MONDAY, July 3, 2006 (HealthDay News) -- Almost 20 years after suffering a severe brain injury in a truck accident, Terry Wallis uttered an astounding word.
It was the first word Wallis, of Mountain View, Ark., had been able to speak since sinking into a "minimally conscious state" (MCS) after the pick-up he and friends were riding in went over a cliff.
And while there have been sporadic reports of other "miracle" recoveries following years of a vegetative state, few, if any, of those have lasted more than a day or so. Wallis's recovery, widely reported in the media when it happened, has gone on for almost three years now.
"This is the only patient who was known to emerge after such a long time from such a state," said Dr. Nicholas Schiff, associate professor of neurology and neuroscience at Weill Cornell Medical College in New York City. "This particular story of a man 20 years out recovering and sustaining the recovery and moving on is certainly, to my knowledge, unique and never studied."
Schiff, senior author of a study on Wallis and his brain in the July issue of the Journal of Clinical Investigation, first saw Wallis eight months after he started speaking. That was in April 2004.
"We saw a man with very severe brain injury with a lot of motor impairment. He had a very inarticulate speech pattern but was fluent in language and had recovered a good deal of what appeared to be his baseline personality," Schiff recalled. "We were told that prior to that event he could look at you, follow you around room, nod his head or grunt inconsistently but not communicate."
More than two years after that breakthrough, Wallis has become more alert, recovered more speech and motor control and, most remarkably, has recovered motor function in his lower extremities.
"That was surprising to us, because we had definitely predicted that he wouldn't recover any function in his limb movements and strengths," Schiff said.
"He still can't walk, but he can move his legs and a little bit also his hands, and he can talk," explained Henning Voss, lead author of the study and assistant professor of physics and radiology at Weill Cornell Medical College. "You can't understand him very well, but he is able to reliably communicate."
The question now is, "What went right?"
In an effort to find the answer, Schiff and his colleagues used state-of-the-art structural and functional neuroimaging techniques to examine Wallis' brain as well as those of 20 healthy individuals and another patient who had been in an MCS for six years with no sign of recovery.
Imaging revealed that neuronal cells in the relatively undamaged areas of Wallis' brain have grown new, significant connections over years. The process is called "axonal re-growth."
"We think that there was some axon reorganization," Voss said. "I think that it was just a very, very slow remodeling of the brain, which takes years."
"The data is compelling to us to consider the hypothesis that what we're looking at here is some form of reconnection among existing neurons," Schiff added.
And medications may have played a role. About two years before he emerged from his minimally conscious state, Wallis started taking the anti-depressant Paxil.
"I have become more willing to believe over time that that might have played a role," Schiff said. "I kind of doubt that axonal regrowth is the whole story."
Whatever happened to Wallis could be of huge import to other patients in similar situations, another expert said.
"Are there ways in which we can use this information to help us find therapies for those who don't recover? The brain has its own mechanisms of self repair," said Paul Sanberg, director of the University of South Florida Center for Aging and Brain Repair, in Tampa.
"This is an important finding," he added.
Voss agreed: "The first thing is that we have to better understand the self-healing processes and, once we know more about it, then we can think about how to support this process."
Many more patients need to be studied in order to validate the hypothesis, Schiff said.
But, he added, medicine needs to accept that what happened to Wallis is real.
"This happened, and we should adapt to that as a medical reality and rethink the way we are tracking patients and what kind of access patients with severe brain injury have to basic clinical follow up," Schiff said.
Visit the Brain Injury Association for more on brain injuries.