In pictures:Lorina Naci/
by Michael Cook/
Canadian neuroscientists have detected conscious activity in a patient who has been in a “vegetative state” for 12 years using functional magnetic resonance imaging (fMRI). Writing in the latest issue of JAMA Neurology, they claim that “in this study we establish for the first time that some entirely behaviorally nonresponsive patients can use selective attention to communicate”.
Lorina Naci and Adrian M. Owen of Western University, in Ontario, examined three patients who were believed to be completely unresponsive after severe brain injuries, two of them in a minimally conscious state and one in a vegetative state. They were able to “respond” by focusing their attention in a way which could be picked up with the fMRI scanner. Two of them communicated repeatedly and accurately. Many bedside assessments had completely missed their capacity for willed behaviour. (See video of Lorina Naci explaining the findings.)
“These results suggest,” they write, “that some patients who are presumed to mostly or entirely lack cognitive abilities can have coherent thoughts about the environment that surrounds them.”
The plight of patients in so-called vegetative state can be awful. Research has shown that up to 40% are misdiagnosed and actually have some degree of awareness.
In a commentary on Naci and Owen’s study, one of America’s leading neurologists, James L. Bernat, says that the data is quite convincing and “that it underscores the duty to treat them as sentient persons, to optimize their ability to communicate, and to reduce their suffering”. He writes:
“We can justifiably assume that as the level of awareness increases in a patient with a brain injury, so does his or her capacity to suffer. The patients in [minimally conscious state] discovered by fMRI studies to have been wrongly diagnosed as being in [a vegetative state] deserve our efforts to reassure them that we know they are aware, to establish a reliable communication system to the fullest extent possible, and to adequately address their medical, emotional, and palliative care needs just as we currently do with our awake and aware but profoundly paralyzed patients with [locked-in syndrome].”