MINUTES AFTER TAKING PILL, HE SAYS HELLO MUMMY
By Ng Tze Yong
EVERY night after work, she rushed to the hospital to tell her son about her day as a sales consultant.
She cleaned him as tenderly as she could, even while she struggled with his limp body to change his gown.
And in the solitude of the night, she finally sat silently, looking at him.
All he ever did was stare back blankly. Not a word. Not even a groan.
Mr Louis Viljoen, her only son, was then 25.
In 1996, in the small South African town of Springs just outside Johannesburg, he suffered severe brain injuries after a truck hit his bicycle.
He was stuck in a persistent vegetative state (PVS) and doctors expected him to die.
But Madam Sienie Engelbrecht, a 57-year-old divorcee, prayed for a miracle. She waited three long years.
Then, on 11 Jan 1999, the unthinkable happened.
‘All I did was crush it up and give it to him in a bottle with fruit juice,’ Madam Engelbrecht recalled in a telephone interview with The New Paper on Sunday.
The ‘it’ was a sleeping pill.
Concerned about spasms in his left arm, Mr Viljoen’s doctor, Dr Wally Nel, had asked Madam Engelbrecht to give her son the pill to calm him down.
About 25 minutes later, she heard Mr Viljoen make a sound like ‘mmm’.
‘Louis, can you hear me?’ Madam Engelbrecht asked.
It was barely a mutter.
Then came the words: ‘Hello, mummy…’
That day, Madam Engelbrecht cried her eyes out. ‘I can’t describe how I felt. I got my son back,’ she said.
What a paradox - a sleeping pill responsible for the miracle of waking up a comatose patient.
OTHER PATIENTS WAKE UP TOO
Mr Viljoen was not the only one. Across three continents - Africa, Europe and America - brain-damaged patients are recovering after being given sleeping pills.
Doctors studying Mr Viljoen’s recovery have a hypothesis that could potentially change laws worldwide governing brain-dead patients, including those in Singapore. (See report on facing page.)
A UK-listed biotechonological company, ReGen Therapeutics Plc, will start clinical trials in South Africa later this month. It wants to establish the new discoveries made about zolpidem - the active ingredient in the pills.
Researchers at the Pretoria Academic Hospital - where the trials will be held - told The New Paper on Sunday that it is ‘too early to comment on the final results’, but it is hard to ignore the possibilities.
Potentially, zolpidem could be used for all kinds of brain damage, including stroke, Parkinson’s disease and Alzheimer’s disease, said Dr Ralf Clauss of the Royal Surrey County Hospital in the UK, who’s been studying Mr Viljoen’s recovery with Dr Nel since 1999.
ReGen, which is awaiting approval for a patent to use zolpidem in cases of brain dormancy, estimates the potential market at US$4.3 billion ($6.8b).
Since 1999, Dr Nel and Dr Clauss’ study has been published in six peer-reviewed medical journals.
Independent research in Europe and the US have also showed similar results.
In a 2004 report in the New England Journal of Medicine, a French doctor reported how a stroke patient spoke again after being given zolpidem.
In another report in the Southern Medical Journal, an American doctor described how zolpidem reduced the spasms of a patient with brain injury.
I’M NO COWBOY
Soon after the discovery, Dr Clauss and Dr Nel carried out a brain scan on Mr Viljoen, and found that the areas responsible for motor function, sight, speech and hearing lit up with activity after zolpidem was given.
Since then, Dr Nel and Dr Clauss have treated about 150 patients with different types of brain damage, and found varying improvements in 60 per cent of the cases.
Dr Nel said he sees these patients after office hours and doesn’t accept payment from them. However, none has repeated Mr Viljoen’s stunning recovery.
‘I’m not a cowboy,’ said Dr Nel, who has been a GP in Springs for 40 years and is married with three children. ‘I want to be very cautious and ethical about this.’
Among the patients treated is a 69-year-old runner who suffered brain damage after a traffic accident, Mr Paul Ras. Now, he takes part in walking marathons - with only one hip.
Then, there is Mr Theo van Rensburg, a 43-year-old lawyer who suffered severe brain injuries in a car crash in 1991. After reporting improvements in balance and co-ordination, Mr van Rensburg now goes horse-riding.
Since his awakening seven years ago, Mr Viljoen remains bedridden. He’s no longer classified as being in PVS.
Every day since, he has been taking sleeping pills, ranging from one to three. Now, he is awake most of the day by taking just half a tablet morning and evening.
Last month, British newspaper The Guardian sent a journalist to witness Mr Viljoen’s treatment. It reported that within 15 minutes of being given the pill, he was awake, laughing, bantering and reaching out to hug his mum.
Dr Nel said that Mr Viljoen has retained his long-term memory, and his short-term memory is improving.
‘He can tell me all his ex-girlfriends’ names,’ said Dr Nel, who has been Mr Viljoen’s GP since he was 4.
Once, Mr Viljoen even played a prank on Dr Nel, pretending not to wake up after being given the pill.
On 13 Oct, Mr Viljoen will turn 36.
Madam Engelbrecht will gather loved ones for a quiet bedside party.
‘He wants a cat,’ she said. He had seven cats before his accident.
‘I’ll get him a soft toy.’
‘TOO EARLY TO SAY IT’S A CURE’
THIS is the verdict of doctors here after The New Paper on Sunday showed them Dr Nel and Dr Clauss’ findings in the medical journal, South African Family Practice.
‘In medical literature, their study is considered ‘anecdotal’,’ said Dr Lee Kim En, senior consultant neurologist at the National Neuroscience Institute (NNI). This means that the number of successful cases is not sufficient to prove the drug works.
For now, zolpidem is only approved for treating insomnia.
Dr Lee said that for zolpidem to be approved for treating brain damage, it must first go through a robust set of clinical trials.
Dr Lee said that researchers independent of Dr Nel and Dr Clauss have achieved ‘beneficial results’ with zolpidem, but they were mostly for other types of brain damage, such as stroke.
But Dr Ng Puay Yong, a neurosurgeon with Mount Elizabeth Hospital, is more optimistic, saying that the study is ‘worth trying here, if it is done in the hospital’.
In Singapore, bioethics has been a subject of heated debate. In 2002, the Bioethics Advisory Committee drew up guidelines for human-tissue research after consultations.
If he were in Singapore, Mr Viljoen would have been kept alive. Only brain-dead patients are considered clinically dead.
But Dr Nel and Dr Clauss believe his awakening should change the way we treat brain-dead patients.
By suggesting the idea of brain dormancy, they are calling for a redefinition of brain death. If their hypothesis turns out to be correct, its potential implications are wide.
Under Singapore law, doctors can harvest the organs of a brain-dead patient, with or without the consent of relatives. Dr Nel and Dr Clauss’s hypothesis, if proven correct, could complicate this.
It would make the signing of an Advance Medical Directive - which allows a patient to state in advance that he doesn’t want to be sustained artificially should he become terminally-ill and unconscious - a potential act of suicide.
But for now, the concept of brain death is a ‘very well-established one’, said Dr Lee. ‘Mr Viljoen’s case cannot challenge it.’
Dr Nel knows this, but says ‘we don’t know enough about the body yet to take life away’.
‘If we hadn’t held on to the hope that Louis would wake up, would we see the joy he is giving to people now?’ he added.