Mental Activity Seen in a Brain Gravely Injured

Our Review Summary

This story reports on the brain activity of a single patient in a vegetative state. That the patient had more brain activity than anticipated has raised many questions about the quality of our existing diagnostic abilities and the meaning of conciousness.

This research study is relevant for two separate but important reasons. First, our ability to assess patients in deep states of unconsciousness is far from perfect. Better assessment techniques are needed to help clinicians care for these patients and provide guidance to loved ones. The goal would be to better identify those who may improve over time and to predict the extent of improvement expected. To help in this endeavor, functional MRI will need to be prospectively studied in larger, more diverse groups of patients and the results of the studies correlated with outcomes over time. It would be extremely premature to view this as a new standard of care for such patients, but one can imagine that this will be strongly advocated by the loved ones of affected patients.

The second issue relates to how such testing will influence a societal debate about what constitutes meaningful life, as reflected in the Schiavo case. One can suppose that individuals who argued that Ms. Schiavo should have remained on life sustaining measures will use the results of this study to support their point of view. Given the nature of this societal debate, it is likely that the scientific assessment of such testing will be influenced by those with strongly held beliefs.

The story adequately describes the nature of the evidence. In several places, the story reminds the reader that the results should not be generalized to all vegetative patients. Furthermore, by accurately describing the woman’s mental state, the story avoids disease mongering. Because the story quotes multiple, independent researchers and clinicians who were not involved in the research study, the reader can safely assume that the story does not rely on a press release as the sole source of information.

The story does mention standard bedside methods of diagnosis, but does not mention other imaging techniques such as PET. The story could have also provided more detail about the pros and cons of the different methods. The story does not mention harms of the imaging technique, either from the risks of the technique itself or from the implications of false positive or negative results. The article does imply that it isn’t clear whether such findings would predict long-term cognitive improvement and the degree of improvement. However, little information is given about the test itself. It involves the use of a short-acting radioactive substance but is probably safe. The greater harm would be around providing false hope of recovery to family members.

The story does not mention the costs of the imaging test, nor does it mention if functional MRI is available and in use for clinical practice or if it is simply a research tool. Functional MRI is an established imaging technique but is not widely available at the present time like standard imaging studies including MRIs and CTs. Functional MRI is mainly used for research purposes, but its potential role in clinical care is likely to increase over time.