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Belgian study finds surprising evidence of brain function in "vegetative" patient

The New England Journal of Medicine is reporting on a new study that is both stunning news and likely to be subjected to undue, superficial speculation.  Using an MRI technique, Adrian M. Owen, a neuroscientist and co-author of the report, has been able to measure brain activity that would suggest active cognitive function in minimally conscious or comatose patients.

Owen's clinic examined 54 patients, looking for meaningful brain activity on the MRI after a prompt.  They found at least a trace of such activity in four "vegetative" patients and one "minimally conscious" patient.  The patients were NOT victims of hypoxia, such as Terri Schiavo, who had suffered diffuse brain injury due to lack of oxygen:  apparently they were all victims of head trauma who had been deemed unable to communicate and unlikely to recover.  It seems as though doctors were attempting to make clear that the information gleaned should not be applied too broadly.

In 2006, the same group of researchers had reported that one young "vegetative" patient's brain was responding [according to MRI findings] to simple commands, such as "think of playing tennis."  In the current experiment, patients were asked to associate thoughts about tennis with "yes" and thoughts about being at home with "no".  They were then asked simple questions, capable of yes or no answers, and their brain images were observed for response.  Because different areas of the brain were activated by association with these responses, the researchers could theoretically monitor whether the patient was communicating an accurate, meaningful response to their inquiries.

The researchers varied the area of brain/association so as to confirm apparently conscious choices and to eliminate any structural bias.  While five patients showed minimal MRI responses, one 29-year old accident victim who had been mute and "vegetative" for five years actually communicated accurately with the researchers in response to these simple queries.  This opens the question of whether a patient in this debilitated state could be consulted with regard to his or her care and condition.  It is also likely to spur torment and false hope among many family members. 

I'm sure that many family members would join me in associating this condition, and the knowledge of a degree of consciousness, with the banned World War I anti-war novel "Johnny Got His Gun."  After a stroke put her in a similar state with no hope of recovery, I took a small measure of solace in the doctors' suggestions that my mother was not aware of her surroundings, despite her apparent, minimal response to her childrens' efforts to communicate.

One Boston physician responded to the situation with a highly intellectual, if seemingly insensitively-timed pun:  "Physicians and society are not ready for 'I have brain activation, therfore I am'...that would seriously put Descartes before the horse."  Nevertheless, the doctor is right about his central point:  this study provides us with information that we are ill-prepared to use productively at this time.

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