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fMRI Finds ‘Vegetative’ Patient Actually Aware

August 26, 2013
Written by: , Filed in: Neuroradiology
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In a heartening but also disturbing finding, a new study has found that patients who are nonresponsive, even thought to be in a vegetative state, can actually follow commands and communicate via functional MRI.

“One patient who had maintained a clinical diagnosis of vegetative state over a 12-year period prior to scanning and also subsequent to it was able to use attention to correctly communicate answers to several binary [yes/no] questions,” said Lorina Naci, PhD, of The Brain and Mind Institute at Western University in London, Ontario, Canada. “In this way, the patient demonstrated that he was aware of his identity and whereabouts.”

Dr. Naci, a postdoctoral scholar at the institute, continued:

In two different hospital visits five months apart, not only were we able to communicate with the patient but found that he was also aware of his environment, meaning he could maintain coherent thoughts and lead a rich mental life.

Dr. Naci was quoted by Medscape Medical News. She is lead author of the study, published online earlier this month in JAMA Neurology.

The study involved a very small sample: one patient diagnosed as being in a vegetative state and two diagnosed as minimally conscious. None of the three responded behaviorally to neurologic examinations. But when hooked up to fMRI, their brain activity showed that all three could follow a simple command to either relax or count. And, again via fMRI, the “vegetative” patient and one of the minimally conscious patients were able to correctly answer yes/no questions, such as, “Are you in a hospital?” and “Are you in a supermarket?”

The study provides hope for nonresponsive patients but also a chilling realization that many such people may have been spent years trapped, conscious and aware, in bodies they could not control.

Two editorials that accompany the study suggest that fMRI and other neuroimaging be routinely used in the diagnosis of a vegetative state and that brain-controlled prosthetic devices could be developed that might be able to free “locked-in” patients from their isolation.

For more on the study, see a Western news release and a London Free Press article.

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