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xepherys · 09-08-2006, 11:21 AM

http://arstechnica.com/journals/scie.../2006/9/8/5230

Quote:

September 08, 2006 @ 11:01AM - posted by Jonathan M. Gitlin
A mind trapped

As regular readers might know, not all traumatic brain injuries (TBIs) are the same. Severe brain injuries can run the gamut from comas to minimally conscious states (MCS) to persistent vegetative states (PVS). And, it seems, not all PVSs are equal, based on a report in this week's Science, regarding the results of fMRI scans performed on a patient who had been in a PVS for five months.

The patient, a 23-year-old woman, suffered a TBI following a car accident, and was diagnosed as being in a PVS following a period in a coma. She displayed sleep-wake cycles, but was not responsive to stimuli, and showed no intentional movement. During an fMRI scan, however, the patient showed brain activity consistent with processing speech compared to random noise, suggesting a certain level of consciousness.Supplementary motor area (SMA) activity during tennis imagery in the patient and a group of 12 healthy volunteers (controls).

In order to confirm these findings, a second fMRI study was performed, where the patient was asked to imagine walking through the rooms of her house, or playing a game of tennis. The results of her fMRI were identical to those from healthy control subjects. Both this, and her cooperation with the researchers, suggest a level of consciousness that belies her diagnosis of being in a PVS. Since then, the patient has exhibited a few more signs of consciousness, being able to track objects for a few seconds with her eyes.

Now, as with the last case of Terry Walker, a brain damaged patient confounding our expectations, I must stress that these findings do not apply to the case of Terri Schaivo, the PVS patient in Florida who was the center of a controversy last year. Terri Schaivo's brain scans showed quite clearly that a large portion of her cerebral cortex was atrophied following oxygen deprivation. Hypoxia is particularly damaging to neurons, and the findings of this single case cannot be applied to all PVS patients. This patient, and Terry Walker, both suffered TBIs but not hypoxia.

It does raise the question of how PVS patients are cared for, though. Despite physical examinations, some PVS patients might be similarly locked in, unable to display signs of conscious thought. Although fMRI scans are costly and time consuming, they may prove useful in determining whether or not patients that have been diagnosed with PVS might bge able to recover some level of interaction with their surroundings. On a personal level, I'm not sure how well I could cope, were I to be in the same position. To be locked inside one's own body, with no way of communicating to those around you must be the worst prison of all.

I'd be interested in seeing this thread take two directions, maybe simultaneously... First, what do you imagine it would be like to be trapped in your own mind? How do you think you'd fare if you were relatively conscious of your situation? Secondly, what do you think about the possible medical ramifications that might come to light if they start using fMRIs as a standard procedure for such patients?

I've heard stories of similar things, often situations where anesthesia doesn't work right so you are aware but cannot communicate. Could you imagine being like that for MONTHS or YEARS? I can't imagine I could come out of it sane... I wonder if claustrophobia could get tripped during a period like this? It seems quite scary to me.

I do, however, think this discovery is wonderful, and could really help people down the road. Perhaps a lot of use will make MRI scans less expensive and offer additional/better treatment options for patients with issues other than this even.