Consciousness still flickers in some “vegetative” patients

It’s hard to tell whether it is good news or bad news, but it is exciting news. Researchers in Britain and Belgium reported in the New England Journal of Medicine this week that they were able to communicate with a 29-year-old man in a vegetative state by using an fMRI scan. They asked him to think of tennis when he wanted to answer Yes and to think of his house when he wanted to answer No. Different parts of the brain lit up and he gave correct answers to 5 out of 6 questions.

Dr Adrian Owen, co-author of the research from the Medical Research Council, said: "We were astonished when we saw the results of the patient's scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts. Not only did these scans tell us that the patient was not in a vegetative state but, more importantly, for the first time in five years, it provided the patient with a way of communicating his thoughts to the outside world."

Dr Steven Laureys, co-author from the University of Liège, confirmed: "So far these scans have proven to be the only viable method for this patient to communicate in any way since his accident. It's early days, but in the future we hope to develop this technique to allow some patients to express their feelings and thoughts, control their environment and increase their quality of life."

The implications of this study are far-reaching, as everyone instantly realized. Neurologists are already aware that 40% of diagnosese of patients in a vegetative or minimally conscious state are flawed. Now they have discovered that it may be possible to communicate with a handful of them. In an accompanying editorial in the NEJM, neurologist Allan H. Ropper, of Brigham and Women's Hospital, in Boston, wrote: “brain activation was infrequent, but it occurred often enough that it will now be difficult for physicians to tell families confidently that their unresponsive loved ones are not ‘in there somewhere’”. 

The divide between consciousness and unconsciousness will also become blurred. Dr Ropper also argued that a response through a brain scan does not necessarily imply that there is lively mental activity or awareness of one’s predicament.

Another consequence which occurred to Dr Ropper is the possibility of asking apparently “vegetative” patients whether they would like their life support turned off. Without conscious consent, this would be illegal nearly everywhere. With consent, it would constitute the withdrawal of burdensome treatment, which is legal nearly everywhere. Perhaps Terri Schiavo was just the beginning. ~ New England Journal of Medicine, Feb 3; Los Angeles Times, Feb 4

MORE ON THESE TOPICS | brain death, consciousness, informed consent

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