Friday, May 13, 2016

A Patient's Astonishing Recovery from Brain Trauma Provides Hope for New Treatments

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On December 28, 2010, 19-year-old Dylan Rizzo suffered devastating head trauma in a car accident close to his home in Lynnfield. He was in a coma and had suffered extensive brain damage. By the time he arrived in the Emergency Room at Massachusetts General Hospital, large hemorrhages were causing a life-threatening increase in pressure within his brain. Neurosurgeon Dr. Jason Gerrard got him into the operating room within 54 minutes of his arrival, a speed that reflected the skills of the clinical team at Mass General’s Neurosciences Intensive Care Unit. Still, an MRI of his brain showed major damage to the white matter (the wires that send signals from one part of the brain to the other).

“Based on the images we saw, the chance of death, vegetative state, or severe disability was very high,” Brian Edlow, MD, says. Dr. Edlow, a critical care neurologist at Mass General, says Dylan’s case highlighted the need for a better understanding of how the brain recovers from trauma.

Dr. Edlow’s Laboratory for NeuroImaging of Coma and Consciousness is using advanced structural and functional imaging techniques to identify the brain networks that support an individual’s ability to wake from a coma. By identifying these brain networks, clinicians will be able to provide patients’ families with more accurate prognoses. Ultimately, Dr. Edlow hopes to develop personalized treatments that can promote recovery.

The lab receives partial funding from the MGH Traumatic Brain Injury Recovery Fund, which is supported by individual donations. Contributions help Dr. Edlow and other researchers develop advanced brain imaging techniques that predict recovery of consciousness after traumatic coma; test new therapies to promote that recovery; and identify MRI, EEG and genetic biomarkers that predict the risk of post-traumatic neurodegenerative diseases, such as Alzheimer’s disease and Chronic Traumatic Encephalopathy.

Based on previous studies of patients with similar MRIs, when the neurocritical care team met with Dylan’s parents, they were not encouraging about the chances for recovery. “We were told Dylan might never be able to sit up on his own or recognize us as his parents,” says his mother Tracy Rizzo. “In the best case scenario, they said he might live another 10 years.”

Even with that devastating prognosis, the Rizzo family asked the team to do everything they could. The combination of outstanding acute care at Mass General, the 24-hour presence of Dylan’s family, the rehabilitative care at Spaulding Rehabilitation and Crotched Mountain Rehabilitation Hospital, and Dylan’s tireless efforts, have led to an astonishing recovery.

“The one thing Dylan had in his favor was his youth,” Dr. Edlow says. An MRI taken six weeks after his accident showed that his damaged white matter had begun to heal, something that had not been seen before. “The ability of the brain to repair itself is much stronger in a young brain than an old brain,” Dr. Edlow says. “But this was also the first time this series of brain images had been available in a patient like Dylan.”

Earlier this year, when Dylan sauntered in to a conference for third-year Harvard Medical School students and neurology residents led by Dr. Edlow, his easy smile and big wave made it hard to believe he’d been through so such trauma.

While he admits some memories are still missing, and he still needs some help with planning and organizing, Dylan says he volunteers as a coach for his high school track team, is busy lifting weights and is getting ready to take some college classes.

 “I just keep going forward,” he says. “I keep getting better and better.”

Dylan’s recovery has provided Dr. Edlow and his laboratory important information about the timeline used for prognosis in the case of traumatic brain injuries. The information has encouraged clinicians not to limit care too quickly, and has provided a measure of hope for families.

“Dylan has been an inspiration to us,” Dr. Edlow says. “Not only for his remarkably upbeat attitude, but for what he’s taught us about how we evaluate the information available to us on MRIs, and how we talk to families about a patient’s prognosis.”

For more information on MGH neurological services and research please visit the Laboratory for NeuroImaging of Coma and Consciousness and the Neurosciences Intensive Care Unit.

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