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Vegetative Patients Talk With Brain

A Few Patients in Vegetative State Signal Awareness by Changing Brain Activity at Will

Vegetative State: Is Anybody in There?

The question families most want answered by a loved one in a vegetative or minimally responsive state is, "Are you there?"

The study does not provide an answer, notes an editorial by Allan H. Ropper, MD, executive vice chair of neurology at Brigham and Women's Hospital and professor of neurology at Harvard University.

"Is there someone in there? There's no way to know," Ropper tells WebMD. "There may have to be a new way of thinking of consciousness. Not whether someone is in or not in, but maybe whether they are in some of the time -- or maybe in there but not able to take their own mental temperature and so not suffering. We just don't know who we are talking to. The current studies do not answer that question."

The ability to respond to questions via brain activity doesn't necessarily imply that a person is aware, says Mark A. Brooks, PhD, consulting neuropsychologist at Glancy Rehabilitation Center in Duluth, Ga.

"Awareness is the functional totality of all cognitive skills - the sum of arousal, orientation, attention, perception, memory, and reasoning," Brooks tells WebMD. "The Monti paper leaves me feeling like there are complete, thoughtful people trapped in these bodies, pining for a means of communication. This is clearly not the case."

Monti, Ropper, and Brooks all worry that the study results will be taken to mean that everyone in a vegetative state is conscious. The results simply show that in rare cases, a vegetative patient may have more consciousness than is at first apparent.

What this means -- and whether these extraordinary patients will be able to communicate such things as whether they are in pain or distress -- will be the subject of future research.

The Monti study, and the Ropper editorial, appear in the early online edition of the New England Journal of Medicine.



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