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Brain-Damaged Fireman's Recovery a Mystery

Science can't provide exact explanation for this rare event

THURSDAY, May 5, 2005 (HealthDay News) -- No one really knows why it happened -- why Donald Herbert suddenly started speaking and responding to people a decade after a brain injury left him mostly unresponsive and living in a nursing home.

Herbert, a 43-year-old firefighter from Buffalo, N.Y., was knocked unconscious by debris in a burning building in 1995, leaving him blind and mostly mute until Saturday, when he suddenly asked for his wife.

"How long have I been away?" the Associated Press quoted Herbert as asking.

Such apparent recoveries have happened before, but rarely and usually not after such a long interval. About two years ago, an Arkansas mechanic, the victim of a car accident who had not talked in 19 years, suddenly started speaking. And a Tennessee policeman broke an eight-year silence caused by a shooting mishap. That recovery lasted only about 18 hours.

In fact, Herbert's wife, Linda Herbert, said Wednesday that her husband has had moments of clarity in recent days, but has not matched Saturday's breakthrough, the AP reported.

"He has had several infrequent moments of lucidity, which has given us much hope for further recovery," Linda Herbert said at a news conference at Erie County Medical Center. "Although the subsequent periods of lucidity were not of the quality of Saturday, they were still of a degree which was considerably higher than before Saturday."

Herbert appeared to have suffered oxygen deprivation and, according to The New York Times, about 15 percent of people who suffer brain damage from oxygen deprivation do recover some awareness within the first few months. About half of the people who suffer traumatic brain injuries recover in the first year. After that, the chances of recovery are slim.

"It's the rare instance that somebody would come to life, so to speak, in such a dramatic fashion," said Dr. Kester Nedd, head of neurological rehabilitation at the University of Miami School of Medicine. "If you really investigate the case, a lot of times it's either a progressive improvement that was ongoing or there's been something like an infection that literally suppressed the person's activity."

"We do think of this [the Herbert case] as unusual after so many years of being essentially, as best as we know, unchanged in neurological function to suddenly recover function that was previously lost," added Dr. Alan Carver, an assistant professor of neurology at the Mount Sinai School of Medicine in New York City.

In some cases, too many medications or the wrong medications can play a role, although it's impossible to know if this was the case with Herbert.

"I've had patients come to me seemingly in a coma and are on too much medication or on drugs with interactions that affect portions of the brain that limit the brain," Nedd said. "By modifying their medication or putting them on drugs that are more stimulating, I could seemingly cause dramatic recovery. This is not an infrequent occurrence."

Some patients may have low-level seizures that are undetectable on an ordinary EKG. When that area of the brain is treated, the patient appears to wake up, Nedd added.

According to the AP, liver disease, lung problems, anemia, infections and diabetes can also be contributing factors.

It's unclear if these seemingly spontaneous recoveries are as spontaneous as they seem. "We don't quite know if, over many years, there was more activity going on than we realized and suddenly it came to the fore or if the brain was essentially unchanged and then had a burst of activity," Carver said.

Nedd suspects it's the former, saying, "In most cases, there is a gradual progression that leads up to the recovery."

Experts also point to the ability of the brain to repair itself, a potential that has only recently begun to achieve recognition.

"What's great about this is it really speaks to the fact that brain function can, in at least some cases, regenerate," Carver said. "It's only been in recent years that we've come to learn that, in fact, brain cells can regenerate and that just because brain cells are either dying or dead doesn't necessarily mean that function will be forever lost."

Paul Sanberg is distinguished professor of neurosurgery and director of the University of South Florida Center for Aging and Brain Repair in Tampa. He said, "We now know that the brain has endogenous stem cells that continue to grow and develop. And while the endogenous stem cells aren't enough to repair traumatic events by themselves, they can repair smaller events, or over many, many years they may repair enough to get an area functional again."

One thing that does seem clear is that Herbert's case is entirely different from that of Terri Schiavo and that Shiavo was highly unlikely to have experienced this kind of awakening, had she lived, experts said.

Schiavo, a severely brain-damaged patient who died March 31 at 41 years of age, was the subject of an intense court battle between her parents, who wanted to keep her attached to life-sustaining nutrition, and her husband, who fought to have her feeding tube removed. The courts ultimately sided with Mr. Schiavo.

"There was a lot more damage in Shiavo," Nedd noted, adding that there's a point where the brain is so severely injured no interventions can be expected to help.

"Terry Shiavo was a completely different scenario because she was in a persistent vegetative state," Carver added. "This [Herbert] is a man who, as best as we know, had a greater degree of functioning in terms of his brain for the past 10 years. This is someone who was able to eat, able to say yes and no, someone who was able to sit and watch television, though he had some difficulty with vision. While he was obviously quite devastated from what happened to him, he was nonetheless neurologically functioning at a very different level from Terri Schiavo."

More information

For more information on brain injury, visit the Brain Injury Association of America.

SOURCES: Alan Carver, M.D., assistant professor, neurology, Mount Sinai School of Medicine, New York City; Kester Nedd, D.O., head, division of neurological rehabilitation, University of Miami School of Medicine; Paul Sanberg, Ph.D., D.Sc., distinguished professor, neurosurgery, and director, University of South Florida Center for Aging and Brain Repair, Tampa; May 4, 2005, The New York Times; Associated Press
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