Posted on 09/12/2006 1:38:33 PM PDT by SirLinksalot
Thoughts of woman in 'waking coma' revealed
Brain scans of vegetative patient ignites debate over her awareness.
Michael Hopkin
Neuroscientists have reignited the debate over whether patients in a vegetative state are conscious of their surroundings, by claiming that a woman in such a 'waking coma' can respond to verbal commands. The researchers say that brain scans show that she can selectively think of performing certain actions, such as playing tennis, on request.
The British-led research team made the discovery after examining the brain of a severely brain-damaged patient who had been in a vegetative state — defined as a lack of detectable consciousness — for five months. After years of studying the brains of vegetative patients, this is the first evidence, the researchers say, of awareness in such a patient, rather than simple automatic brain responses.
Three healthy participants at the MRC Cognition and Brain Sciences Unit show increased activity in the motor areas of the brain when asked to imagine playing tennis. The activation observed in the vegetative patient was identical.
The patient, a 23-year-old woman who was severely injured in a car accident in July 2005, had shown no outward signs of awareness. She had retained normal patterns of sleep and open-eyed 'wakefulness', report Adrian Owen, of the Medical Research Council Cognition and Brain Sciences Unit in Cambridge, UK, and his colleagues — but her open eyes could not focus or follow someone around a room.
The team first compared scans of the patient's brain with those of 12 healthy volunteers in response to commands either to picture themselves playing a game of tennis or to imagine walking around their house. The two imagined activities produced markedly different patterns of brain activation when scanned using functional magnetic resonance imaging (fMRI), which highlights regions of brain activity.
When asked to imagine the different scenarios, the patient showed strikingly similar patterns of brain activation to those of the healthy volunteers, the researchers report in this week's Science1 (see picture). This shows that she can 'play tennis in her head', they argue, even though she shows no outward response to the request.
Aware?
The research throws open the question of what constitutes a vegetative state. "She does fulfil all the clinical criteria," says Owen. "What we have developed is a method for detecting when someone is aware in the absence of other clinical evidence."
Other experts are not convinced that the results genuinely show that the patient was responding to the commands, rather than having a more instinctive response. "You don't really know whether the patient is imagining a tennis game or simply responding to the word 'tennis'," comments Paul Matthews, a clinical neuroscientist at Imperial College, London. "There's a lot that's interesting about this research but I think their result is overclaimed."
"Our results could not be explained by an automatic response," Owen counters. "We have shown that the word 'tennis' produces a very transient response of just a few seconds. But the response in our study was long-lived, lasting around 30 seconds, and stopped when we told her to stop and rest."
Ethical issues
If vegetative people's brains do indeed respond to what is going on around them, the method opens up the exciting prospect of allowing these patients to communicate with the outside world. Asking the patient a series of yes/no questions, about her feelings and about facts such as her name, could help to clear up whether the response is truly conscious, as well as allowing a line of communication with her.
What we've developed is a method for detecting when when someone is aware in the absence of other clinical evidence.
"It's obviously the next thing to do, but it's too early to say if it would work," says Owen. "We just don't know exactly what she's capable of."
What's more, so far they have only seen this effect in a single patient, Owen admits. His team is hoping to investigate more patients to try and replicate the results.
If other patients seem to have similar abilities, it raises the possibility that some vegetative patients have a "rich and complex internal life", suggests Narender Ramnani, a neuroscientist at Royal Holloway, University of London.
That raises troubling ethical questions, similar to those raised by the case of Terri Schiavo, a vegetative patient whose feeding tube was removed in March 2005. "Given that such patients might be conscious and capable of making their own decisions," Ramnani asks, "is it acceptable for others to terminate their lives without the consent of the patients?"
Schiavo, however, was almost certainly much more severely injured than the patient in the latest study, Owen says. Schiavo was diagnosed as 'persistently vegetative', having shown no sign of recovery for years. For Owen's patient, who had suffered a head injury only five months previously, there is "something like a 20% chance of recovery", he says. There has been no change in her condition, however, since the research was carried out in late 2005.
Perhaps the ultimate problem for understanding the vegetative state is that it can be caused by widely varying brain injuries, meaning that every patient is different. Patients at the least severe end of the spectrum, such as the latest case, may indeed have some awareness of the world. "But we can't get inside her head and see what the quality of her experience is like," Owen admits.
Waiting for the pro-death conservatives to show up.
They're on the other thread.
""You don't really know whether the patient is imagining a tennis game or simply responding to the word 'tennis'," comments Paul Matthews"
This guy seems to miss the fact that whether she responded to playing tennis or simply responded to the word 'tennis', she RESPONDED!
With the killing of Terri they essentially validated another means of legalized murder. We will continue to carry a heavy price tag for that heinous crime.
It'd be really nice if Terry's parents would sue all involved in killing her. I think they've looked into this...but today with these brain damaged folks waking up...may be they'd have more of a case.
... in the first five months.
After one year, the odds of them improving drop off. Terri was PVS for what? 15 years?
She was alive, and she wouldn't be dead now unless she'd been deprived of what we ALL NEED TO LIVE...FOOD and WATER. That's good enough for me. THAT IS COLD BLOODED MURDER, pure and simple, no matter how you spin it. And she WAS responsive...no one, I don't care how death-minded and eager to kill the handicapped, can deny that.
Brain responses of not, Terri was a living human being who was loved by other living human beings.
And it really doesn't matter if a patient appears responsive. A coma patient for 5 years awoke after being given one Ambien. And we've heard of very rare cases where people awoke from comas 10 or more years later.
Full recovery may be impossible, but these new tests show we just don't have the scientific understanding or moral authority to condemn a coma patient's mental or spiritual quality of life.
This story makes me so sad--and mad--thinking of what could have been for Terri. Shame on everyone who participated in her death.
In light of this case, maybe they have basis for a wrongful death suit.
Her body was being kept alive artificially, yes.
"And she WAS responsive."
No. Not at all. We're talking about Terri Schiavo, right? Not someone else?
Brain activity may be true in early cases, but cognitive thought is something else. However, in the case of Terri Schiavo she had been in a persistant vegitative state for years and on autopsy her brain was shown to have largely liquified.
Saying she was being kept alive artifically is too broad a brush. She could not feed herself just like a newborn. Is a newborn being kept alive artifically???????? Ah you say but she had a feeding tube. Yes she did. Alot of feeding tubes are put in place becaue of the ease of feeding not cause all patients can not swallow. Is a baby bottle a qusai feeding device????????? These moral questions are not as broad or as black and white as you paint.
I don't think the issue is so much about the technology of keeping someone alive in a vegitative state as WHO has the right to keep them alive (or not). Since when does the GOVERNMENT (local, state or federal) have any say whatsoever?
AFAIC no Government should interfere with anyone's right to life.
I understand that. Then you've got docs when someone is hooked up in an hospice situation...that'll pull the plug on those folks. No matter how much the family tells him NO.
This seems like a case of swatting the hornets' nest to get maximum coverage of a story. The case is not similar to Terri Schiavo. There is absolutely no mention of anybody trying to deny food and/or water to the current case.
Owen admits that they have only seen this effect in a single patient -- and science requires that results be replicated before valid assumptions can be made.
Owen's patient had suffered a head injury only five months prior to his tests; and she was not thought to be in a persistent vegetative state. He also admits that there has been no change in her condition since the research was carried out in late 2005.
Owen admits that Schiavo, however, was almost certainly much more severely injured than the patient in the latest study and that she had shown no sign of recovery for years.
They finally state the best qualifiers in the last paragraph. All patients are different ... the subject case was at the least severe end of the spectrum ... we can't get in the head, etc.
The writer did not even attempt to answer the troubling ethical questions he speaks of -- but he did use Terri Schiavo to reach maximum impact.
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