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Will The Vegetative Awake? Imaging May Tell

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A new European study with significant ethical implications found that brain imaging did a good job of identifying the patients in a vegetative or minimally conscious state who would eventually return to full consciousness.

An article about the research was published online last week in The Lancet. The journal also published an accompanying commentary that explored some ramifications of the study. For example, it addressed pain management:

To treat these individuals as being conscious, and hence be generous with the provision of appropriate supportive treatments such as analgesia, would be ethically prudent.

Commentary authors were Jamie Sleigh, MD, professor of anesthesia at the University of Auckland in New Zealand, and Catherine E. Warnaby, PhD, who uses neuroimaging to research anesthesia, sleep, and pain at the University of Oxford in Great Britain.

The researchers imaged the brains of 126 patients referred to the University Hospital of Liège in Liège, Belgium, from January 2008 through June 2012. Forty-one were diagnosed with unresponsive wakefulness syndrome (vegetative), four with locked-in syndrome (fully conscious but unable to move or communicate), and 81 with minimal consciousness.

Subjects received PET imaging with FDG tracer, functional MRI, or both. Technical problems and, with MRI, spontaneous movements prevented the researchers from using both modalities on all patients.

Both techniques identified all four locked-in patients as fully conscious. Of the others, PET correctly predicted outcomes in 75 of 102 patients (74 percent). fMRI correctly predicted outcomes in 36 of 65 patients (55 percent).

Drs. Sleigh and Warnaby suggested that today’s newer fMRI techniques probably would yield better MRI results. In any case, they predicted, brain imaging would now become a standard tool for evaluating unconscious and unresponsive patients: “In the future, we will probably look back in amazement at how we were ever able to practice without it.”

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If texting or using social media in the operating room results in a medical error, one doctor suggests, the entire surgical team should be shot. It’s not really a serious proposal. We think. For the scary details, see our Facebook page.

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