Sunday 13 February 2005

Brain Shutdown as a Defence vs Rabies

Exactly 5 people are known to have survived a case of Rabies, having received innoculation after infection but before major symptoms appear. Until late last year, exactly none had survived after major symptoms appeared.

But the University of Wisconsin used an experimental technique, and the gamble paid off. From the New York Times of November 2004 :
A Wisconsin teenager is the first human ever to survive rabies without vaccination, the Centers for Disease Control and Prevention said yesterday, after she received a desperate and novel type of therapy.

Last month, doctors at the Children's Hospital of Wisconsin in Wauwatosa, a suburb of Milwaukee, put the critically ill girl into a drug-induced coma and gave her antiviral drugs, although it is not clear which, if any, of the four medicines contributed to her surprising recovery.
And from JSOnline of Nov 24 2004 :
Using an innovative approach, a team of eight specialists at Children's Hospital of Wisconsin in Wauwatosa intentionally placed Giese into a coma within an hour after her diagnosis on Oct. 19.

The goal was to protect her brain while the virus ran its course through her body, said Rodney E. Willoughby, the pediatric infectious disease physician who headed the care team.

Within three days, Giese was on a four-drug cocktail - two anti-virals that helped salvage her brain and two anesthetics. She was never given a rabies vaccine because it is considered ineffective once clinical symptoms develop.

"It was an informed gamble," Willoughby said. "We had an idea of what we wanted to do, but no one had done this in an animal model, so, yes, we jumped out of thin air."
The Rabies virus replicates inside the Central Nervous System, and does so so quickly that the body's immune system doesn't have time to mount an effective counter-offensive. By dramatically slowing down the metabolism of the brain, viral replication was reduced, giving the immune system the adequate time. The question was though, how bad would the damage from Rabies be, and would it be temporary (as theorised), or permanent?

Now there's good news and bad news. The damage is quite extensive, but indeed, it appears to be temporary.

From the Children's Health and Hospital System News of Decemeber 31, 2004 :
Although the effects of the illness - which attacks the nervous system - and the protective coma still are evident, tests conducted within the past few weeks leave Dr. Rodney Willoughby optimistic for a nearly full recovery with continued therapy.

"Medically, Jeanna is sound," Willoughby said. "On her MRI scans, there is slight evidence of her past rabies, as well as evidence for ongoing repair of her brain two months later. The MRI findings are mild enough to not be clinically important. We expect Jeanna will continue to refine her speech and coordination through therapy. She has had some extra movements that are subsiding. She's lost a lot of weight, muscle mass and flexibility that she needs to regain. We truly won't know whether her recovery is full until she shows us where her progress stops -- there's no limit currently. Intellectually, she can certainly go to back to high school and pick up where she left off."
And more recently, from ABC (the US one) news of Jauary 14 :
Thanks to that treatment, Jeanna made history by becoming the first person to ever survive rabies without receiving the vaccine. And last week, she continued rewriting the record books, going home a month before her doctors believed she could.

Her body is recovering, and her brain is now undergoing what doctors describe as a "rebirth," as it begins to rewire itself. Nerves are reconnecting to muscles and organs, including her heart.

As part of her rehabilitation, the teen is learning to use her arms and legs again and undergoing speech therapy to speak and swallow. Although she still has a long way to go, doctors continue to be amazed by her progress.
. Finally, from WBAY on February 8th :
Now, just four months after she was diagnosed with advanced rabies, Jeanna Giese is back to school.

Doctors tell us Jeanna's return to St. Mary's Springs High School in Fond du Lac is much earlier than expected.
She's still not able to play Basketball yet - the amount of brainpower required for such co-ordination is surprisingly high, compared with "higher brain functions" like composing a symphony, designing a computer network, or engaging in politics. But considering the really extensive damage, including problems with the brainstem leading to heart irregularities, such a recovery is remarkable. Yet another clue as to how much we don't understand about the mechanics of thinking.

But a teenage girl is now back at high school, with an undamaged personality and healing body, rather than being yet another medical statistic. And that makes this Brain post a rather happier one than others.

1 comment:

Ron Van Wegen said...

I have to be careful - I seem to prefer bad news so thanks for that.