A story in yesterday’s Guardian would seem to provide hope that a simple sleeping pill can revive people from a persistent vegetative state.
We have always been told there is no recovery from persistent vegetative state – doctors can only make a sufferer’s last days as painless as possible. But is that really the truth? Across three continents, severely brain-damaged patients are awake and talking after taking … a sleeping pill. And no one is more baffled than the GP who made the breakthrough. Steve Boggan witnesses these ‘strange and wonderful’ rebirths.
For three years, Riaan Bolton has lain motionless, his eyes open but unseeing. After a devastating car crash doctors said he would never again see or speak or hear. Now his mother, Johanna, dissolves a pill in a little water on a teaspoon and forces it gently into his mouth. Within half an hour, as if a switch has been flicked in his brain, Riaan looks around his home in the South African town of Kimberley and says, “Hello.” Shortly after his accident, Johanna had turned down the option of letting him die.
Three hundred miles away, Louis Viljoen, a young man who had once been cruelly described by a doctor as “a cabbage”, greets me with a mischievous smile and a streetwise four-move handshake. Until he took the pill, he too was supposed to be in what doctors call a persistent vegetative state.
Across the Atlantic in the United States, George Melendez, who is also brain-damaged, has lain twitching and moaning as if in agony for years, causing his parents unbearable grief. He, too, is given this little tablet and again, it’s as if a light comes on. His father asks him if he is, indeed, in pain. “No,” George smiles, and his family burst into tears.
It all sounds miraculous, you might think. And in a way, it is. But this is not a miracle medication, the result of groundbreaking neurological research. Instead, these awakenings have come as the result of an accidental discovery by a dedicated – and bewildered – GP. They have all woken up, paradoxically, after being given a commonly used sleeping pill.
Across three continents, brain-damaged patients are reporting remarkable improvements after taking a pill that should make them fall asleep but that, instead, appears to be waking up cells in their brains that were thought to have been dead. In the next two months, trials on patients are expected to begin in South Africa aimed at finding out exactly what is going on inside their heads. Because, at the moment, the results are baffling doctors.
[…]
“Something strange and wonderful is happening here, and we have to get to the bottom of it,” he says. “Since Louis, I have treated more than 150 brain-damaged patients with zolpidem and have seen improvements in about 60% of them. It’s remarkable.”
After Louis’ awakening was publicised in the South African media, Dr Ralf Clauss, a physician of nuclear medicine – the use of radioactive isotopes in diagnostic scans – at the Medical University of Southern Africa, contacted Nel to suggest carrying out a scan on Louis. “The results were so unbelievable that I got other colleagues to check my findings,” says Clauss, who now works at the Royal Surrey County Hospital in Guildford. “We did scans before and after we gave Louis zolpidem. Areas that appeared black and dead beforehand began to light up with activity afterwards. I was dumbfounded – and I still am.”
[…]
No one yet knows exactly how a sleeping pill could wake up the seemingly dead brain cells, but Nel and Clauss have a hypothesis. After the brain has suffered severe trauma, a chemical known as Gaba (gamma amino butyric acid) closes down brain functions in order to conserve energy and help cells survive. However, in such a long-term dormant state, the receptors in the brain cells that respond to Gaba become hypersensitive, and as Gaba is a depressant, it causes a persistent vegetative state.
There are several other patients detailed in the story. A quick check of GoogleNews shows a smattering of other reports on this topic going back to last week after the research was published in the prestigious Science.
These reports will doubtless renew the bitter debate sparked by the Terri Schiavo case. Dean Esmay recounts the vitriol surrounding his siding with the parents over the husband and feels some vindication over the report. Some doctors familiar with the new study disagree.
Accident victims, like the woman in the Science report, often have severed connections between brain cells, although the neurons themselves may remain intact. As many as half of those patients regain at least some consciousness within a year of the accident. After a year, however, few recover. Those who don’t are considered to be in a persistent vegetative state.
Patients who suffer heart attacks or strokes, like Schiavo, have a much more widespread death of brain cells because of lack of oxygen, sharply reducing their chances of recovering. The window of recovery for such patients is only about three months, Fins said.
A 1994 study of 700 patients found that none who had been in a persistent vegetative state for at least two years regained awareness. Schiavo had been bedridden for 15 years.
I’m still reasonably confident that Terri Schiavo could not have been revived, let alone had anything like a normal life. Dean’s trump card is that we can’t be certain, a point with which I agree. Then again, life doesn’t offer many certainties.
All we can do in tragic cases like Schiavo’s, it seems to me, is trust that the next of kin, in consultation with the doctors, are making the best decision they can in the interest of all concerned. In cases where there is an inter-family dispute, it’s reasonable to have judges look at the situation to ensure there is no reason to believe the spouse isn’t acting in good faith. Telling them they have to allow their loved one to remain in a persistent vegetative state indefinitely–or, perversely, divorce them–because there might be a cure one day is simply too cruel a fate to ponder.
