Positivity: Brain Implant ‘Rewires’ A Decade Of Trauma

From New London, CT (carried in full because stories at the source link become unavailable to non-subscribers after a week, and this one is too good to lose access to):

Published on 2/10/2008

To hold your right arm straight and steady doesn’t seem like a big deal to most people, but for Justin Matylewicz, being able to do just that on Jan. 24 was nothing short of a medical miracle.

Eleven years after a terrible car accident almost killed him, 25-year-old Justin Matylewicz has taken a bold next step in his long recovery.

His singular journey began when the traumatic brain injury caused by the accident put him into a coma for 31/2 months. Doctors, his mother Melissa recalled, suggested she and her husband consider taking him off life support, warning them that if he did wake up, the extent of the brain injury he had suffered could leave him severely disabled. Until then, he had been a typical 14-year-old, enjoying baseball, basketball and soccer.

“They said he’d have no quality of life,” Melissa Matylewicz said. While her son, the younger of her two children, was in the hospital, she read all she could about traumatic brain injury and how the brain can rewire and retrain itself through therapy.

After he awoke from the coma, he spent three more months at Bride Brook Nursing & Rehabilitation Center in Niantic. Finally, he returned home to Montville, in a wheelchair, but was soon using a walker.

Years of physical, occupational and speech therapy gave him back his ability to walk and talk. He relearned everyday tasks such as holding a fork or glass and writing left-handed, though that remains difficult. He still struggles with short-term memory and balance problems and, until recently, the inability to use his right hand and arm, which has been enslaved by tremors that cause it to flail uncontrollably, limiting the young man’s lifelong job prospects.

View a slideshow of Justin.

He works two part-time jobs, one at the F.R.E.S.H. farm not far from his home, and the other stocking shelves, pricing and bagging bulk foods at a grocery co-op in Willimantic. Because he’s unable to drive, he gets rides to work from a special service for people disabled by brain injury. His long recovery, he said, separated him from his peer group. He longs for more friends his own age, and a girlfriend.

“He does get depressed and disgusted sometimes,” said his mother. “He has to work 10 times harder than anyone else to do anything. Everything he’s learned to do he’s had to retrain his brain.”

Despite setbacks and disappointments over the years, Matylewicz never wanted to give up finding a way to stop the arm tremors.

“The way I look at it,” he said, “I could live the rest of my life like this, but why? If there’s something better out there, why not give it a shot? I’ve always been a go-getter, so I go after what I want, and if I fail, I fail.

“You have to have the desire to be better,” he said, then looking across to his parents, added, “and you have to have somebody to help you.”

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Over the years Matylewicz tried medications, biofeedback, cranial therapy and other means to quell the tremors, with little or no success.

“It’s incredibly tiring, to be moving that way all the time,” said Dr. Alice Flaherty, director of the movement disorders program at Massachusetts General Hospital in Boston, where Matylewicz is a patient. “It’s just work. People think it’s just cosmetic, but he was so disabled by it.”

But last month, in an exam room at Mass General with Flaherty and his parents, Melissa and Peter tucked into a corner to watch, a seeming miracle of modern medical science occurred. A long, razor-thin electrical stimulator implanted a month earlier in Matylewicz’s brain was turned on.

Matylewicz doesn’t use foul language freely, but this was one moment he couldn’t contain himself. An amateur poet, he appreciates precise word choice, but are there any right words for the sensation of having someone mucking around in your brain — literally?

Flaherty, a neurologist, had been tapping codes into the computer for several minutes. The codes were directing a battery in Matylewicz’s chest to send electrical pulses to the four electrodes of the brain stimulator.

Suddenly, she found just the right combination of voltage and location.

“Holy (expletive)!” Matylewicz cried.

“Was it painful, what you felt?” Flaherty asked.

“No,” he replied slowly, with the far-off gaze of one searching the ether to express the inexpressible. “It was just … weird … I couldn’t … It was kind of something that radiated from my core out … Ooh. It’s radiating again.”

“To me that’s good news,” said Flaherty. “I’m going to write that in your chart.”

Smiling, she read the words aloud as she typed them on the computer keyboard.

Matylewicz had been semi-conscious when Mass General neurosurgeon Dr. Emad Eskandar implanted the deep brain stimulator on Dec. 28, but the only part he remembers is being asked to move his right arm as the doctor tested to make sure the device was in the correct location. Two weeks later, Matylewicz had a pacemaker-like generator powered by a plutonium battery implanted in his chest.

A wire connecting the two runs up the back of his neck and scalp, the outline just visible under the skin, like a large, raised vein. Once activated and adjusted by Flaherty, three volts of electricity began continuously flowing from the generator to the stimulator, feeding a stream of tiny pulses to the part of Matylewicz’s brain that controls the movement of his right arm, called the ventral medial nucleus of the thalamus.

The brain is, after all, an electrical organ, susceptible to misfiring if electrical signals get crossed, and also capable of repair if new signals pinpoint the right spot.

In essence, the electrical signals from the stimulator help control the tremors because they scramble the haywire oscillations in his brain tripped by the injury. This allows deliberate commands from the brain to reach the arm undisrupted, Eskandar explained.

“The stimulator operates at a higher frequency, to remove that abnormal fluctuating signal,” he said.

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Deep brain stimulators have been in use for about a decade, primarily to help control tremors caused by Parkinson’s disease. Detailed mapping of the brain made possible with advanced imaging techniques has enabled neurosurgeons to place the stimulators in the precise brain region connected to particular functions.

Dr. James Kelly, fellow with the American Academy of Neurology and professor of neuroscience and rehabilitation medicine at the University of Colorado, said use of stimulators for tremors caused by brain injury has been tried on a limited basis over the last decade. They work, he said, when one specific part of the brain is sending the misfirings.

“Sometimes the injury is so diffuse and so many parts are damaged, they won’t work,” he said.

Hospitals that do the procedure, he said, typically submit requests to lengthy scrutiny because there can be serious complications like brain hemorrhage, and there are no guarantees that it will work once activated. In Matylewicz’s case, his mother recalled, it was two years from the time she approached Mass General after she saw a TV medical show about the stimulators until the day he had the surgery.

“The approval process is slow and methodical and tedious, and rightly so,” said Kelly. “This is not science fiction, where we go around implanting people’s brains willy-nilly. It’s a risky procedure.”

Still, he said, the use of stimulators is growing gradually, as doctors discover new applications for them for patients with severe depression and others left in a state of “limited consciousness” by an accident. Last week a report in the Annals of Neurology told of a severely obese man getting a stimulator to control his appetite. He began recalling vivid childhood memories during the operation, leading to speculation that they could be used for memory disorders.

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On the day before he was scheduled to have his stimulator turned on, Matylewicz joked about being the “bionic man,” and how he planned to shave his head to better show off the scars from his brain surgery. All the while he talked, he pinned his right arm down to the chair by holding his left hand over it.

“It takes on a life of its own,” he said of his limb. “I can’t do anything meaningful with it.”

The next day, after Flaherty found the right spot in his brain, Matylewicz had to be reminded that his arm wasn’t moving on its own any more. He had been practicing by touching his right index finger to hers, then to his nose or chest, going faster and faster as the session progressed.

“Did you notice you’re not holding your hand down?” she asked at one point.

She sat back in her chair and smiled. Matylewicz held his right arm out in front of him. It didn’t waiver.

“Holy cow,” said his mother. “Wow.”

“This is a really good start,” said Flaherty. She added a new note to his chart: “Can stroke beard with right hand.”

Once satisfied that the device was properly programmed, Flaherty gave a lesson in how to turn the device on and off — she recommended leaving it on constantly, but explained that it can get turned off accidentally by getting too close to magnetic security devices at store entrances or to magnetized refrigerator doors. While the initial results look promising, she and Eskandar said, it would take some time for his brain to adjust before he could expect to get its full benefit.

“Over the next couple of weeks,” Flaherty told him, “note the things that are hard for you and the things that are easier. We may need to fiddle around with it a few times.”

She would see him again in a few weeks to make some adjustments, trying different combinations of voltage levels to different electrodes.

He planned to start occupational therapy sessions to help the process along, and was looking to buy Nintendo Wii to practice using his arm with its simulated sports games. One especially proud moment came a few days after he’d been home. It was his niece Haley’s 3-year birthday party, and Matylewicz was able to pick her up using both hands, without shaking.

“He hasn’t turned it off at all,” his mother said. “He’s really happy this is happening to him.”