Study Finds Trace of Thoughts in 'Vegetative' Patients

(Feb. 4) – Patients who appear to be in a vegetative state, unresponsive even for several years, may all the while be aware of their surroundings and have desires to communicate.

That's according to a new study by British and Belgian scientists with huge implications for how society cares for patients in a persistent vegetative state -- and whether they're truly "brain-dead" when loved ones decide to take them off life support and let them die.

The study was published Wednesday in the New England Journal of Medicine. It details how five of 54 patients previously diagnosed as being either in a vegetative state or as minimally conscious showed signs of brain activity on imaging tests.

In perhaps the most startling case, a man who'd been unresponsive for five years was able to communicate "yes" or "no" responses to doctors' questions through his brain waves. It indicates he may have been aware of his surroundings all along, and able to hear the voices of people around him.

Researchers did MRI tests on 54 patients with severe brain injuries. Of those, 31 were diagnosed as being in a minimally conscious state – meaning they showed some occasional signs of awareness like laughter or crying. The other 23 were considered to be in a vegetative state, unresponsive and unaware of their surroundings.

Hooked up to the MRI scanner, the patients were asked to imagine playing tennis or walking around their home – tasks that activate the part of the brain associated with movement. The brains of four of the 23 vegetative patients showed the same kind of brain response as healthy subjects would. One of the minimally conscious patients showed the same ability.

Scientists used the same technique to see if the patients could answer simple questions like "Do you have any brothers?" Patients were asked to imagine playing tennis to indicate a "yes" response or to imagine walking around their home to say "no." One of the four – an Australian man who suffered brain trauma in a car accident in 2003 – was able to respond correctly to several questions.

"We were astonished when we saw the results of the patient's scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts," Adrian Owen, a neuroscientist at the U.K.'s Medical Research Council and one of the study's authors, told the BBC.

He said the findings opened up many possibilities for future treatment. "You could ask if patients were in pain and if so prescribe painkillers, and you could go on to ask them about their emotional state," Owen said.

In an editorial published on the medical journal's Web site, another neurologist, Allan Ropper, cautioned against overstating the study's findings. Brain activity was only found in a minority of the small number of patients studied, and only ones who had suffered brain trauma from an accident, rather than those whose brains had been starved of oxygen after a stroke or heart attack, for instance.

The findings don't necessarily mean the patient has self-awareness or the ability to reflect, wrote Ropper, of Brigham and Women's Hospital in Boston. But "the line between consciousness and unconsciousness will be blurred" as scientific understanding of vegetative states deepens, he wrote.

The MRI technique, first used by Owen in 2006, could be used in the future to test the brain activity of people who wake up from a coma but remain unresponsive, Ropper wrote.

The research could certainly change how people think about patients in a vegetative state. "There has been a kind of nihilism towards these patients. This represents a cultural shift," Joseph J. Fins, chief of the medical ethics division at Weill Cornell Medical College, told The Wall Street Journal. Fins wasn't involved in this study, but is working on a similar one about brain injuries.

The study could rekindle the contentious debate in the U.S. over how much life-sustaining care to continue giving unresponsive patients. The biggest and most bitter right-to-die case in the U.S. recently was that of Terri Schiavo, a 41-year-old woman who died in 2005 after she'd been in a vegetative state since a heart attack in 1990. Her husband fought a long legal battle to have doctors remove her feeding tube. The case raised ire among conservative Christians and even prompted then-President George W. Bush to intervene.

But experts say vegetative patients are more likely to have brain function if their injuries were from trauma rather than a stroke or heart attack, as in Schiavo's case, which creates permanent damage by cutting off oxygen to the brain.

Still, Ropper warned of potential ethical dilemmas for doctors and patients' families. "It will now be difficult for physicians to tell families confidently that their unresponsive loved ones are not 'in there somewhere,'" he wrote.