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Thursday February 4, 2010

“Vegetative” Patients may Retain Awareness: Study

By Hilary White

February 3, 2010 ( – A new study has found that patients deemed to be in a “vegetative” state still have brain function and can even communicate in some cases. Published in the New England Journal of Medicine, the study examined 54 patients with “disorders of consciousness” and assessed their “ability to generate willful” responses during two “established mental-imagery tasks.”

Five of the patients were able to “willfully modulate” their brain activity and three of these displayed “some sign of awareness.” One of the five was able to communicate yes or no answers to simple questions.

These results, the researchers said, indicated that some patients diagnosed as vegetative could have some measure of “preserved awareness.”

The researchers concluded “that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition.”

“Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.”

The research, led by Martin M. Monti, Ph.D. of the Medical Research Council Cognition & Brain Sciences Unit in Cambridge, England, also warned of high rates of misdiagnosis, up to 40 per cent, in cases of patients in a “minimally conscious state.”

The report noted that “purposeful response to stimulation,” is crucial in assessing patients in a “vegetative state” and has “implications for subsequent care and rehabilitation, as well as for legal and ethical decision making”. In jurisdictions that allow the removal of organs from patients deemed to be “brain dead,” such decision-making is a matter of life and death.

“We were stunned when this happened,” Monti told the New York Times, “I find it literally amazing. This was a patient who was believed to be vegetative for five years.”

Bobby Schindler, the brother of Terri Schiavo, who died after her feeding tube was removed under the orders of her husband, responded to the findings of the study, saying that he wished that such technology had been made available for his sister.

“It’s upsetting to me when I see this type of research,” Schindler said. “We were looking to afford these kinds of tests for Terri, but the court did not allow us to perform these kinds of tests.”

Schiavo’s case ignited a firestorm of publicity in between 1998 and 2005. Ultimately, the courts sided with doctors who testified that Schiavo was in a persistent, vegetative state with no hope of recovery—though doctors that the Schindlers brought to court said there was a chance of recovery.