Up to 40% of Patients in "Persistent Vegetative State" are Conscious; British Scientists Work to Prevent Misdiagnosis of PVS

It has been known for at least a decade that as many as 40% of brain-injured patients diagnosed with a Persistent Vegetative State are in fact aware and may retain memories, emotion, and personality. This statistic was originally calculated through a survey of brain-injured patients by Professor Keith Andrews, former head of the Putney Hospital, and has since been confirmed by similar studies in Europe and the United States. Now, the Times Online says British scientists are working to free patients from a misdiagnosis that often means an aware and conscious patient will suffer neglect, a complete lack of rehabilitation efforts, or even death.

One amusing anecdote related to the Times by a psychologist at Putney's Royal Hospital for Neuro-disability illustrates the capacity of brain injury survivors to retain certain key aspects of their pre-injury personality: "Young man with motorbike head injury in a coma. His mum, a keen evangelical, comes every day with friends to sing 'Onward, Christian Soldiers' by his bedside. She’s hoping to stimulate his brain into action. It works: he comes round, but he can’t speak. So they fit him up with one of those Stephen Hawking-type laptops, and the first words he speaks are: “For God’s sake, Mum, shut it!"

A brain-research team from Cambridge University has taken on the painstaking task of conducting trial after trial on brain-injured patients, using brain scanning machines, anaesthetics, and personal observation to develop innovative diagnostic techniques that could lead to more complete rehabilitation of patients like the young biker frustrated with his mother's singing, or like Kate, a schoolteacher who was diagnosed with PVS but who now can communicate using limited speech and a letter board.

In 1998, Kate became the first PVS patient scanned by Dr. Adrian Owen, who now heads the Cambridge team. His scans discovered "islands" of activity in what was thought to be a brain completely destroyed by inflammation. When Owen showed Kate photographs of her parents, his scans showed markedly increased levels of brain activity. The areas of activity were the same as those shown in healthy volunteers doing the same task. Six months later, Kate was able to leave the hospital. Now, Kate paints, sends and receives email, watches television, and listens to books on CD.

But Owen's innovations go beyond helping to identify patients with a chance at partial or complete recovery after a PVS diagnosis: He's even discovered that it may be possible to communicate with people unable to respond physically, using the brain scanning equipment and yes-or-no questions. He says he's successfully communicated with patients simply by asking them to activate certain areas of the brain using their thoughts in order to answer his questions.

“It works like this,” says Owen. “Say you have a patient who responds positively, with proven volition to the command ‘Imagine you’re playing tennis.’ You can then progress to an easy yes-no response.” Owen gives a crooked smile: “To coin a phrase, it’s a no-brainer. If the answer to a question is yes, the patient thinks of playing tennis; if it’s no, the patient doesn’t think of playing tennis.”

But not everyone has welcomed Owen's innovations. Critics say the brain scans could offer false hope by registering sporadic activity that doesn't translate to awareness or a chance of recovery. One Putney psychologist expressed concerns for family members who have completed the grieving process and chosen to have a PVS patient's feeding tube withdrawn after an extended period. If a brain scan were to show activity, the withdrawal would have to be halted, even though the patient still might never communicate or show any other sign of consciousness.

In the case of Karen Weber, a brain injured woman whose husband petitioned for the removal of her feeding tube nearly a year after her PVS diagnosis, a similar sequence of events occurred. Her family contended that Ms. Weber was able to communicate. A court battle between Karen's husband and parents followed, and was ended without a legal resolution when Karen died in her hospital bed this September. Some fear that cases like Karen's will become more common if Owen's brain scan method is routinely used on PVS patients.

What do you think? Is Owen an innovator whose techniques could give patients a second chance at life and interaction with loved ones, or would his brain scans only cause more suffering to families already coping with tragedy? Should Owen's methods be used to scan all patients diagnosed with PVS? If you became severely brain-injured, would you want someone like Dr. Owen to attempt to communicate with you through your thoughts?