Understanding Donald Herbert's Stunning Reawakening

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Firefighter Donald Herbert suddenly became lucid Saturday after living in an unresponsive state for 10 years. Robert Siegel talks with neurologist Dr. James Bernat, a professor at Dartmouth Medical School.

ROBERT SIEGEL, host:

On Saturday, Donald Herbert suddenly became lucid. The Buffalo, New York, firefighter had not spoken in almost 10 years. In 1995, he was trapped under a collapsed roof. He went without oxygen for several minutes and suffered brain damage. He woke up for a while in 1996, but otherwise, ever since the accident, he was unresponsive, uncommunicative, until Saturday. He asked for his wife. He talked with his family. He spoke sensibly, his doctors said. He counted to 200. Well, since that surprising development, his family says there have been some bursts of conversation but nothing nearly so dramatic as his breakthrough on Saturday. Mr. Herbert's doctors say they changed his medication three months ago; they won't say what the new medication is. Dr. James Burnat is a professor of neurology at Dartmouth Medical School, and he joins us from Hanover, New Hampshire.

Dr. Burnat, how rare is a recovery of the sort we've heard described from brain damage of this sort that we've heard described?

Dr. JAMES BURNAT (Dartmouth Medical School): Well, the recovery is quite rare. I believe that it is reasonable to conclude that, in his case, it was induced by the prescription of certain stimulant medications that he was given.

SIEGEL: And would you assume, from the fact that he has not continued to be so lucid, that he should be given more of that medication? His doctor said he thought it might take as much as six months for the medication to show results.

Dr. BURNAT: Yes. I listened to the press conference and heard the medical details reviewed. And although they didn't and wouldn't say what the medications were because of privacy concerns, they did say that they were medications that were intended to stimulate neurotransmitters in the brain. These types of medications have been used in brain-damaged disabled people, although it's quite rare for the effect to be quite as dramatic as this case.

SIEGEL: Dr. Jamil Ahmed, the rehabilitative specialist who's been treating Mr. Herbert, said in response to a reporter's question at that news conference that Mr. Herbert was `close to a persistent vegetative state.' Now does that sound right to you?

Dr. BURNAT: It's probably more accurate to classify his condition as a minimally conscious state rather than as a persistent vegetative state. Now I haven't examined him. I think I'm dealing with the same set of facts that everyone else is, but to me, my understanding of his level of functioning prior to the introduction of these new medications was what we would call a minimally conscious state.

SIEGEL: You talked with us several weeks ago during the time that the whole country was focused on the fate of Terri Schiavo, who was in a persistent vegetative state. I guess the question on many people's minds around the country is: Was somebody in her condition capable, conceivably, of such a surprising recovery as Mr. Herbert has experienced?

Dr. BURNAT: I think that would be highly unlikely. There is a big difference between persistent vegetative state and minimally conscious state. And the major difference is that the persistent-vegetative-state patient has an utter lack of awareness, whereas in the minimally conscious state there is awareness. There have been reports before of brain-damaged people in a minimally responsive or minimally conscious state that flooding neurotransmitters into the brain seems to induce improvement. There have only been a very few instances in persistent vegetative state of any improvement.

SIEGEL: Do you think of lucidity, in the case of a patient like this one, as a plateau that one can leap up onto and generally stay there, or is it sort of something that one must constantly try to grab ahold of and might just as easily slip down from?

Dr. BURNAT: I would say the latter. People who have this degree of brain damage are exceedingly sensitive to minor fluctuations in metabolic and toxic factors in the bloodstream. If they get a fever, if they become dehydrated, that can be sufficient to convert them from being aware to unaware.

SIEGEL: During yesterday's news conference, Dr. Ahmed, the rehabilitative specialist, suggested that there might be many patients in nursing homes who haven't been given similar medication but might become remarkably more responsive if they were treated. Does that strike you as right?

Dr. BURNAT: This dramatic improvement is very, very rare. But in people who have stable degrees of brain damage from either cardiac arrest, stroke, head trauma or whatever the cause is, if they're in a minimally conscious state, it would certainly be reasonable for their physicians to prescribe trials of these medications to see whether they may benefit. The downside of doing that is minimal and the benefit may be very high.

SIEGEL: Well, Dr. Burnat, thank you very much for talking with us today.

Dr. BURNAT: It's been my pleasure. Thank you.

SIEGEL: Dr. James Burnat spoke to us from Hanover, New Hampshire. He is a professor of neurology at Dartmouth Medical School.

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