TBI: Coming to

A 65-year-old Virginia business executive slipped into a coma a few years ago after complications from open-heart surgery. Doctors told his family he would never regain consciousness. Dr. Philip A. DeFina proved them wrong.

Using specialized treatment techniques, including electric brain stimulation and drugs, DeFina and his team revived the patient. The man has since regained his ability to speak and is resuming a normal life. As a result, his family donated money to start the International Brain Research Foundation in New York, which draws upon the expertise of more than 100 neuroscientists and clinicians around the world.

Since that first success, DeFina and his colleagues have revived no fewer than 15 patients from comas, including two soldiers who suffered traumatic brain injuries in Iraq and one who was injured in a motorcycle accident in the United States. They have now launched a six-bed treatment effort called the Severe Disorders of Consciousness Program at Kessler Institute for Rehabilitation in West Orange, N.J.

DeFina, an Army veteran, recently spoke with The American Legion Magazine.

Q: Could you explain how your treatment works?
In essence, we are reprogramming the brain's function through the manipulation of brain chemistry and electrical activity. We use electronic stimulators to send signals back into the brain. This increases blood flow, which increases both the amount of oxygen delivered to the brain and glucose metabolism. We think this helps preserve areas of the brain that have been shut down as a result of an injury until they can be reintegrated with the rest of the brain. We're borrowing medications from the treatment of depression, anxiety and Parkinson's disease along with high-potency vitamins and herbs to stabilize the brain and enable it to produce needed chemicals on its own. Finally we use neurofeedback - which is like biofeedback to the brain - to reprogram and restore the brain's ability to become active again.

Q: How safe is it?
We have not had any significant side effects from their use. All of these techniques are approved by the FDA for other things. We modified them and refined them to treat disorders of consciousness - that is, patients who are in a coma, vegetative state or in a minimally conscious state. This is called "off-label" use. For example, we're using commercially available stimulators designed to treat neuromuscular problems to stimulate the brain.

Q: What kind of attention is your work getting?
Every time we wake someone up or improve someone's level of consciousness, it's looked at as anecdotal. I tell people to come and visit us - see we what we do firsthand.

Q: How did you come to treat your first veteran?
The mother of a soldier who was injured in a mortar attack contacted us. He suffered a severe brain injury, and the loss of oxygen to his brain and had gone from a coma to a vegetative state - where he was slightly less impaired - at different points in time. We saw him about a year and a half after his injury. A retired general said years ago they would have given him morphine and sent him home in a body bag. Not only were we able to arouse him, we were able to compensate in terms of rewiring his right and left (brain) hemispheres for language ability. Before he left, he was able to hit a button for yes-and-no responses with 80 to 90 percent accuracy.

Q: How are the other two soldiers progressing?
The soldier who was injured in the motorcycle accident is communicating with us by double blinking and hand squeezing. The other soldier has a lot of complications, and his prognosis is much slower at this point.

Q: Can you treat all brain-injury patients?
Despite the fact we've had such incredible success, no treatment program will be able to help everyone. But we are developing diagnostic techniques and treatments that give these patients a higher probability of recovery. And I think we could probably help bring a number of severely injured soldiers back to consciousness.

– Ken Olsen