Vegetative patients show brain activity

British researchers have established limited communication with patients in a persistent vegetative state by using magnetic resonance imaging. The findings show that at least some patients who are otherwise unresponsive may have some residual awareness, the researchers reported in the New England Journal of Medicine. Of 54 patients with a clinical diagnosis of being in a vegetative state or a minimally conscious state, five with traumatic brain injury were able to modulate their brain activity by generating voluntary responses in predefined neuroanatomical regions when prompted to perform imagery tasks, the researchers found. In three of these patients additional bedside testing revealed some signs of awareness, and one patient was able to answer ‘yes’ or ‘no’ to questions. The researchers suggest that this approach could be used to address clinical questions such as whether a patient is feeling pain. “With further development, this technique could be used by some patients to express their thoughts, control their environment, and increase their quality of life,” they concluded. However, in an accompanying editorial Allan Ropper (Brigham and Women's Hospital, Boston) said the research was "easily subject to over interpretation and sensationalism." He cautioned that brain activation was seen only in a few patients and only in those with a traumatic brain injury, rather than global ischemia and anoxia. Furthermore, he said, cortical activation does not provide evidence of an internal "stream of thought", memory, self-awareness, reflection, synthesis of experience, symbolic representations. “Without judging the quality of any person's inner life, we cannot be certain whether we are interacting with a sentient, much less a competent, person. Moreover, persons who look to this study to justify continued and unqualified life support in all unresponsive patients are missing the focus of the findings.” Describing the findings as provocative, Ropper concluded that physicians and society were not ready for "I have brain activation, therefore I am." “That would seriously put Descartes before the horse,” he said....