Maybe there are miracles.

September 12, 2006 8:29 AM

Logically, the last thing you would think would help a person trapped in a persistent vegetative state is a nervous system is sleeping pill. Illogically, when you do, many of them wake up.
posted by eriko (56 comments total)

yup. and when kids are hyper, yo give 'em speed.
posted by lester's sock puppet at 8:34 AM on September 12, 2006

wow
posted by farishta at 8:34 AM on September 12, 2006

See also, A small but passionate group of doctors say that electricity applied deep in the brain can jolt patients out of irreversible comas.
posted by MetaMonkey at 8:37 AM on September 12, 2006

And when someone bonks their head and gets amnesia, you gotta bonk on the head again to restore their memory.
posted by jefbla at 8:41 AM on September 12, 2006

Just curious -- what sort of timeframe do doctors use to determine if a person will recover from a coma? Are they working on the assumption that, if more than two weeks or two months have passed, 90% of comatose patients will never regain consciosness?
posted by jason's_planet at 8:41 AM on September 12, 2006

And when someone bonks their head and gets amnesia, you gotta bonk on the head again to restore their memory.

Alternatively, you can jump on their foot and make them forget about the bonk on the head.
posted by rollbiz at 8:55 AM on September 12, 2006

Repeatedly attempting to parse this post put me into a persistent vegetative state.

Fortunately, I was given a sleeping pill.
posted by BaxterG4 at 8:56 AM on September 12, 2006

This cherry pie is a miracle.
posted by SmileyChewtrain at 8:58 AM on September 12, 2006

A lot of snarks, but if you read the article you realize that this can have some fairly serious ethical issues raised about the definition of vegetative state.
posted by linux at 9:01 AM on September 12, 2006 [1 favorite]

Wow. Quit snarking, and read the whole article:

After Louis' awakening was publicised in the South African media, Dr Ralf Clauss, a physician of nuclear medicine - the use of radioactive isotopes in diagnostic scans - at the Medical University of Southern Africa, contacted Nel to suggest carrying out a scan on Louis. "The results were so unbelievable that I got other colleagues to check my findings," says Clauss, who now works at the Royal Surrey County Hospital in Guildford. "We did scans before and after we gave Louis zolpidem. Areas that appeared black and dead beforehand began to light up with activity afterwards. I was dumbfounded - and I still am."

Clauss says immediate improvements in the left parietal lobe and the left lentiform nucleus were visible. In lay terms, these are important for motor function, sight, speech and hearing.

"I remember saying to Dr Nel that we were witnessing medical history," says Clauss.

No one yet knows exactly how a sleeping pill could wake up the seemingly dead brain cells, but Nel and Clauss have a hypothesis. After the brain has suffered severe trauma, a chemical known as Gaba (gamma amino butyric acid) closes down brain functions in order to conserve energy and help cells survive. However, in such a long-term dormant state, the receptors in the brain cells that respond to Gaba become hypersensitive, and as Gaba is a depressant, it causes a persistent vegetative state.

It is thought that during this process the receptors are in some way changed or deformed so that they respond to zolpidem differently from normal receptors, thus breaking the hold of Gaba. This could mean that instead of sending patients to sleep as usual, it makes dormant areas of the brain function again and some comatose patients wake up.

posted by orthogonality at 9:10 AM on September 12, 2006

Sorry, I didn't mean to take away from the fact that this is actually amazing stuff. Because it is.
posted by rollbiz at 9:14 AM on September 12, 2006

In other news:

Doctors give 10 vegetative patients sleeping pills. 9 patients, unable to swallow, choke to death on pill. Doctors say: DOH!
posted by tkchrist at 9:27 AM on September 12, 2006

I can't believe that the drug company doesn't want in on the research - and amazing that this happens with an existing, out-of-patent, available-as-generic drug rather than something new, expensive and out of reach of most people.

That part is pretty miraculous. Usually it's all about a big company making a buck.
posted by caution live frogs at 9:38 AM on September 12, 2006

This is very interesting -- for quite some time people have known that a small group of patients with depression of the central nervous sytem as a result of cirrhotic liver failure (those with hepatic encephalopathy), including those in a comatose state, can show short-term improvement after being given the drug flumazenil.

Flumazenil [note: .pdf] is a benzodiazepine antagonist (that is, it reverse the effect of drugs like diazepam (Valium) and lorazepam (Ativan)). That it can mitigate the effects of hepatic encephalopathy may indicate a role for the neurotransmitter GABA in this condition.

Incidentally, Zolpidem (Ambien) binds to the GABA-A receptor alpha-1-subunit.
posted by scblackman at 9:40 AM on September 12, 2006

Serendipitous findings are the best.
posted by owhydididoit at 9:42 AM on September 12, 2006

This is extremely interesting to say the least, it is friggin incredible and confirms that some discovery just occours by chance.

ReGen has applied for a patent to use the drug, now out of patent and generically available, for the treatment of secondary brain injury after brain trauma.

To charge more for it ? For the love of Jebus go fuck yourselves stop exploiting NEED , patent a significant derivative that reduces the side effects or go understand why and how it work..but nooooooo it is cheaper to repatent and charge 100 times more. I so much loathe these parasites.

He says market research estimates the potential market for zolpidem in brain-damaged patents could top $4.3bn (£2.3bn).

Again not for the love of, but for avoidance of bad consequences by enraged human beings, the goddam molecule is already out of patent, go find a derivative by risking you OWN MONEY , not by milking national healthcare system, private insurers and patients !

In 1969 the neurologist Dr Oliver Sacks used the then new drug L-Dopa to awaken a group of catatonic patients who had survived the 1917-1928 epidemic of the mysterious "sleeping disease", known as encephalitis lethargica. The 1990 film Awakenings chronicles Sacks' delight at his patients' progress and his despair when the medication stops working and they slip back into a catatonic state.

That's my fear. There is no time for patent bullshit it's research time , no patent dispute and lawyeresque bullshit should delay one second this research.
posted by elpapacito at 9:55 AM on September 12, 2006

I wonder if they've tried giving longer acting benzos, like lorazepam... ambien is useful as a sleeping pill because it is short acting, or at least the sedative effects are thought to be short acting. Maybe there's another effect at work. This brain, it is complex.
posted by mert at 10:03 AM on September 12, 2006

I can't believe that the drug company doesn't want in on the research - and amazing that this happens with an existing, out-of-patent, available-as-generic drug rather than something new, expensive and out of reach of most people.

Oh, I can believe it.
posted by atrazine at 10:10 AM on September 12, 2006

That's my fear. There is no time for patent bullshit it's research time , no patent dispute and lawyeresque bullshit should delay one second this research.

If the board of directors of a pharmaceutical company approved research into something that they couldn't make money off of, they could theoretically be personally liable for the money spent on the research.
posted by atrazine at 10:13 AM on September 12, 2006

Rather like when AZT, developed in 1964, was patented for treatment of AIDS by Burroughs Wellcome (now GlaxoSmithKline) in 1986. It must be added that they neither invented the drug nor discovered its efficacy, but nevertheless the patent was upheld.
posted by George_Spiggott at 10:14 AM on September 12, 2006

I think Kid Rock may be self-medicating.
posted by owhydididoit at 10:15 AM on September 12, 2006

(That was meant as a response to elpapacito.)
posted by George_Spiggott at 10:16 AM on September 12, 2006

I had to make a painful decision years ago with a family member who was in a persistent vegetative state. The damage was down to the brain stem, and the reason we decided to withdraw artificial life support was because we firmly believed that there was no way in hell.

The thought that a simple sleeping pill could bring someone back is awesome, yet makes me feel horribly guilty and upset at the same time.
posted by MysticMCJ at 10:26 AM on September 12, 2006 [1 favorite]

Rather inspiring bit of business, this.
posted by Isabeau Sahen at 10:35 AM on September 12, 2006

How is that "illogical"?
posted by delmoi at 10:36 AM on September 12, 2006

Maybe there are miracles? Is that not an antithetical conclusion to draw from an article that's based entirely on neurochemical reactions?
posted by prostyle at 10:38 AM on September 12, 2006 [1 favorite]

I wonder if this would have done anything for Terry Schiavo.


So does this mean that everyone in a persistent vegetative state should be given the sleeping pill before a decision is made on whether to pull the plug?
posted by Brandon Blatcher at 10:39 AM on September 12, 2006

24 posts and half of them are dumb fuck snarks from people who haven't even read the article....
posted by A189Nut at 10:40 AM on September 12, 2006 [1 favorite]

I wonder if this would have done anything for Terry Schiavo.

I don't think I want to try the 'sleeping pill' that re-congeals and re-constitutes liquified brain matter.
posted by sonofsamiam at 10:42 AM on September 12, 2006

Yes, Terry Schiavo didn't just have dead brain tissue, she was missing brain tissue.

Still, this is incredible. This brings so much hope, but at the same time, so much potential guilt for people like MysticMCJ's family who made the best decisions they could based on the information they had. Damn.
posted by maudlin at 10:47 AM on September 12, 2006

Wow, an interesting medical article and half the responses are nothing but trolling, nice. Seriously folks, if pissing on other people's posts is your kick, there are other places to do it.

I wonder if this article could be used as a case for administering a sleeping drug to a vegetative patient here. What would the legal implications be?
posted by Vindaloo at 10:49 AM on September 12, 2006 [1 favorite]

To charge more for it ? For the love of Jebus go fuck yourselves stop exploiting NEED , patent a significant derivative that reduces the side effects or go understand why and how it work..but nooooooo it is cheaper to repatent and charge 100 times more. I so much loathe these parasites.

Exploiting need? C'mon elpacito. The entire world economy is based on some people "exploiting" the needs (or wants) or others. If someone finds a new and unexpected use for an existing compound - and invests in the R&D necessary to bring that new and unexpected use through clinical trials to FDA approval why shouldn't they profit from it?

You can put your hope in Jebus, but I prefer plain old economic incentives.
posted by three blind mice at 10:49 AM on September 12, 2006

I don't think I want to try the 'sleeping pill' that re-congeals and re-constitutes liquified brain matter.


posted by dammitjim at 10:55 AM on September 12, 2006

Amazing news—thanks for the post.
posted by languagehat at 10:57 AM on September 12, 2006

> thus breaking the hold of Gaba ...

This is a wonderful post, thanks for the news.

It does sound like my tech support people's advice -- reboot, see if the problem goes away.
posted by hank at 11:03 AM on September 12, 2006

MysticMCJ writes "The thought that a simple sleeping pill could bring someone back is awesome, yet makes me feel horribly guilty and upset at the same time."

I can understand why you feel upset, but guilty of what , making a choice ? At the time you didn't have the new information and you certainly had reason to make the difficult choice and the choice of pulling the plug did make sense _at the time_. Now you see , one of the problems with being human is that we like absolute certainity, immutable parameters, we like to feel 101% sure we did the "right" thing or the "only reasonable possible thing" ....we don't like thinking we could have done "better" and so we blame science for being too late, or ourselves for not waiting just a little longer.

Maybe it would have worked, maybe not , we will never know. In the past few people, afaik, ever reached vegetative state because medicine wasn't advanced enough to keep em alive ..so they died and people took it as "fate" ..now we control fate, but we don't have perfection..we will never have..but step by step we will be able to save more people.
posted by elpapacito at 11:37 AM on September 12, 2006

Man, metafilter was down ALL DAY here. I hadn't been to the Grauniad for months but came across this earlier today and thought, that'd be a great post. Unfortunately, the site was down. Glad the story made it here anyway, though, eriko, way to obfuscate a post... I have no idea what that paragraph actually says - it's like a collection of seemingly related words that says nothing...

This is one of the most amazing articles I've read in a long time. You can almost feel the journalist being blown away by what she is seeing as it progresses and she meets more patients.

I was pretty devastated to read that a patent would be applied and that the "market" for this drug will run to billions of dollars. This development seems far too important for profit to be put first. It's (hopefully) a significant advance for all those suffering from brain trauma, the drug already exists and all thats wanting is a proper trial..

Is there any way to petition against a patent issued in this manner (ie for a new use of an already existing drug)?
posted by davehat at 11:39 AM on September 12, 2006

three blind mice writes "The entire world economy is based on some people 'exploiting' the needs (or wants) or others."

Oh mice that equation need=want is false and you know it.

three blind mice writes "and invests in the R&D necessary to bring that new and unexpected use through clinical trials to FDA approval why shouldn't they profit from it?"

Because they didn't cause the new and unexpected use and because they already exploited the patent on the molecule ; ialso they didn't change the molecule, they just found out it is better then they tought and they found by chance, without investing a dime. They added no value, so no value should come back to them.

IF they want a patent, let them study why the precedent molecule works and maybe developed a significantly different one with significant benefits and patent THAT molecule ; if their getting the patent is the only way to have somebody study and advancement, then it is wiser to remove or reject any further application of patent from that company because it doesn't promote advancement in practice, it just promises (which costs nothing) and keeps profiting, while others may do better.
posted by elpapacito at 11:50 AM on September 12, 2006

a chemical known as Gaba

Gaba gabba HEY!
posted by ZenMasterThis at 11:58 AM on September 12, 2006

24 posts and half of them are dumb fuck snarks from people who haven't even read the article....

Including YOURS.

Lighten up.

Most people are not doctors. Nor do they have the bio-chemestry background to fully comment in-depth on the subject. Not without soundling like jack-asses.

I read the article. I thought..."Hmmm. Interesting." For the record my sister-in-law was in a coma after her lungs collapsed due to CF complications. Reviving her may have been more cruel than not since she had suffered colapse of both lungs and they would never function again. I am almost glad this was NOT an option.

PS. I say if a snark is at least entertaining let it fly. Some of the best comments on Mefi posts have been snarks. Otherwise stuff like this doesn't get read at ALL and is better suited to hard science boards and novices won't get any exposure to it.
posted by tkchrist at 12:05 PM on September 12, 2006

This is really incredible- thank you for posting this. Post should so have been called Gaba-Gaba-Hey though.
posted by Dormant Gorilla at 12:31 PM on September 12, 2006

Thanks, DG.
posted by ZenMasterThis at 12:36 PM on September 12, 2006

Most people are not doctors. Nor do they have the bio-chemestry background to fully comment in-depth on the subject. Not without soundling like jack-asses.

Indeed. Why take the risk of sounding like a jackass when one can all but ensure the same result? I'm of the mind that it's best to remove risk from the equation and ensure reward.

Thanks for the read, Eriko. Very cool news.
posted by The God Complex at 12:38 PM on September 12, 2006

this is a fantastic FPP. thank you!
posted by analogue at 12:45 PM on September 12, 2006

Most people are not doctors. Nor do they have the bio-chemestry background to fully comment in-depth on the subject. Not without soundling like jack-asses

It's an article in the Guardian, a daily newspaper for heaven's sake. Hardly the Lancet or JAMA.
posted by A189Nut at 1:19 PM on September 12, 2006

MysticMCJ I was in a similar postion with my mother, and had the same feelings on reading this of guilt and frustration, and the whole "what if", but, we did what we did with the best info we had then.
All the old cliches about hindsight being 20/20 vision come to mind, but you know, it still feels fucking awful.

I still don't know what to feel, because so much brain damage is irreversible, that's why I made a living will with my partner as soon as possible after my mother's death.

But if brain function can be largely rehabilitated......Fuck, fuck, fuck, fuck!
posted by Wilder at 1:30 PM on September 12, 2006

Reminds me of the principle behind homeopathy, funnily enough. That if you expose the system to a small dose something resembling its current unhealthy state, it will react with an attempt to return to the healthy state.

Just thinking out loud here, really.
posted by poweredbybeard at 3:10 PM on September 12, 2006

This is just reminding me of the Oliver Sacks story made into the movie Awakenings...
posted by griffey at 3:15 PM on September 12, 2006

I'm just astonished there have been no snarks about sleep-eating.
posted by selfmedicating at 3:48 PM on September 12, 2006

If I'm in a coma, can I ask that people try to wake me through frequent blow jobs?

Uh-oh, room's starting to spin ...
posted by Astro Zombie at 4:16 PM on September 12, 2006

24 posts and half of them are dumb fuck snarks from people who haven't even read the article....

Welcome to the new Metafilter.
posted by stavrosthewonderchicken at 4:46 PM on September 12, 2006

Ambien (zolpidem) works in very mysterious ways indeed. Anyone who's ever had a drink after taking it knows that...
posted by clevershark at 6:02 PM on September 12, 2006

For the love of Jebus go fuck yourselves stop exploiting NEED

So, in your dream world things like food, medical care and your municpal sewer system would be free, produced and maintained by a handful of cloistered monks, but tennis shoes, boy band CD's and black plastic party favors that said, "over the hill" would cost a small fortune. Sounds great. Now, explain a few things to me.

1) Under your system, why would I have stayed at work 11 hours yesterday to work on this? Be sure to explain how I would pay my mortgage, college costs and personal expenses. For extra credit, fill in the blank: "_________ is a much harder class than physical chemistry."

2) Compare and contrast the amount of time a drug company has exclusive rights to their work with the amount of time the Walt Disney Company has had exclusive rights to a guy's drawing of a mouse.

3) Heart disease is the leading cause of death in the United States. One of my group's goals has been to improve the purity of our material without reducing process yeild so much that no one can afford the treatment. In your opinion we should:
a) Make it as pure as possible, even if it ends up costing $100,000 a treatment.
b) Go with what we've got. It'll be cheaper that way and process impurities make you tough!
c) Get rid of our expensive HPLC's and make penis shaped party favors for bachelorette parties.
posted by Kid Charlemagne at 6:17 PM on September 12, 2006 [1 favorite]

I thought organic chemistry was harder than p-chem...
posted by Justinian at 7:15 PM on September 12, 2006

wow. this is incredible. forgive me, if this comment isn't proper, but i'd love to put a set of headphones on someone emerging from the PVS for the first time and play "whatever it is" by ben lee.

AWAKE really IS the new SLEEP
posted by eli_d at 9:00 PM on September 12, 2006

There's something very creepy about all this. Sometimes vegetable is better.
posted by cytherea at 8:18 PM on September 14, 2006