Coma case raises questions about consciousness

Washington - The case of a woman in a vegetative state who appeared to play tennis in her head highlights one of the key frustrations of doctors who treat such patients -- trying to figure out what is going on in someone else's brain.

British and Belgian researchers said functional magnetic resonance imaging or fMRI brain scans showed the 23-year-old woman appeared to respond to commands to imagine playing a game of tennis and walking through her home, although she remained immobile and outwardly unresponsive.

Adrian Owen, a neuroscientist at Britain's Cambridge University, and colleagues said their study showed the woman was conscious, although she had lain still and silent for five months after a vehicle accident.

Experts overwhelmingly agreed that the case, reported in Friday's issue of the journal Science, does not mean that many people in apparently vegetative states may in fact be conscious.

More likely, Owen and others agreed, is that the woman may in fact have been on the road to recovery and moving to a less severe state known as a minimally unconscious state.

People have been known to survive in such states for years, such as American Terry Wallace, who recovered from minimal consciousness in 2003, 19 years after a car accident.

Brain experts said such scans may offer a way to predict which patients are most likely to recover.

Dr. Nicholas Schiff, a neuroscientist at Weill Cornell Medical College in New York, has been using fMRI in patients in a similar state. "We didn't find anything like this," he said.

"I can think of patients that we will try this on," said Schiff, whose lab is one of two in the world that do this kind of work. The other is run by Dr. Steven Laureys at the University of Liege, who worked with Owen to assess the British patient.

It is also difficult to do, said Schiff. Patients in such states can move, making MRI scans blurred and useless, and it can be difficult to determine when they are asleep and thus unlikely to respond to anything.

Dr. James Bernat, a neurologist at Dartmouth medical school in New Hampshire and a fellow of the American Academy of Neurology, said the study showed it is possible to make a mistake in diagnosing a patient as unconscious.

"What we don't know is how often you see this discrepancy between the physical exam findings and fMRI findings," Bernat said. "Is this one case in 1,000? Is it 1 in 10?"

Some patients do recover after being in vegetative states for months, Bernat said. But this is difficult to predict.

"This is an important case because it shows us the limitations of the physical exam when we assess awareness at the bedside," Bernat said. "We can't get into the mind of another person and experience what they experience."

Bernat said he had been "humbled" by the latest report.

The neurologists agreed the British case was not relevant to the debate over Terri Schiavo, a Florida woman who spent 15 years in a persistent vegetative state and was allowed to die in March 2005 after a long court battle.

Although some of her relatives had believed she could recover, Schiavo had been in a vegetative state for much longer than the British woman, allowing for severe deterioration of her brain.

Experts also noted the British woman had relatively little brain damage, and said traumatic brain injury often healed better than injury caused by stroke or heart attack such as Schiavo suffered. -- Reuters Limited

Click Here To Have Your Say On This Story

Brudirect.com News

Brunei's Fastest Growing Website with