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Giffords’ Case Offers Insight on Mysteries of the ‘Changeable’ Brain

January 17, 2011 at 12:00 AM EST
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The treatment of severe brain injuries has garnered increased attention in the wake of the shooting of Arizona Rep. Gabrielle Giffords.
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JEFFREY BROWN: Next: new advancements in the understanding and treatment of brain injury, a field receiving much attention after the shooting of Congresswoman Gabrielle Giffords.

Ray Suarez has the story.

RAY SUAREZ: The public and her doctors have been impressed by the congresswoman’s progress. She’s responded to questions. And doctors say they may send her home within days to weeks.

But the road ahead is undoubtedly long. We look at what medicine understands about treating the brain and its ability to adapt.

Dr. Henry Brem is chairman of the Department of Neurosurgery at the Johns Hopkins Medical Center in Baltimore. And Dr. Norman Doidge is a psychiatrist who specializes in this field. He’s author of “The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.”

And, Dr. Brem, we’re talking about a woman who was shot at close range, and about 10 days later, is giving her husband a neck rub, blinking her eyes, moving her limbs on command. It’s unusual, no?

DR. HENRY BREM, Chairman, Department of Neurosurgery at Johns Hopkins Medical Center: It’s extraordinary.

Two-thirds of people who are shot by a gun in the head die at the scene. And over 90 percent of the people die within a short amount of time after the injury. So, surviving in any level of function is — is truly extraordinary. And she’s — she, by reports, is doing very well. She’s making progress and getting better and better.

RAY SUAREZ: Today, in Tucson, Dr. Michael Lemole said the next major step is the graduation to rehabilitation. What does that mean?

DR. HENRY BREM: It means that the surgical issues seem to be behind her, that there are — you know, there are two issues related to brain injury. The first is the actual injury itself, the gunshot wound. And that’s frequently fatal.

But the second issue is the swelling and bleeding and the secondary consequences. And that’s what the surgeons are most concerned about, because they can’t do anything about the destruction from the bullet. But they can do things to prevent the secondary problems, like infection as well.

And they reacted extremely quickly and properly and with the highest level of care. And she seems to be getting over the fence of where the major risks are.

RAY SUAREZ: So, briefly, what do you have to do now?

DR. HENRY BREM: Now it’s really a matter of letting the brain recover. And that recovery period can take anywhere from — from weeks to months to, you know, up to a year to see the maximum recovery.

RAY SUAREZ: Dr. Doidge, does the brain heal like other tissues in the body that may be bruised or broken or cut?

DR. NORMAN DOIDGE, Author, “The Brain That Changes Itself”: Well, it turns out that it does — it does heal, although, for about 400 years, we thought that it was far — far less good at that than any organs in the body.

For 400 years, we thought that the circuits of the brain were formed and finalized in childhood, and that the brain was like a machine with parts, and each part performed a single mental function in a single location.

And it meant that, if you had something like a gunshot wound, what you would do is, you would — wait until the swelling went down, the inflammation went away, and you would see what was left. But now there are — are new approaches because we have discovered that the brain is plastic, in the sense of changeable and adaptable. And it can respond to mental experience and stimulation, and so that, even though parts of the brain die, adjacent areas can often take over those mental functions.

And it’s given rise to a whole new approach to rehabilitation, which takes over after that year has gone. After the — we see what we’re left with, we can then build up new processors in many — in many instances. The — the brain is not infinitely plastic, but it can do far more than we ever dreamed it could.

RAY SUAREZ: So, are these things that the healing brain just starts to do, or is this something that someone has to be taught how to do after the healing is over?

DR. NORMAN DOIDGE: Well, yes, you know, the brain exists in an environment. It evolved to be in an environment. And it evolved to get stimulation and to do things. So, you always have to be stimulating the brain.

You know, when the brain is damaged, parts of it die, and parts of it are alive, but they’re sending off noisy aberrant signals. And so it’s out of sync. So, one of the things we have to do is we have to synchronize it.

It turns out that it’s a use-it-or-lose-it brain, so we have to give it lots of stimulation from things that are low-tech, like lots of touch, all the way up potentially to new forms of stimulation, electromagnetic kinds of stimulation, or just doing activities that stimulate the brain.

But these are done in concentrated, massed practice in these new — in these new forms of treatment, where the person pays very close attention, and one focuses on the particular mental functions that are lost and develops different exercises for the different lost functions.

RAY SUAREZ: So, Dr. Brem, that old idea about, if you have accepted a wound, a trauma, an insult to a part of the brain that controls, let’s say, language, or moving your limbs, if that’s damaged, you can’t move your limbs and you can’t talk anymore, we’re now talking about brains that can just reassign that work to someplace else?

DR. HENRY BREM: Well, it’s an astounding change in our thinking.

And that was a traditional teaching, was, whatever was lost — and, in fact, as we age, that what was lost would never recoup. And that thinking is changing, you know, very much.

For example, children who have hemispherectomies, where half the brain is removed to control terrible seizures — George Jallo, Ben Carson at Hopkins are doing that kind of work — those children can learn the function of the other side of the brain with rehabilitation and live normal lives, even though half the brain has been removed.

Also, there’s work with — that Alfredo Quinones has shown, and others, that stem cells around the ventricles are capable of regenerating normal brain cells. That was never understood before. That was thought just the opposite was true.

So, we’re now beginning to understand that there are some regenerative capabilities in the brain. And as — exactly as you said, that means that with proper stimulation, with optimizing the environment, and working with the patient that we can see much more recovery than previously was expected.

RAY SUAREZ: Dr. Doidge, Representative Giffords is 40. Is her age working in her favor? Is she better fixed to heal than if she would if she were 60?

DR. NORMAN DOIDGE: Well, probably.

DR. NORMAN DOIDGE: You know, the brain, though, is plastic, neuroplastic, from cradle to grave, but there are these epochs of plasticity, and they vary over the course of time.

So, in early childhood, it’s especially plastic. But an older person, like the representative, probably has an extraordinary amount of motivation. She’s been a very disciplined person. So, she will know a lot about paying attention. So, some of those factors that come into play at middle age will be to her favor.

But the height of plasticity is in early youth. But there’s enough plasticity that we have seen, I mean, really remarkable recoveries by people in middle age, even for lesions or traumas that they sustained 10, 20, 30 years before.

RAY SUAREZ: Dr. Brem, in the small amount of time that we have left, what kind of timeline are we talking about here? Her doctors are cautioning patience. Will we know in three months, six months, a year what kind of shape her brain is in?

DR. HENRY BREM: So, in general, it’s impossible to predict, that someone could — it depends on the nature of the primary injury. It could be weeks, months. It could be — a year is usually where things begin to plateau from the initial recovery. And it could be years. So, really, it’s impossible to tell for an individual person.

RAY SUAREZ: Doctors, thank you very much.

DR. NORMAN DOIDGE: Thank you.

DR. HENRY BREM: Thank you.