Wednesday, August 08, 2007

Twilight Geek: The Eye of the Beholder

Two recent bits of news on the medical front, both via the BBC.

1) "Minimally Conscious State" is a neurological state where the person exhibits intermittent or greatly limited signs of awareness. It's differentiated both from a coma, where the person is deeply unconscious, and a persistent vegetative state, or PVS, which is characterized by wakefulness but no awareness. For some time, it was felt there was little that could be done for people in a minimally conscious state and institutional care with the hope of spontaneous recovery (which did happen) was the usual course.

Now, that may have changed. Consider this case of a man badly beaten six years ago, causing brain damage that left him in a minimally conscious state.
Deep brain stimulation with electrical pulses may offer hope for patients trapped in a minimally conscious state.

Treatment of a 38-year-old man with a severe brain injury enabled him to use words and gestures, chew and swallow and drink from a cup, say US doctors.

Before the stimulation, done through electrodes implanted in his brain, he could only make slight eye or finger movements, the team report in Nature. ...

The procedure involves electrodes implanted with millimetre accuracy to specific areas of the brain. ...

Over a period of six months the researchers alternated periods of electrical stimulation with fake stimulation to assess whether it was having an effect.

Within 48 hours of the first stimulation, the patient was able to keep his eyes open, turn his head, and utter words.

After several treatments he is now able to perform complex tasks such as brushing his hair, although with difficulty due to severe immobility caused by his condition.

And he can chew and swallow his food where before he needed a feeding tube.
One example, of course, is not conclusive: There have, again, been enough spontaneous recoveries to hold off judgment. But the FDA has now approved tests on 12 additional patients and if the results are replicated, it could dramatically change the standard of care and radically improve their chances of getting better.

2) A disease whose seriousness is often overlooked because its effects tend to be cumulative over a period of years, is diabetes. Those effects can indeed be devastating: blindness; ulceration, even gangrene, of the feet; nerve damage; kidney failure; heart disease. But something new has come up that may make the condition, while incurable, even more manageable than it is now.
A simple vitamin deficiency may be the cause of many of the side effects of diabetes, a study suggests.

Researchers found people with the disease expelled thiamine - vitamin B1 - from their bodies at 15 times the normal rate in a study of 94 people.
The study, done by a team at Warwick University, found thiamine levels in the blood plasma of diabetes patients at levels 75% lower than they should be. This hadn't been noticed before, the team said, because it turned out that the standard test to determine thiamine levels wasn't necessarily revealing. This is important because
[t]hiamine is key to warding off vascular problems such as kidney, retina and nerve damage as well as heart disease and stroke.

It works by helping protect cells against the effect of high glucose levels.

Trials are now being carried out to see if supplementing diet with thiamine could return levels to normal.
As usual, the caveat "more research is needed" applies, but as Matt Hunt of Diabetes UK, which helped to fund the study, said, this "could potentially have very exciting outcomes."

My wife is diabetic and suffered from diabetic retinopathy as a side effect of the disease. My mother was diabetic. She wound up with cataracts of both eyes, had trouble walking because of loss of circulation in her legs and feet, and died of kidney failure - all related to diabetes. I want that exciting outcome.

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