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A wake up call for those who think that patient's in a coma have no thoughts

In what can only be described as ground breaking research, the New England Journal of Medicine this week reports on new findings concerning the ability of individuals in the "vegetative state" to know and appreciate their condition. Previous studies have shown that the rate of misdiagnosis is approximately 40 percent.

The study out of Belgium discusses a case of 29 year old man who was diagnosed as being in the vegetative state following injuries received in an automobile accident.  For the past five years after emerging from a coma, he has been diagnosed as having no purposeful activity, no ability to think and without ability to follow commands, all hallmarks of a condition known as the persistent vegetative state. 

His physicians began attempts to communicate with him while his brain function was being recorded on a functional MRI machine (fMRI) which unlike traditional MRI studies looks at brain functioning rather than the brain's structure.  What the doctors found was despite his outward appearance of being unconscious and unable to communicate, he was cable of brain thoughts and was able to formulate answers to simple yes-no questions posed to him.

These findings clearly change the landscape in diagnosing and making decisions for patients previously thought to be in the vegetative state, a condition thought to be someplace between the initiate stage of unconsciousness known as a coma and the third stage of unconsciousness known as the minimally conscious stage. 

In the future, it may be possible to communicate with these individuals and find out if they are feeling pain and adjust medication accordingly, this method of communication will allow these individual to be able to express their thoughts and interact with their environment and allow them to control their own medical treatment and destiny.  

The study also has profound implications for attorneys representing victims of severe brain trauma in court.  Many states, including New York require proof of some type of conscious awareness before damages can be awarded for the loss of the pleasures and pursuits of life.  Without proof of this awareness, an individual although seriously injured is deprived of a financial compensation for the enormous losses sustained.  This new study will change the way that this issue is addressed at trial and will allow proof that those diagnosed in the persistent vegetative state are capable of conscious awareness. 

You can download the full study "Willful Modulation of Brain Activity in Disorders of Consciousness" at the New England Journal of Medicine web site.



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