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News of the Day ... In Perspective

9/8/2007

Functional imaging shows cognitive function in patients incapable of motor response

A just-published article in Archives of Neurologyy demonstrates that patients may retain conscious awareness despite peripheral motor damage so severe that they cannot make any overt response, even eye blinking.

Functional magnetic resonance imaging shows distinguishable patterns of activation in specific areas of the brain when patients are asked to imagine playing tennis or moving from room to room in their house.

Certain stimuli can elicit automatic responses without willful intervention. For example, write authors Adrian Owen et al., one can’t choose to not recognize a face or words spoken clearly in one’s native language. This, however, cannot explain the complex responses that were observed. Non-instructive key words elicit only transient responses in areas of the brain used for word processing.

In several cases, “activation studies have been used to identify residual cognitive function and conscious awareness in patients who are assumed to be in a vegetative state yet retain cognitive abilities that have evaded detection using standard clinical methods.”

Authors caution, however, that “negative functional neuroimaging findings in patients who are diagnosed as being in a vegetative state cannot be used as evidence for lack of awareness.” Patients might have fallen asleep or may not have properly heard or understood the instructions (Owen AM, Coleman MR, Boly M, et al. Using functional magnetic resonance imaging to detect covert awareness in the vegetative state. Arch Neurol 2007;64:1098-1102).

The authors allude to “feats of rudimentary mind reading.”

On the negative side, writes neurologist Lawrence Huntoon, M.D., Ph.D, “I fear this may become the new ‘lie detector’ for use in law enforcement.”

On the treatment scene, a man who was in a minimally conscious state for 6 years after a brutal beating and skull fracture has partially recovered, thanks to a six-month experiment of brain stimulation through deeply implanted electrodes. Terri Schiavo received the treatment, but possibly too soon after injury to make a difference. The research team works at New York-Presbyterian/Weill Cornell, the JFK Johnson Rehablitation Institute, and the Cleveland Clinic Foundation (LifeNews.com 8/2/07).

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