Deep brain stimulation with electrical pulses may offer hope for patients trapped in a minimally conscious state.

Electrical pulses 'rouse' patient

The electrodes were placed at specific points in the brain

Deep brain stimulation with electrical pulses may offer hope for patients trapped in a minimally conscious state.

Treatment of a 38-year-old man with a severe brain injury enabled him to use words and gestures, chew and swallow and drink from a cup, say US doctors.

Before the stimulation, done through electrodes implanted in his brain, he could only make slight eye or finger movements, the team report in Nature.

Experts said more studies were needed to assess which patients may benefit.

Now, my son can eat, express himself and let us know if he is in pain. He enjoys a quality of life we never thought possible Patient's mother

Deep brain stimulation is already used in the treatment of tremors associated with Parkinson's disease.

The procedure involves electrodes implanted with millimetre accuracy to specific areas of the brain.

Badly beaten

The man involved in the study was badly beaten six years ago, leaving him severely brain injured and in a minimally conscious state, in which patients show intermittent signs of awareness.

Over a period of six months the researchers alternated periods of electrical stimulation with fake stimulation to assess whether it was having an effect.

Within 48 hours of the first stimulation, the patient was able to keep his eyes open, turn his head, and utter words.

After several treatments he is now able to perform complex tasks such as brushing his hair, although with difficulty due to severe immobility caused by his condition.

And can chew and swallows his food where before he needed a feeding tube.

Further tests on 12 patients have gained FDA approval. The researchers say if these results are replicated, it could change the standard of care for such patients, most of whom have to be cared for in long-term nursing facilities.

Dr Ali Rezai, the neurosurgeon at Cleveland Clinic's Center for Neurological Restoration who carried out the procedure said the changes in the man had been "remarkable and sustained".

Study leader, Dr Nicholas Schiff, associate professor of neurology and neuroscience at Weill Cornell added: "The work challenges the existing practice of early treatment discontinuation and also changes the approach to assessment and evaluation."

Communicate

His mother, who does not wish to be identified said it had been very hard for her to see her son lying in the nursing home, unable to communicate with them.

"I'll never forget the words the doctor said to us: 'if your son recovers from this in the next 72 hours, and we don't know if he will, he will be a vegetable for the rest of his life.'

"Now, my son can eat, express himself and let us know if he is in pain. He enjoys a quality of life we never thought possible.

"And the most important part is he can say 'I love you mommy'."

Professor Paul Matthews, an expert in clinical neurosciences at Imperial College London, said the study offered hope.

"The causes and severity of brain injury vary between minimally conscious state patients," he said.

"More experience with the approach is needed to understand which patients may be expected to benefit."

Professor Tipu Aziz, expert in neurosurgery at the University of Oxford, added there had been cases of patients recovering spontaneously after being in a minimally conscious state for a long time and no firm conclusions could be made.

"Much more needs to be done into the research of the best management of such patients but there is little funding to do so."

Third of Iraqis 'need urgent aid'

Oxfam say basic services cannot meet the needs of the Iraqi people

Nearly a third of the population of Iraq is in need of immediate emergency aid, according to a new report from Oxfam and a coalition of Iraqi NGOs.

The report said the Iraqi government was failing to provide basic essentials such as water, sanitation, food, and shelter to up to eight million people.

It warned the continuing violence was masking a humanitarian crisis that had grown worse since the invasion in 2003.

It also found that four million Iraqis had been uprooted by the violence.

More than two million people have been displaced inside the country, while a further two million have fled to neighbouring countries, according to the report.

On Thursday, an international conference in Jordan pledged to help the refugees with their difficulties.

'Dire poverty'

The BBC's Nicholas Witchell in Baghdad says the report by the UK-based charity and the NGO Co-ordination Committee in Iraq (NCCI) makes alarming reading.

OXFAM/NCCI REPORT IN FULL Rising to the humanitarian challenge in Iraq (324KB) Most computers will open PDF documents automatically, but you may need to download Adobe Acrobat Reader. Download the reader here

The survey recognises that armed conflict is the greatest problem facing Iraqis, but finds a population "increasingly threatened by disease and malnutrition".

It suggests that 70% of Iraq's 26.5m population are without adequate water supplies, compared to 50% percent prior to the invasion. Only 20% have access to effective sanitation.

Nearly 30% of children are malnourished, a sharp increase on the situation four years ago. Some 15% of Iraqis regularly cannot afford to eat.

The report also said 92% of Iraq's children suffered from learning problems.

Millions of Iraqis have been forced to flee the violence, either to another part of Iraq or abroad - many of those are living in dire poverty Jeremy Hobbs Director of Oxfam International Alarming humanitarian crisis

"Basic services, ruined by years of war and sanctions, cannot meet the needs of the Iraqi people," the director of Oxfam International, Jeremy Hobbs, said.

"Millions of Iraqis have been forced to flee the violence, either to another part of Iraq or abroad. Many of those are living in dire poverty."

Mr Hobbs said that despite the violence, the Iraqi government and the international community could do more to meet people's needs.

"The Iraqi government must commit to helping Iraq's poorest citizens, including the internally displaced, by extending food parcel distribution and cash payments to the vulnerable," he said.

"Western donors must work through Iraqi and international aid organisations and develop more flexible systems to ensure these organisations operate effectively and efficiently."

Oxfam has not operated in Iraq since 2003 for security reasons.

Sweden plans to be world's first oil-free economy

· 15-year limit set for switch to renewable energy
· Biofuels favoured over further nuclear power

John Vidal, environment editor
Wednesday February 8, 2006
The Guardian


Evergreen... Sweden will develop biofuels from its forests. Photograph: Mattias Klum/Getty Images

Sweden is to take the biggest energy step of any advanced western economy by trying to wean itself off oil completely within 15 years - without building a new generation of nuclear power stations.

The attempt by the country of 9 million people to become the world's first practically oil-free economy is being planned by a committee of industrialists, academics, farmers, car makers, civil servants and others, who will report to parliament in several months.

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The intention, the Swedish government said yesterday, is to replace all fossil fuels with renewables before climate change destroys economies and growing oil scarcity leads to huge new price rises.

"Our dependency on oil should be broken by 2020," said Mona Sahlin, minister of sustainable development. "There shall always be better alternatives to oil, which means no house should need oil for heating, and no driver should need to turn solely to gasoline."

According to the energy committee of the Royal Swedish Academy of Sciences, there is growing concern that global oil supplies are peaking and will shortly dwindle, and that a global economic recession could result from high oil prices.

Ms Sahlin has described oil dependency as one of the greatest problems facing the world. "A Sweden free of fossil fuels would give us enormous advantages, not least by reducing the impact from fluctuations in oil prices," she said. "The price of oil has tripled since 1996."

A government official said: "We want to be both mentally and technically prepared for a world without oil. The plan is a response to global climate change, rising petroleum prices and warnings by some experts that the world may soon be running out of oil."

Sweden, which was badly hit by the oil price rises in the 1970s, now gets almost all its electricity from nuclear and hydroelectric power, and relies on fossil fuels mainly for transport. Almost all its heating has been converted in the past decade to schemes which distribute steam or hot water generated by geothermal energy or waste heat. A 1980 referendum decided that nuclear power should be phased out, but this has still not been finalised.

The decision to abandon oil puts Sweden at the top of the world green league table. Iceland hopes by 2050 to power all its cars and boats with hydrogen made from electricity drawn from renewable resources, and Brazil intends to power 80% of its transport fleet with ethanol derived mainly from sugar cane within five years.

Last week George Bush surprised analysts by saying that the US was addicted to oil and should greatly reduce imports from the Middle East. The US now plans a large increase in nuclear power.

The British government, which is committed to generating 10% of its electricity from renewable sources by 2012, last month launched an energy review which has a specific remit to consider a large increase in nuclear power. But a report by accountants Ernst & Young yesterday said that the UK was falling behind in its attempt to meet its renewables target.

"The UK has Europe's best wind, wave and tidal resources yet it continues to miss out on its economic potential," said Jonathan Johns, head of renewable energy at Ernst & Young.

Energy ministry officials in Sweden said they expected the oil committee to recommend further development of biofuels derived from its massive forests, and by expanding other renewable energies such as wind and wave power.

Sweden has a head start over most countries. In 2003, 26% of all the energy consumed came from renewable sources - the EU average is 6%. Only 32% of the energy came from oil - down from 77% in 1970.

The Swedish government is working with carmakers Saab and Volvo to develop cars and lorries that burn ethanol and other biofuels. Last year the Swedish energy agency said it planned to get the public sector to move out of oil. Its health and library services are being given grants to convert from oil use and homeowners are being encouraged with green taxes. The paper and pulp industries use bark to produce energy, and sawmills burn wood chips and sawdust to generate power.