A 38-year-old man with a severe head injury who spent more than five years in a minimally conscious state is now communicating regularly with family members and recovering his ability to move after his brain was stimulated with pulses of electric current.

The experimental study, led by Nicholas Schiff, associate professor of neurology and neuroscience, and Joseph Fins, M.D., professor of medicine, public health and medicine in psychiatry at Weill Cornell Medical College; and researchers at the JFK Johnson Rehabilitation Institute and the Cleveland Clinic Foundation, provides the first rigorous evidence that a prosthetic device can initiate and sustain recovery in such a severely disabled person years after the injury occurred. The result was published in the Aug. 2 issue of Nature.

The patient was treated with deep brain stimulation surgery, a technique that targets deep-brain structures with millimeter-precision using computer-generated maps, image-guided navigation and physiological brain mapping. Tiny electrodes implanted into the brain are connected to programmable pacemaker batteries in the chest.

"We knew that some patients in MCS [minimally conscious state], including our subject, retain functioning brain networks above the brainstem," said Schiff, who is also director of the Laboratory for Neuromodulation at WCMC. "Activity within these integrated neural networks is supported by cells in an area of the brain called the central thalamus, which is thought to be key to adjusting brain activity as it responds to cognitive demands."

Said Joseph T. Giacino, the study's co-lead author and associate director of neuropsychology at JFK Johnson Rehabilitation Institute and the New Jersey Neuroscience Institute: "Our theory was that electrical impulses targeted to this area would help amplify the existing low level of activity that we thought was already there. In other words, we assume that the signals that help drive speech and movement are still present in the brain -- we're just bumping up their efficiency and function to help get them working better."

Experts estimate that from 100,000 to 300,000 patients with traumatic brain injury are diagnosed as MCS. Under the current standard of care, most do not receive active rehabilitation and are cared for in long-term nursing facilities.

This first DBS procedure is part of an FDA-approved pilot study that will include 12 patients in post-traumatic MCS. The study and its funding sources are described in more detail at http://news.med.cornell.edu/wcmc/wcmc_2007/08_02_07.shtml.