New Treatment for Coma

New Treatment for Coma
(from Time Magazine in partnership with CNN)

The would-be suicide, rushed to a hospital in a coma and with a belly full of drugs, can be one of medicine’s most devilish problems. Before they can prescribe an antidote, doctors must identify the drugs—and all too often the suicide is the only available source of information. How to ask him? Merely keeping him alive is a heroic chore. Oxygen, artificial respiration and a tracheotomy may all be called for simply to keep the comatose patient breathing and pumping blood.

When he got to Honolulu’s Tripler General Hospital, reports U.S. Army Surgeon Robert J. Hoagland in the American Journal of Medical Sciences, he discovered that the military community provided him with more than his share of such exasperating emergencies.

Anxious to do something about his desperate patients, Dr. Hoagland suggested that emergency-room physicians try to combat coma with doses of “analeptics”—a class of drugs that includes Benzedrine and Dexedrine, and works by stimulating the central nervous system into a state of hyper-wakefulness.

Massive Injections
Hoagland’s colleagues showed little enthusiasm for the idea. Analeptics, they all said, had been tried on patients in coma before, had proved worthless in some cases, actually harmful in others. They had unpredictable effects on the blood pressure and respiration. Even so, on the basis of animal experiments, Dr. Hoagland thought that one analeptic, methylphenidate (trade name: Ritalin), was worth a try.

Dr. Hoagland’s hunch seemed to pay off. Methylphenidate not only roused would-be suicides from their comas, but it was also effective for patients suffering from coma resulting from brain damage and liver failure. For the first time, such patients were able to swallow food and medication, cough up sputum and mucus, thus avoiding one of coma’s worst complications, suffocation.

Fears of side effects proved to have been exaggerated. A patient whose skull had been fractured in a three-story fall awoke from a coma 90 seconds after an injection of methylphenidate. Other patients who suffered no side effects from the drug included a five-year-old girl knocked senseless by a swing and a woman who received massive methylphenidate infusions in an eight-hour period to help bring her out of a coma induced by an overdose of an antidepressant. The worst that happened was that two patients vomited and two others were temporarily disoriented.

How Does It Work?
Now director of the Army Medical Research Laboratory at Fort Knox, Dr. Hoagland is still not sure how methylphenidate works. Like other analeptic drugs, it may stimulate the subcortical region of the brain and help control general alertness; it also seems to stimulate the respiratory center. But why does methylphenidate appear to be safer than other drugs? Dr. Hoagland suspects that the answers may eventually be traced to the drug’s rapid excretion from the bloodstream and into the urine. “But until we understand more about coma,” says he, “we cannot hope to understand Ritalin.” Meanwhile, despite such gaps in medical knowledge, Dr. Hoagland suggests that emergency rooms should take advantage of the drug’s unique qualities.