Each year in the U.S., as many as 3,000 children drown in water. About two-thirds of them are resuscitated, but the brain damage is usually devastating.
Now, a newly-published study by a San Antonio researcher shows there may come a day when doctors can target the brain damage from drowning and perhaps even treat it in the emergency room to change the outcome.
Summer time is prime time for swimming. Water lures even the youngest of children and can lead to disaster.
San Antonio mother Liz Tullis knows this the hard way. Her son Conrad was visiting at his grandfather’s when an accident happened. "When Conrad was 17 months old, he fell into a swimming pool," she explained.
Then, the unthinkable. Her son was breathing, but he wasn’t moving. He was fed through a tube. She had to decide whether to withdraw treatment, put him in long-term care, or take him home.
"There’s not really a road map," Tullis commented.
She took Conrad home. That was 13 years ago. During that time, her son started waking and sleeping, and reacting, she thought, to what was going on around him. He is awake and aware, but unable to communicate.
She was convinced it was no coincidence.
"I started sensing he understood what was going on," Tullis said.
This determined and curious mother sought out help from a UT Health San Antonio neurologist, Peter Fox, MD, and his scanning technology.
"The brain is the organ that’s most greedy for oxygen," Fox said.
Fox explained when a child inhales water and drowns, their heart stops beating very quickly. By the time they get to an emergency room, they’re usually comatose or convulsing.
Using MRI machines at the Research Imaging Institute, Fox scanned Conrad and nine other children from around the country in similar condition. What he found was surprising.
"The lesion is smack in the motor fibers,” he noted.
Using tests that can reveal both structural damage and functional capabilities, Fox has now published his work, which shows the damage in children whose brains have been starved of oxygen in a drowning, is concentrated in a small, specific area in the basal ganglia found deep and near the center of the brain.
Every child Fox scanned had damage in the same place – a crucially important motor pathway. The other results fascinated him.
"The motor system was severely damaged. Perceptual systems, feeling touch, seeing, hearing, were essentially intact. Cognitive structures were in between," Fox outlined. "The children are largely cognitively intact, much more intact than has been given credit to them by the medical community."
The damaged grey and white matter is near major arteries, meaning the location could be reached using interventional radiology, perhaps by threading a catheter to the site and delivering medication to minimize brain damage.
Knowing this provides a new target of sorts and Fox is hopeful.
"This gives us directions to go therapeutically that we didn’t have before," he said. "This has the potential of saving children from this really devastating syndrome."
Tullis is intrigued.
"If we can make that never happen again, and that has to do with something about Conrad, both of us want that," she said.
Conrad has attended public schools since kindergarten. He now goes to classes at Alamo Heights High School. If her son is in there somewhere, Tullis wants to provide the stimulation and interaction he needs to live the best life possible.
Most children who drown are between the ages of one and four – old enough to run away from their parents, too young to have learned to swim.
"This is an enormous problem that is drastically under studied," Fox noted. "Someone needs to address this."
Now that Fox has determined the machinery of consciousness is intact in these young patients, he wants other clinicians to build on his discovery.
To learn more about Conrad's story and research being conducted to improve the understand and treatment of anoxic brain injuries, click here.
