The Iron Ring

Appearing today in Nature is a list of five blogs written by scientists that have made the technorati list of top 3500 blogs-

So congrats to the big five listed here: http://www.nature.com/news/2006/060703/full/442009a.html this is no small feat in the web universe.

Moving on- today’s post is regarding a piece that appeared in the Journal of Clinical Investigation this week (http://www.jci.org/cgi/content/full/116/7/1823) about a man, named Terry Wallis, who emerged from a minimally conscious state 19 years after a traumatic brain injury caused by a car accident. Doctors documented recovery of verbal skills, and further, they used magnetic resonance diffusion tensor imaging to detect changes in white matter pathology. In comparing the results of Wallis’s scan to that of a patient that did not improve, they speculated that axonal growth was responsible for his recovery.

Before we begin dredging up memories of Terry Schiavo and right to life discussions, it should be remembered that there is a major difference between a minimally conscious state (MCS) and a vegetative state (VS). As stated in the abstract of the JCI paper;

“Patients in MCS will show more than the purely reflex or automatic behavior observed in VS survivors, but they will nevertheless be unable to communicate their thoughts and feelings. Recent preliminary evidence indicates that MCS patients demonstrate improvement over a longer period of time and attain better functional recovery as compared with VS patients.”

In the early stages following injury it is possible to move from VS to MCS, although very little is known about the major differences between patients who are able to make this move and those who are not. In addition, little is known about the difference between MCS patients whose status does not change, and patients such as Terry Wallis who after 19 years begin to speak again. According to the bbc (http://news.bbc.co.uk/2/hi/americas/3052433.stm) Wallis’s doctors speculate that time spent with his family on weekends away from his Nursing and Rehab Center may have helped. As with most other applications of the scientific method, it would be valuable to compare ‘baseline’ values for Wallis, those taken immediately after his injury to his white matter pathology now. Unfortunately, Wallis did not even see a neurologist after his accident (see cnn.com news story http://www.cnn.com/2003/US/South/07/07/mute.no.more/) because his insurance would not cover it. But I suppose that discussion is best left for a different post.

# posted by Sarah : 9:19 PM