"Vegetative State" Patients Can Communicate 347
Kittenman writes "The BBC is carrying a story about researchers in the UK and Belgium who can detect the thinking processes within a patient previously thought to be in a vegetative state. The researchers ask the patient verbally to think in certain ways to indicate a 'yes', in other ways to indicate a 'no' — and have successfully communicated with 4 out of 23 patients previously thought to be in a coma."
Summary wrong: Not a coma! (Score:5, Informative)
From TFA:
"Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage. "
Coma, not in a hollywood way. (Score:5, Informative)
This is not really surprising if you are aware what a real coma is. There is a lot of states between fully consciousness and complete unconsciousness. In movies, and in soaps you switch between those states in a surprise wake-up. In reality this is much more complex.
Anyway, better diagnosis is needed to prevent accidents like Brain scan finds man was not in a coma--23 years later [cnet.com] and other possible improvements in brain damage treatment.
Re:Summary wrong: Not a coma! (Score:5, Informative)
Considering that Schiavo had no cerebral cortex, it's pretty much a given that she had no awareness. The article doesn't say all patients in a vegetative state are aware, just that some are, or more to the point, have been misdiagnosed.
Re:False Positive (Score:5, Informative)
Re:Coma, not in a hollywood way. (Score:5, Informative)
Sorry, but that man in the coma for 23 years, is only "communicating" with the world through "facilitated communication", which is a hoax. A discredited technique.
Re:Great! (Score:3, Informative)
- What does it say? - "Kill me." Over and over again. It says, "Kill me."
Re:Summary wrong: Not a coma! (Score:5, Informative)
More importantly, she was put in a MRI scanner and there was nothing there..
http://www.amptoons.com/blog/archives/2005/03/20/regarding-the-cat-scan-of-terri-schiavos-brain/ [amptoons.com]
However, her situation was only one of the possible PVS states people can end up in..
I can only hope that -all- PVS patients get such a scan before anything is disconnected, and if there is a brain left they then get an active MRI scan to see if they are actually thinking. While it may not have saved Terri I'm pretty sure it will save some others.
Oh; and I really worry about decisions made before active MRI and other techniques came about, I think some horrible things have happened.
Re:False Positive (Score:5, Informative)
I don't think they addressed the "no answer" vs. "B", however, they did assess the patients' ability to answer a series of factual questions about the patient's life prior to whatever put them where they were - I think that pretty much shows that there is something non-spurious being measured here and it's not just the dead salmon fMRI effect as another reply suggested - the probability of random readings matching up with the correct answers to a series of such questions seems very minute.
And 4 out of 23 is not a success rate - it's a misdiagnosis rate! Nobody in their right mind is claiming that *all* patients in persistent vegetative states have meaningful cognition occurring (except the EXTREMELY inaccurate and misleading Slashdot article title). Rather, some patients who failed the standard tests to assess consciousness levels are perhaps more conscious than was previously detectable.
Locked-in syndrome, a skeptic's take: (Score:2, Informative)
Try:
http://www.sciencebasedmedicine.org/?p=3122 [sciencebasedmedicine.org]
for a critical point of view.
Re:Confusion of terms (Score:3, Informative)
A vegetative state is by definition where there is no detectable awareness. You could legitimately say that they were "previously thought to be in a vegetative state," but if you detect awareness then they are in a coma.
A persistent vegetative state is a condition of patients with severe brain damage who were in a coma, but then progressed to a state of wakefulness without detectable awareness. [wikipedia.org]
Vegetative > coma > dead.
Re:False Positive (Score:3, Informative)
Just ask a long enough series of questions, randomize them so that you aren't asking them in a way to expect any sort of pattern in the responses.
Is your name John Smith? Expect yes
Did you attend wrong school name? Expect no
Did you get married?
Did you have any children?
Did you have 1 child
Did you have 2 children.
Was your mother's name...
And so on.
You can look into the rate at which your 'yes' or 'no' indicators happen. If it is him moving his thumb, when not being asked questions, or when being stimulated with sounds, does his thumb indicate yes more often than no, if so, how much?
You use that as a factor for determining what should be the neutral response. If it were binary random chance, you would expect a result of 50% correct to 50% incorrect after you apply your modifiers.
(You also have to factor in the person having brain damage and memory loss/dementia so it would be hard to determine how much correct is correct. You could even have a person who is fully cognitive but simply does not remember)
Re:Summary wrong: Not a coma! (Score:3, Informative)
RTFA moron [nytimes.com]. They specifically mentioned her as a case where this does not apply:
The new report, posted online by The New England Journal of Medicine, does not suggest that most apparently unresponsive patients can communicate or are likely to recover. The hidden ability displayed by the young accident victim is rare, the study suggested.
Nor does the finding apply to victims of severe oxygen depletion, like Terri Schiavo, the Florida woman who became unresponsive after her heart stopped and who was taken off life support in 2005 during an explosive controversy over patients’ rights.
--NYT (emphasis mine)
Re:False Positive (Score:4, Informative)
The scanning was done in a fashion that is typical of fMRI studies in that an active condition was alternated with a rest condition. In fMRI it's essentially impossible to get a meaningful activation without contrasting two different conditions, in this case Answer with Relax, so the "activation" that is measured is a comparison between the answer and relax conditions. If a subject just had continuous spurious activation in the target brain region: 1) it wouldn't have been identified in the localizer task (described briefly below) and 2) it wouldn't show up as a differential activation between the Answer and Relax periods.
The subjects first underwent a "localizer" task to determine what particular region of the motor cortex to use for their responses. They alternated periods of mental imagery (imagining playing tennis, and imagining navigating through a familiar city) with relax. This identified the regions that would later be used to indicate Yes or No responses (one type of imagery for yes, the other for no).
Re:Summary wrong: Not a coma! (Score:3, Informative)
The WSJ gave more details:
"Researchers at two centers, in England and Belgium, used functional magnetic resonance imaging (MRI) tests on 54 patients with severe brain injury. Of these patients, 31 were diagnosed as being in a minimally conscious state, meaning they showed intermittent signs of awareness such as laughing or crying. The other 23 were diagnosed as being in a vegetative state, meaning they were considered unresponsive and unaware of their surroundings."
http://online.wsj.com/article/SB10001424052748704259304575043494009308442.html?mod=googlenews_wsj [wsj.com]
Re:One beep for "yes", two for "no" (Score:3, Informative)
Not to ruin the funny but I was horribly bored so here goes ...
ZAP: Philip J. Fry, you stand accused of travelling to the forbidden planet Omega 3. A crime punishable by 12 concurrent death sentences. Do you understand the charges? ...
KIF; One beep for yes, two beeps for no.
FRY: *BEEP*
ZAP: Yes. So noted. You pleed guilty?
FRY: *BEEP* *BEEP*
ZAP: Double Yes. Guilty. I will now carry out the sentence
It's the first minute and a half or so from the episode "Where no fan has gone before" if someone is wondering.
Study only applies to focal brain injury (Score:5, Informative)
Of the 54 patients examined in the study most had suffered either from traumatic brain injury or anoxic brain injury. Anoxic brain injury for the most part means your heart had stopped for a prolonged period of time (although other things such as severe prolonged hypoglycemia or carbon monoxide can do the same thing). Anoxic brain injury is a diffuse process and its course is highly predictable. Depending on the severity of the initial event with anoxia patients will either improve after a relatively short period of time or they never will. Of all of the 'miracle' re-awaking cases that have occurred (extremely rare cases of people waking up to a severely disabled state) none of them have been by someone who has suffered anoxia.
Traumatic brain injury has a less predictable course as some of the parts of the brain are destroyed while other parts can be relatively undamaged. Of the five patients in the study who were found with some brain activity all of them were traumatic brain injury cases.
Schiavo suffered anoxic brain injury due to cardiac arrest. These patients never need fancy brains scan as their external findings accurately reflect what has happened to their entire brain. The current New England Journal of Medicine article actually serves to support that anoxia patients have no cognition.
Please Mod Parent UnInformative (Score:4, Informative)
Yes, living wills, and informing your loved ones to remove you from life support in such cases are very important. But as the Schivo case proved, it doesn't really matter when religious politics become involved. Your living will is only as valid as the willingness of your relatives to honor it.
Schiavo did NOT have a living will, which was the cause of the interminable legal wrangling. Had she clearly designated someone to exercise medical power of attorney, there would have been no controversy. Instead, the Florida default rules it fell to her husband who claimed that she had orally represented to him that she did not want to be kept alive in such a case. Her parents claimed that she would not have, given her religious faith. "Religious politics" had nothing to do with it. Quoting Wikipedia (my emphasis)
Given the lack of a living will, a trial was held during the week of January 24, 2000, to determine what Schiavo's wishes would have been regarding life-prolonging procedures. Testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes was heard. Michael claimed that Schiavo would not want to be kept on a machine where her chance for recovery was minuscule, her parents claimed that Schiavo was a devout Roman Catholic who would not wish to violate the Church's teachings on euthanasia by refusing nutrition and hydration.
Honestly, the case really boils down to that -- who do we believe is best qualified to take an essentially random guess about what a person would want. Ideologues on both sides tried to make it into more than that but it just wasn't. If she was genuinely religious and would have wanted to be kept alive, we should have kept her alive. If she would have wanted to die, we should have let her die. The resolution of this essentially factual question (in the absence of any reliable evidence) neatly solves the entire affair.
To summarize, if we can learn anything from the whole shitfest, please leave notarized documentation of your desires. Not even for yourself (although that should be motivation enough) but so your loved ones can feel confident in your wishes instead of being forced to guess. That is not a burden I would wish on the people that care about me, nor do I think it's fair to give them that responsibility. The document does not have to be complicated or expensive -- it can be as simple as designating a person to chose for you.
Re:Terrible fear (Score:2, Informative)
Metallica - One
Land mine has taken my sight
Taken my speech
Taken my hearing
Taken my arms
Taken my legs
Taken my soul
Left me with life in hell
Re:Wait. What? (Score:3, Informative)
Maybe you are missing the part where the expected rate is 0%.
Re:Coma, not in a hollywood way. (Score:4, Informative)
The keyboard awas assisted by someone else. In fact, he doesn't even look at the keyboard and gts the expected answers.
Give him people that don't speak the same language to assist.
Here is a nice look at the story:
http://www.sciencebasedmedicine.org/?p=2838 [sciencebasedmedicine.org]
Re:Euthanasia (Score:2, Informative)
My relative had a living will specifying life support as long as there was brain function. This sounds entirely reasonable to the layman. As long he could think, he wanted to stay alive to make a choice himself.
The fallacy is that you can make a choice at that time. This is totally false. If you ever make a living will, be aware of what sort of extraordinary life support you allow yourself to be put on, because even if you change your mind later, you often cannot choose to remove the life support anymore later. My relative was put on life support without his choice while unconscious (based upon his living will). When he regained consciousness he was presented with the news that his close relatives passed away while he was in coma, and that he had the prognosis never leaving the hospital, being unable to speak, and with limited eyesight for reading or writing. He made the personal choice that it would be better to withdraw life support, as he did not have much lifespan to look forward to (he was 85), and his care costs were extremely high.
He was told that he no longer had the choice, and that the rehab hospital could not withdraw life support once offered. They did put him on prozac and elavil, when he tried to remove the tubes himself. The drugs helped him endure the stay, and he passed away after a year of not much fun, and he died only due to hospital error. It might have gone on for longer. The only time you have full choice to refuse life support is when it is offered. Be aware that once you are on life support, even involuntarily, it may not always be withdrawn easily. It depends a lot on state law and the care facility you have chosen. Note that any care facility has a financial interest in keeping the fully insured alive on life support as long as possible.
The doctors at the original hospital tried to warn the family of this possiblity, but they were ignored. Don't let this happen to yourself or your loved ones; a little foresight goes a long way. Give medical power of attorney to someone you trust, and make sure they are aware that some types of life support cannot be revoked. Do not depend upon a living will alone, it has absolutely no power without someone looking after your interests, otherwise it can be totally ignored.
Re:Euthanasia (Score:3, Informative)
Mod me a troll if you like, but I speak from experience. My wife used to work in emergency rooms. There was more than one occasion where people who were not quite brain dead were taken for organ harvesting. She was so disturbed that she never does organ donor cards now.
Never mod someone -1 Troll simply because you disagree with the politics.