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To: Hospice Patients Alliance <patientadvocates@...>
Subject: Vegetative Patient Shows Signs of Awareness, Study Says
Date: Thursday, September 07, 2006 7:37:59 PM

Hi,

Anyone who followed the real facts behind the Terri Schindler Schiavo
case and her court-ordered execution will find confirmation (of the
possibility that Terri WAS aware) within this article. Top neurologists
found that Terri was NOT in a vegetative state as contrasted with those
neurologists who were hand-picked physician/euthanasia supporters (they
had an agenda). More and more cases are showing that patients may
recover given proper attention and therapy, even after 20 years in a
coma in some cases.

Ron Panzer
for HPA

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Vegetative Patient Shows Signs of Awareness, Study Says
By BENEDICT CAREY NY Times September 7, 2006
http://www.nytimes.com/2006/09/07/health/07cnd-brain.html?hp&ex=1157688000&en=9c
e8b8e9db2cd104&ei=5094&partner=homepage



A severely brain-damaged woman in an unresponsive, vegetative state
showed clear signs of conscious awareness on brain imaging tests,
researchers are reporting today, in a finding that could have
far-reaching consequences for how unconscious patients are cared for and
diagnosed.

In response to commands, the patient’s brain flared with activity,
lighting the same language and planning regions that are active when
healthy people hear the commands. Previous studies had found similar
activity in partly conscious patients, who occasionally respond to
commands, but never before in someone who was totally unresponsive.

Neurologists cautioned that the new report characterizes only a single
case, and did not mean that unresponsive brain-damaged people were more
likely to recover or treatment was possible. The woman in the study
could not communicate with the researchers, and there was no way to know
whether her subjective experience was anything like what healthy people
call consciousness. The woman was injured in a traffic accident last year.

Yet the study so dramatically contradicted the woman’s diagnosed
condition that it exposed the limitations of standard methods of bedside
diagnosis. And its findings are bound to raise hopes for tens of
thousands of families caring for unresponsive, brain-damaged patients
around the world — whether those hopes are justified or not, experts said.

“One always hesitates to make a lot out of a single case, but what this
study shows me is that there may be more going on in terms of patients’
self-awareness than we can learn at the bedside,” said Dr. James Bernat,
a professor of neurology at the Dartmouth Medical School, who was not
involved in the study. “Even though we might assume some patients are
not aware, I think we should always talk to them, always explain what’s
going on, always make them comfortable, because maybe they are there,
inside, aware of everything.” Dr. Bernat added that brain imaging
promised to improve the diagnosis of unconscious states in certain
patients, but that the prospect of imaging could also raise false hopes
in cases like that of Terri Schiavo, the Florida woman who was removed
from life support and died last year after a bitter national debate over
patients’ rights.

Ms. Schiavo suffered far more profound brain damage than the woman in
the study and was unresponsive for some 15 years, according to
neurologists who examined her.

The journal that published the new paper, Science, promoted the finding
in a press release, but also added a “special note” citing the Schiavo
case and warning that the finding “should not be used to generalize
about all other patients in a vegetative state, particularly since each
case may involve a different type of injury.”

The brain researchers, led by Adrian Owen at the Medical Research
Council Cognition and Brain Sciences Unit in Cambridge, England,
performed scans on the patient’s brain five months after her accident.
The imaging technique, called functional M.R.I., reveals changes in
activity in specific brain regions. When the researchers spoke sentences
to the patient, language areas in her brain spiked in the same way
healthy volunteers’ did.

When presented with sentences containing ambiguous words, like “The
creak came from a beam in the ceiling,” additional language processing
areas became active, as in normal brains. And when the researchers asked
the woman to imagine playing tennis, or walking through her house, they
saw peaks in the premotor and other areas of her brain that mimicked
those of healthy volunteers.

“If you put her scans together with the other 12 volunteers tested you
cannot tell which is the patient’s,” Dr. Owen said in an interview.
Doctors from the University of Cambridge and the University of Liege in
Belgium collaborated on the research.

Dr. Nicholas Schiff, a neuroscientist at Weill Cornell Medical College
in New York, said that the study provided “knock-down, drag-out”
evidence for conscious activity, but that it was not clear “whether
we’ll see this in one out of 100 vegetative patients, or one out of
1,000, or ever again.”

The study authors reported that, 11 months after her injury, the patient
exhibited a potential sign of responsiveness: she tracked with her eyes
a small mirror, as it was moved slowly to her right. This may mean that
the young woman has been in transition from an unresponsive, vegetative
state to a sometimes-responsive condition known as a minimally conscious
state. An estimated 100,000 Americans exist in this state of partial
consciousness, and some of them eventually regain full awareness.

The chances that an unresponsive, brain-damaged patient will eventually
emerge depend on the type of injury suffered, and on the length of time
he or she has been unresponsive. Traumatic injuries to the head, often
from car accidents, tend to sever brain cell connections and leave many
neurons intact. About 50 percent of people with such injuries recover
some awareness in the first year after the injury, studies find; very
few do so afterward. By contrast, brains starved of oxygen — like that
of Terri Schiavo whose heart stopped temporarily— often suffer a massive
loss of neurons, leaving virtually nothing unharmed. Only 15 percent of
people who suffer brain damage from oxygen deprivation recover some
awareness within the first three months. A 1994 review of more than 700
vegetative patients found that none had done so after two years.

The imaging techniques used in the new study could help identify which
patients are most likely to emerge — once the tests are studied in
larger numbers of unconscious people, said Dr. Joseph Fins, chief of the
medical ethics division of New York Presbyterian Hospital-Weill Cornell
Medical Center.

Without this context, Dr. Fins said, the imaging tests could create some
confusion, because like any medical tests they may occasionally go
wrong, misidentifying patients as exhibiting consciousness or lacking
it. “For now I think what this study does is to create another shade of
gray in the understanding of gray matter,” he said.



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