7 replies to this topic

[DrinkTheElixir]

Fascinating - and it sheds a whole new light on past cases where treatment was withdrawn from patients who were thought to be in a vegetative state.  

'Vegetative state' patients can respond to questions

By Fergus Walsh
Medical correspondent, BBC News  



Dr Adrian Owen, co-author of the research: "This changes things" Scientists have been able to reach into the mind of a brain-damaged man and communicate with his thoughts. The research, carried out at in the UK and in Belgium, involved a new brain scanning method.  Awareness was detected in three other patients previously diagnosed as being in a vegetative state. The study in the New England Journal of Medicine shows that scans can detect signs of awareness in patients thought to be closed off from the world.

Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage.

Scanning technique

The scientists used functional magnetic resonance imaging (fMRI) which shows brain activity in real time. They asked patients and healthy volunteers to imagine playing tennis while they were being scanned. In each of the volunteers this stimulated activity in the pre-motor cortex, part of the brain which deals with movement. This also happened in four out of 23 of the patients presumed to be in a vegetative state.

I gave the scientists two women's names, one of which was my mother's. I imagined playing tennis when they said the right name, and within a minute they had worked out her name. They were also able to guess correctly whether I had children.

Questions

This is a continuation of research published three years ago, when the team used the same technique to establish initial contact with a patient diagnosed as vegetative. But this time they went further. With one patient - a Belgian man injured in a traffic accident seven years ago - they asked a series of questions. He was able to communicate "yes" and "no" using just his thoughts.

The team told him to use "motor" imagery like a tennis match to indicate "yes" and "spatial" imagery like thinking about roaming the streets for a "no". The patient responded accurately to five out of six autobiographical questions posed by the scientists. For example, he confirmed that his father's name was Alexander. The study involved scientists from the Medical Research Council (MRC), the Wolfson Brain Imaging Centre in Cambridge and a Belgian team at the University of Liege.

Dr Adrian Owen from the MRC in Cambridge co-authored the report:

"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."

Dr Owen says this opens the way to involving such patients in their future treatment decisions: "You could ask if patients were in pain and if so prescribe painkillers and you could go on to ask them about their emotional state."

It does raise many ethical issues - for example - it is lawful to allow patients in a permanent vegetative state to die by withdrawing all treatment, but if a patient showed they could respond it would not be, even if they made it clear that was what they wanted. The Royal Hospital for Neurodisability in London is a leading assessment and treatment centre for adults with brain injuries.

Helen Gill, a consultant in low awareness state, welcomed the new research but cautioned that it was still early days for the research: "It's very useful if you have a scan which can show some activity but you need a detailed sensory assessment as well.

"A lot of patients are slipping through the net and this adds another layer to ensure patients are assessed correctly."

She said the hospital did a study of 60 patients admitted with a diagnosis of vegetative state and 43% could communicate.


http://news.bbc.co.u...lth/8497148.stm

[Martine]

Fascinating!
However, I think, from reading this, that the real issue will be not to extrapolate these findings to people in a coma. For most lay people both states sound about the same. But they are not.

Very interesting article. This will indeed change a lot!

[Aardwolves Lower]

a brilliant step forward!

I knew a kid in high school that suffered a brain aneurysm and he could only look around with his eyes...so tragic...I would talk to him and play r.e.m. and zeppelin while I visited and his eyes seemed to glow so I think he knew more than his parents thought he knew...

this is terrific news!

[raveman2001]

This and the related stories from lately are really unreal. What a nightmare to be trapped in your body. I told my wife tonight about this and gave clear instructions on how to handle me if I ever had something like this happen to me! Hopefully many people are tested soon and new treatments/ways of life can be attempted.

[yensen]

Yeah...it's amazing in a way, but also pretty horrific.  It's good we're getting to the point where we can communicate with these people, but I can't even imagine the decades of nothing.  Maybe it'll be better in the future, but in the present I think I'd just want it all done with, and see what's next.  Even nothing would be better.

[Aardwolves Lower]

that poses the question, would you want them to pull the plug if you were in a catatonic state?
for me, I say yes, yank the plug!

[Red Frog]

A aardwolves B lower C me said:

that poses the question, would you want them to pull the plug if you were in a catatonic state?
for me, I say yes, yank the plug!

Most definitely.

[DrinkTheElixir]

A aardwolves B lower C me said:

that poses the question, would you want them to pull the plug if you were in a catatonic state?
for me, I say yes, yank the plug!

No, because catatonia is completely different condition to being in a vegetative state. So if I were suffering from a mental illness that was characterised by catatonia, I wouldn't want to be euthanised because is is a treatable condition.

Edited by DrinkTheElixer, 09 February 2010 - 07:48 AM.
typo