. These aren't people who suddenly wake up and start talking after tDCS

rcthompson 13y ago
I guess the next step is to set up blind studies, where one doctor sets up the apparatus for either a real or sham treatment, and then leaves the room, then another doctor comes in with the family and runs the treatment without knowing which treatment is being administered. Alternatively, the treatment is administered (or not) by a second doctor in another room who can't communicate with those in the room.
tjaerv 13y ago
> These aren't people who suddenly wake up and start talking after tDCS Did you actually read the article? "Some recovered the ability to communicate"

md224 13y ago

Those of you fascinated by electrical manipulation of consciousness may find this interesting: http://blogs.discovermagazine.com/neuroskeptic/2014/02/23/disconnecting-consciousness-external-environment/ http://blogs.discovermagazine.com/neuroskeptic/2014/02/23/di... > Guillaume Herbet and colleagues describe the case of a 45 year old man in whom electrical stimulation of a particular spot in the brain “induced a dramatic alteration of conscious experience in a highly reproducible manner.” Basically, when they zapped a certain point in his brain, it sent him into some kind of dream state. Very interesting.

jhvh1134 13y ago
And this is how Total Recall became a reality

LukeShu 13y ago

mybbor: You appear to be shadow banned. All of your comments since December 2010 are "[dead]". https://news.ycombinator.com/item?id=7320083 https://news.ycombinator.com/item?id=7320083

pessimizer 13y ago

That 'facilitated communication' isn't mentioned in this article is worrying. How were the vegetative people communicating, how was it observed and recorded, and how conscious were the experimenters of (possibly subconscious) mistakes in the past related to the interpretation of slight movements from the disabled or vegetative as communication? edit: http://theness.com/neurologicablog/index.php/man-in-coma-23-years-is-he-really-conscious/ http://theness.com/neurologicablog/index.php/man-in-coma-23-... http://www.skepdic.com/cleverlinda.html http://www.skepdic.com/cleverlinda.html

Luc 13y ago
Yup, this is the same researcher from a few years back: https://www.google.com/search?q=facilitated+communication+Steven+Laureys https://www.google.com/search?q=facilitated+communication+St... It's shameful, really. See also this article (about the 2010 'revelation'): http://www.csicop.org/si/show/fabricating_communication/ http://www.csicop.org/si/show/fabricating_communication/ "At the beginning and at the end of our trials, we tried to make normal conversation with Houben, and the FC seemed to work perfectly fine, producing intelligible and sometimes even elaborate sentences. In one test, we asked the facilitator to leave the room while we showed Houben a large printed word, which we read aloud to him several times. The facilitator was then allowed to return and assist Mr. Houben in giving the word back to us. Although a well-formed word, the resulting answer was completely wrong. We tried the same test with a large and simple drawing, which yielded identical results. In another test, we shielded the keyboard from the facilitator’s view in the midst of an answer. Immediately, the typing changed into gibberish and soon halted completely"
- pessimizer 13y ago
  Awful. I didn't even catch that. As a journalist, writing up this story without reference to Houben must be some sort of malpractice. http://scienceblogs.com/insolence/2009/11/28/coma-man-dr-steven-laureys-just-doesnt-g/ http://scienceblogs.com/insolence/2009/11/28/coma-man-dr-ste... http://www.psychologytoday.com/blog/adventures-in-old-age/201002/gullible-science-where-is-clever-hans-when-we-need-him http://www.psychologytoday.com/blog/adventures-in-old-age/20...

muraiki 13y ago

I found it interesting that the article mentions amantadine. I suffered a mild traumatic brain injury with post-concussion syndrome whose effects were persisting for quite a long time. While vestibular therapy made a big difference, once that treatment plateaued I started taking amantadine -- it had been suggested by my doctor before, but I'm a stubborn person. The difference that amantadine made in terms of my concussion was significant. My migraines almost completely vanished, but more importantly I had the cognitive energy to do things that had been impossible for many months, such as programming and playing my musical instruments. I had to take it slow at first, but the difference amantadine made was truly remarkable. It's not fully understood how this drug works, especially considering that it was originally used as an anti-flu medicine. Furthermore, my understanding is that it was no longer used in treating Parkinsons. But it's one of the few drugs that seems to have an effect in people suffering from post-concussion syndrome. A cousin of mine who also suffered from pretty serious post-concussion syndrome likewise had good results with amantadine. It should be noted that the use of amantadine is controversial in concussion treatment. From what I've heard, some patients don't get much benefit, and the effects tend to wear off over time. Also, it caused me to have problems with insomnia, which were mostly addressed through sleep hygiene and melatonin. But I thought that I'd share my experience here, as this experience helped me to understand just how physical our mind is, and how there are likely a variety of avenues for helping the brain when it is damaged.