Back from the dead: A cure for comas

Published: March 27, 2007 | 5878th good news item since 2003

There were times when Sienie Engelbrecht wondered whether her only child would be better off dead. Louis Viljoen had been in a persistent vegetative state since 1996, when he was hit by a lorry while cycling to work as a hospital switchboard operator. He was 25 and engaged to be married.

Sienie, a 58-year-old sales consultant, visited him every evening in a rehabilitation centre near his home in South Africa. She always talked to him, but he never responded. “For me it was a very heartfelt story because he was very sporty. He used to play soccer and was a very good swimmer. To see him lying like that in a coma not doing anything was terrible. I couldn’t stand it. He couldn’t talk, he didn’t do anything. He was just looking at you all the time. I don’t know whether he realised it was me. Sometimes I thought why didn’t God take him away. It would have been better,” says Sienie, who lives in Springs, about 40 miles from Johannesburg.

One day, in 1999, one of the ward sisters told Sienie that Louis had been restless and was pulling at his mattress. Sienie spoke to her GP, Dr Wally Nel, who suggested that she gave him one of the sleeping pills he had just prescribed for her. She duly crushed it, put it in a drink and gave it to him. She was astounded by what happened next.

“After about 20 minutes I heard Louis make a sound like ‘mmm’. I thought, am I dreaming? He didn’t make any sound usually. I looked at his eyes and they were sparkling. He turned his head to me and I said: ‘Louis, can you hear me?’ And then all of a sudden he said ‘yes’. I couldn’t believe it. I just cried. I said ‘say hello to me’ and then he said ‘hello, Mummy’ and started talking. I was so heartsore I couldn’t talk.”

After about two hours, Louis slipped back into a semi-conscious state. His mother gave him the drug for the following few nights and each time the reaction was the same. Convinced that Zolpidem was the cause, she told Dr Nel. He came to the rehabilitation centre and watched as Louis became fully conscious again about 20 minutes after taking the drug. It was the world’s first reported case of a Zolpidem-induced awakening.

“There was definitely a tear in my eye,” says the GP, who has worked at the same practice in Springs for 35 years. Dr Ralf Clauss, a nuclear medicine physician at the Royal Surrey County Hospital in the UK, who at the time was working in the Medical University of Southern Africa, performed a brain scan on Louis before and after taking Zolpidem. Before taking the sleeping tablet, about 30 per cent of his brain was in darkness, which is abnormal. After taking the drug, it lit up. “We were elated to see it and really surprised. At that point we didn’t know what we were dealing with,” says Dr Clauss.

Since then, another South African and an American, both classified as being in a permanently vegetative state, have also been roused to full consciousness by the drug. There have also been reports that about 10 to 15 patients in a minimally conscious state have been awakened. One of them can be seen coming out of her partial coma for the first time on My Shocking Story: Coma Miracle on the Discovery Channel on Thursday. Dianne Katz, 51, had been in a semi-conscious state since she had two brain aneurysms and three strokes two years ago. The book-keeper from Kenilworth, Johannesburg, couldn’t talk, eat or wash unaided. She is seen coming round and talking shortly after taking the drug, while her family looks on in amazement.

But it is not only those with impaired consciousness who have been helped by the sleeping pill. Those brain damaged by trauma and strokes have also significantly improved. Dr Clauss says Zolpidem seems to help between 30 to 60 per cent of patients with less severe injury, such as a small stroke. For those with serious impairment of consciousness the figure is around 15 per cent. Dr Nel also has a small number of patients with spinal injuries, which have had some response. One quadriplegic patient is now able to hold his torso upright in his wheelchair. Some patients can talk again, hear and move their limbs.

One of his patients, Paul Ras, 70, who also lives in Springs, was in a head-on car accident in 1995. His jaw was broken, he suffered five broken ribs and a crushed pelvis. He spent three weeks in a coma. After the same hip was replaced twice, the runner, who was used to competing in 50km races, finally had it removed altogether in 1999. With one leg shorter than the other, he had to wear a built-up shoe and was told he would never be able to do sports again. That year he was prescribed Zolpidem for sleep problems. “When I woke up in the morning I was a different man,” he says. “It’s changed me completely. I can do my gardening myself. I’ve built a double garage all on my own. I carry my own bricks. People can’t believe it with no hip.”

The drug, which is also available in the UK, is still only under licence as a sleeping pill. “We are not experimenting,” insists Dr Nel, 65. “We can give it to people as a sleeping tablet and then I follow it up on the clinical picture. At the end of the day my ear is red from people phoning me. We get so many queries because with a brain injury that was the end of the road. Nobody said that a brain could ever recover and now we say there is hope. It’s a whole new world opening for brain injury.”

It has taken eight years of research for Dr Clauss to reach his hypothesis of how Zolpidem affects brain injury. “The drug is a GABA agonist, which means in normal tissue it stimulates GABA receptors and normally they put you to sleep,” he explains. “But in Louis’s brain, for example, these GABA receptors are abnormal and overactive. They keep Louis’s brain in a sleeping or dormant state all the time. The drug distorts these abnormal receptors which put Louis to sleep, dormancy is switched off and the brain returns back to normal.”

So why does it help some patients and not others? “Some people have dormancy – inactive brain tissue which is functioning, but not functioning correctly, and others have dead tissue. It doesn’t do anything to the dead tissue, but it reverses the dormant tissue, and the response depends on how big the dormancy part is.”

The British firm ReGen Therapeutics is carrying out a trial on 20 patients in South Africa already on the drug. Percy Lomax, the firm’s chairman, says: “Stroke is the third biggest cause of death in the United Kingdom. Around 450,000 people in the UK are currently suffering from some form of disability from a stroke. If we can reduce that disability that would seem to me to be an important step forward.” It is not expected that Zolpidem will be licensed for use for brain injury for several years.

Meanwhile, Dianne Katz, who “woke” last November, can now walk on her own, talk and eat unaided. And Louis, now 36, is going from strength to strength. He is now fully conscious. “He still talks and has got such a good sense of humour and he remembers everything before the accident: his birthday, my birthday, where he went to school and work,” says his mother. “I’m so glad, I can’t describe it to anyone. Nobody could believe that a sleeping tablet would get someone out of his coma.”

Published in Science & Technology
See also: news.independent.co.uk
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