News: New Goalpost for Awareness?

Tests Reveal Activity in 'Vegetative' Brain

by Nicky Penttila

September 8, 2006

News in September 2006 that a United Kingdom woman considered to be in a vegetative state showed specific, apparently responsive, brain activity adds to the debate over when awareness ends.

The woman, injured in a car crash last year, was pronounced vegetative—awake but not aware—using the standard methods of observation and physical tests. Doctors assumed that her outward unresponsiveness mirrored an unresponsive brain.

But tests using a functional magnetic resonance imaging (fMRI) scanner seem to show that she was responding, deep inside. When asked to imagine herself playing tennis or walking around her home, scans showed she activated the same sections of her brain as did 12 conscious volunteers asked to do the same. That kind of response is not considered automatic, but something the person must intend to do, said Dr. Adrian Owen of the Medical Research Council Cognition and Brain Sciences Unit, Cambridge, who reported on his study in the Sept. 8 issue of the journal Science.

That's "knock-down, drag-out" evidence for some kind of awareness, Dr. Nicholas Schiff, a neuroscientist at Weill Cornell Medical College, told the New York Times. But this is one person and one result: It's not clear whether this is a unique case or common among recently injured people or among all non-responsive patients.

Dr. Schiff knows about one-of-a-kind patients. He and his Cornell colleagues studied the recovery of Terry Wallis, who spent 19 years in a "minimally conscious state," then regained the ability to speak and to make some movements. The Cornell researchers also used a type of brain scanning, diffusion tensor imaging, and watched as over a few months some sections seemed to right themselves, growing slowly more similar to what is seen in uninjured patients. The New York Times and other major newspapers wrote about the research in July. Dr. Schiff wrote a special piece for the Dana Foundation's July issue of Brain in the News, called "A Remarkable Patient's Recovery."

At the least, these unique stories suggest that brain scanning may be vital for helping doctors make decisions on how to care for their patients, says Dr. Joseph Fins, chief of the medical ethics division of Weill Cornell Medical Center. If scans of hundreds or more people in similar states of consciousness show enough consistencies, he said, doctors might be able to use them as a pattern to help identify who among their own patients is most likely to emerge from a vegetative state and who may not be as vegetative as they outwardly appear.