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Transcranial magnetic stimulation (TMS) is used to to bring a patient out of a coma. When Josh Villa suffered massive head injuries and fell into a coma, he was enrolled in a six-week study in which an electromagnetic coil was held over the front of his head to stimulate the underlying brain tissue.
Theresa Pape has revealed that TMS is the same approach that has been investigated as a way of treating migraine, stroke, Parkinson's disease, and depression in the past, with some promising results.
The rapidly changing magnetic fields created by the coil were used to excite brain cells in the right prefrontal dorsolateral cortex—that has strong connections to the brainstem, which sends out pulses to the rest of the brain that tell it to pay attention.
At first, there was little change in Villa's condition, but after around 15 sessions something happened.
"You started talking to him and he would turn his head and look at you. That was huge," New Scientist magazine quoted Villa"s mother Laurie McAndrews as saying.
Villa started obeying one-step commands, such as following the movement of a thumb and speaking single words.
"They were very slurred but they were there. He'd say like "erm", "help", "help me," says Pape, who presented her findings this month at an international meeting on brain stimulation at the University of Göttingen, Germany.
The TMS was stopped after the 30 planned sessions were over. Though the patient became very tired without it and his condition declined a little, he was still much better than before.
Villa was given another 10 sessions six later, but there were no further improvements.
He was eventually sent home, where he presently remains.
Villa might not have been cured completely, but the treatment has made him much easier to care for. Besides, he can interact with visitors.
"When you talk to him he will move his mouth to show he is listening. If I ask him, "Do you love me?" he'll do two slow eye blinks, yes. Some people would say it's not much, but he's improving and that's the main thing," says his mother.
Steven Laureys of the Coma Research Group at the University of Liege in Belgium said: "This is the first and very interesting use of repetitive TMS in coma."
"Even after eight months, it is not uncommon for patients to transition from the vegetative to the minimally conscious state without any particular intervention," says John Whyte of the Moss Rehabilitation Research Institute in Philadelphia, Pennsylvania.
Pape acknowledges that further studies are needed to demonstrate that TMS really is beneficial.
Pape hopes to begin treating a second patient in a coma-like state later this year. This time she plans to adjust the number of pulses of TMS in each train, and to alter the gap between pulses to see if there is an optimum interval.
However, there are some experts who believe that Villa's case alone does not show that TMS is a useful treatment.