Sleeping Pill Ambien Cure for Persistent Vegetative State?

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.

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James Joyner
About James Joyner
James Joyner is a Security Studies professor at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. McGehee says:

    Well, we sure can be certain she won’t be coming back from her present state.

  2. John Burgess says:

    I think the CT scans of Schiavo’s brain–validated by the post mortem examination of her brain–show that we can be very, very sure that she would not have benefited from Ambien. Only a treatment that could have regrown over 50% of her brain would have returned her to sentient life.

    As the article notes, there’re different kinds of brain damage. Some seem amenable to treatment with Ambien. Others, with different etiologies and different states of destruction of the brain are not.

  3. Tano says:

    Yes, as John points out above. A sleeping pill may influence the brain’s biochemistry in interesting and unexpected ways, but it doesn’t regrow neurons.

    It is quite irresponsible, aside from being wrong, to give credence to the claim that this phenomenon has anything to do with Schaivo’s condition. Sorry, but we can be certain about that.

  4. R.Mutt says:

    “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.”

    Dean’s trump card in the Schiavo case? Please explain how this report vindicates Esmay or has any bearing to the actual facts of Terri Schiavo’s condition after having been in a persistent vegetative state for a decade. Repeated cat-scans and review of Ms. Schiavo’s diagnosis by several independent doctors all came to the same conclusion. Ms. Schiavo had suffered permanent irreversible degeneration to approx. 1/3 of the part of her brain associated with cognition and consciousness.This being the case, how would a drug that seemingly wakes up dead brain cells have helped. The quoted portion of the report you posted didn’t seem to mention the prospect of regenerating lost brain matter. Repeated judicial reviews of her case reaffirmed the diagnosis, but were drawn out for years by her parents who, egged on and supported by anti-abortion and right-to-life groups, fanatics like Randell Terry and championed by partisan idiots like Esmay, accused Michael Schiavo of everythingg from abuse to murder. I didn’t follow Dean’s commentary very closely, but I have a good hunch that he was hurling invective and unsupported insinuations at Mr. Schiavo with his usual penchant for overheated rhetorical excess. (Please tell me differently and I will be glad to apologize.) I can’t think of a more nakedly partisan and ugly chapter in recent years as the public humiliation and excoriation of Michael Schiavo. It’s pathetic and telling that Dean Esmay thinks this research provides a scintilla of justification or vindication for his views.

  5. boinkie says:

    Ummm…the term persistant vegetative state is a sham, since it is widely overdiagnosed.
    I worked with the profoundly retarded. It is scary that many specialists saw these people as better off dead…not as handicapped people who need our help.
    Not putting a feeding tube in Grandmom who has end stage alzheimer’s disease is ethical because it won’t prolong her life. Alas, too often feeding tubes are not needed, but placed for convenience… the fact that Schiavo lived for 15 years suggests that she was able to swallow saliva (and not die of aspiration pneumnia) and therefore she could eat with a spoon…so her death was murder of an inconvenient spouse.

  6. Patterico says:

    I’m not going to say Ambien would have revived Schiavo. But did you all actually read the article?

    What about the recent case of Terry Wallis?

    Doctors have their first proof that a man who was barely conscious for nearly 20 years regained speech and movement because his brain spontaneously rewired itself by growing tiny new nerve connections to replace the ones sheared apart in a car crash.

    One of you says:

    Please explain how this report vindicates Esmay or has any bearing to the actual facts of Terri Schiavo’s condition after having been in a persistent vegetative state for a decade. Repeated cat-scans and review of Ms. Schiavo’s diagnosis by several independent doctors all came to the same conclusion.

    Well, the main subject in the article was diagnosed as being in a persistent vegetative state for five years. And brain scans showed his brain to be dead:

    “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.”

    I think with the autopsy we know that Schiavo was beyond hope. But until then, I don’t see how you could say for sure — because a bunch of experts wrote off the folks in this article, for similar reasons.

  7. John Burgess says:

    Patterico: I think you might be conflating two conditions. The Schiavo CAT scans, done years before her death, showed not just death of brain tissue, but the liquidification of over 50% of her brain mass. What was gone was all of the cerebral cortex. That was clear in the CAT scan and confirmed in the post-mortem.

    In the case you cite from the UK, the issue was different in two ways: First, it was called “dead”, but it was still present, i.e. not liquified. Second, it appears that the problem was the shearing of neuronal connections between different parts of the cortex.

    It does appear that under some circumstances, neuronal tissue can grow. That’s a very exciting development. But it doesn’t suggest that brains can be regrown, only re-linked in damaged areas.

    If somehow Schiavo’s life could have been run backwards, so that her brain “deliquified” back to living tissue, and at that point Ambien or some other drug could have connected the parts (I’m skipping over the issue of how major her first, dibilitating stroke was, i.e., how much true destruction of cortex occured), then perhaps she might have benefited from the treatment.

    Since we don’t have time machines, since we didn’t have Ambien-like treatments 15 years ago, it’s all moot.

    But even now, it’s a comparison of apples and oranges.

  8. Anon says:

    Patterico, you are mistaken. I am all for never giving up hope. But in the Schiavo case, her brain was just simply destroyed. In the MRI scan, you can detect where there are living neurons. There was a huge part of Shiavo’s brain that was gone.

    The Viljoen case is completely different. His brain was there, it was just not working, do to broken wiring. His brain scan was most likely a PET scan, which detects brain activity, and uses radioactive isotopes of oxygen. The doctor was being figurative when he said “black and dead”. He meant dead in the sense of inactive, not dead in the sense of just fluid where there should have been cells.

    A lot of this confusion is that PVS is a term that doesn’t indicate the cause. It’s like a TV that doesn’t work. It could be not working because someone totally destroyed major internal parts. Or it could be not working because a single wire inside has been disconnected.

    In the former case, there is no hope. In the latter case, there is, however. But a lot of confusion can result when a single term describes both conditions.