Professors Neil Scolding, from the University of Bristol, Adrian Owen, from the University of Western Ontario and John Keown, from Georgetown University in the United States conclude in their latest study along with a letter of complaint that medical practice is ignoring the fact that thousands of people in a prolonged vegetative state are aware of their reality.
What is the prolonged or persistent vegetative state? It is that state in which consciousness has been affected by damage to the brain. It could be due to a traumatic brain injury, stroke, or other cause of brain damage.
There are three disorders of consciousness: coma, which is when a person shows no signs of being awake or conscious; the vegetative state , when a person is awake but shows no signs of consciousness (they may open their eyes, wake up, and fall asleep at regular intervals) and the minimally conscious state, when a person shows clear but minimal or inconsistent awareness. A person can enter a minimally conscious state after being in a coma or vegetative state, for example.
The details of the study
In the UK there could be up to 25,000 people with a prolonged disorder of consciousness (PDOC), aware of their situation and unable to communicate, experts say.
For their study, they connected patients who appear to be in persistent vegetative states to a functional magnetic resonance imaging (fMRI) machine and asked them to think about playing tennis if they really wanted to answer yes to a question posed, or to think about walking inside. their own home if, on the contrary, they wanted to answer the same question in the negative. The results determined that “structural damage to motor fibers can lead to reduced responsiveness in PDOC patients in all diagnostic subcategories and therefore (medical) behavioral assessments may underestimate the level of function. Retained cognitive and awareness across the PDOC spectrum ”.
Experts have criticized the guidelines for the care of these patients in hospitals and nursing homes, arguing that they do not recommend the use of brain scanning technologies to detect consciousness. They predict that thousands of patients with prolonged disorders of consciousness (PDOC), one in five, who are believed to have no brain activity, are actually aware of their surroundings.
Previous studies have shown that the use of bedside MRIs or EEG, a monitoring tool that uses electrodes, can detect consciousness in some patients who are believed to be unaware of their surroundings.
In a letter to the Times, the experts write: “Remarkable research using neuroimaging has shown that about 20% of patients labeled PDOC are in fact fully, or at least partially, conscious.”
It is possible to communicate with them
In their article, published in the journal Brain , the three experts say that detecting consciousness in these patients could allow them to express their views and feelings and could even help determine if they have the mental capacity to make decisions about their care . “This is an evolving area of medicine that is continually reviewed,” they clarify.
Referencia: Prolonged disorders of consciousness: a critical evaluation of the new UK guidelines. Neil Scolding, Adrian M Owen, John Keown. Brain, 2021 Jul 28;144(6):1655-1660. DOI:10.1093/brain/awab063.
