The Cortical Column

Schiff et al. recently described a method whereby deep brain stimulation (DBS) is applied to the intralaminar nuclei of the thalamus, critical for attention and arousal. Within 48 hours, a patient with widespread cerebral damage awoke from a six year coma. DBS is unfortunately a highly invasive surgery, and given our speculative knowledge of neuroscience, these electrical fields often amount to a shock in the dark.

But is DBS the only way to stimulate the thalamus? In a recent New Yorker article by Jerome Groopman titled “Silent Minds,” we learn of a technique called Deep Pressure Stimulation (DPS), which is almost completely undocumented in the literature, except by autistic professor Temple Grandin in her “Hug machine.” DPS was applied to a patient in a vegetative state due to a brain hemorrhage by Dr. Joseph Giacino at the J.F.K. Johnson Rehabilitation Institute:

The neurologists examined the woman, who lay with her eyes half closed and did not respond to the doctors’ commands. The neurologists concluded that she was in a vegetative state. “So I sort of sheepishly said, ‘Let me show you what happens when we stimulate her,’ ” Giacino recalled. He had been using a technique called “deep-pressure stimulation,” which involves squeezing a patient’s muscles with force and precision. Giacino started with the woman’s face and worked his way down to her toes, pinching her muscles between his fingers. As he explained, the nerve endings of the muscles send impulses to the brain stem, which relays them to other brain structures and rouses the patient to consciousness. “I did a cycle of deep-pressure stimulation, and within a minute or so she was talking to us,” Giacino said. “The neurologists were flabbergasted.” The woman was able to say her name and her husband’s name, and answer simple questions, such as “Is there a cup at your bedside?” After a few minutes, however, she became unresponsive again.

Now consider this diagram of the thalamus. This is mere speculation, but the brain stem projects to the midline nuclei, which is an anatomical neighbor of the intralaminar nuclei:

Could these two nuclei be functionally related? Consider further the conclusions of Werf et al. (2002) in “The intralaminar and midline nuclei of the thalamus. Anatomical and functional evidence for participation in processes of arousal and awareness“:

These anatomical relationships, in combination with functional studies in animals and in humans, lead us to propose that the midline and intralaminar nuclei as a whole play a role in awareness, with each of the groups subserving a role in a different aspect of awareness.

DBS and DPS are both fascinating, but I have to wonder, did this patient go through this highly invasive surgery when all she needed was a good massage? I hope they get the memo!