Regaining signs of consciousness after 15 years in a vegetative state!

Emma Hazelwood.

A man in France has regained some signs of consciousness after being in a vegetative state for fifteen years.

A vegetative state is defined as the absence of responsiveness and awareness due to brain damage, although some motor reflexes are maintained as normal. The issue of consciousness has baffled humans for centuries – there is no one test to determine whether someone is conscious. Instead, there is a scale known as the Coma Recovery Scale, which looks at various aspects of consciousness (including communication and auditory and visual functions).

The 35-year-old went into a coma after being involved in a car accident in 2001, and had shown no signs of improvement since. That is, until scientists tried a new treatment, involving using electricity to stimulate a nerve in the man’s body, known as the vagus nerve. This nerve runs from the brain to several areas of the body, including areas involved in emotion, alertness and memories. It was thought that after this treatment the patient may be able to regain some consciousness, without the risk of side effects from medication.

Improvements in the subject’s condition could be seen within a month of treatment. At first, this just meant being able to open his eyes more often. His brain showed activity in areas which had previously been quiet, and eventually he was able to follow an object around the room with his eyes, and even respond to requests to turn his head from one side to the other. He reacted with surprise when the examiner’s head suddenly approached his face. Amazingly, he shed tears and could smile with the left side of his face when he was played his favourite music.

According to medical professionals, this is known as a “minimally conscious state” – the man has not fully regained consciousness to the extent he had before the accident, but he is able to show some self and environmental awareness.

Although the test needs to be repeated in other patients, the results have neurologists very excited for future potential treatments involving this technique.

However, this experiment further demonstrates how little we know about consciousness, and brings into question the ethics surrounding treatment of people in vegetative states. Recently, the Court of Protection in England and Wales ruled that if doctors agree it is in the patient’s best interests, families of people in vegetative states no longer need the court’s permission to let their loved one die.

We do not have a perfect way of deciding whether someone is conscious or not. A 2010 study by the New England Journal of Medicine found that 40% of patients who had been assumed to be completely vegetative were actually able to communicate, even if it was just through yes or no questions.

If someone can “wake up” after fifteen years of no environmental awareness, this may complicate the already complex issue of whether it is right to decide to stop artificially feeding people in vegetative states. This could add to the guilt and emotional distress of families trying to decide whether or not to keep their loved one alive through machines, not knowing whether or not they are in pain or will ever wake up; or letting them die, never knowing whether they would have recovered.

The process may also be emotionally distressing for the patient. In this example, doctors have not yet asked the man whether he is in pain. Furthermore, doctors agree that he has such severe brain damage that it is unlikely he will ever be able to walk or talk again – even if he is eventually able to fully regain consciousness. This brings into light concerns around whether it is right to bring back someone who has been unconscious for so long (so many things have changed since he went into a coma in 2001), and to a lower quality of life than before, especially when we do not fully understand the process.

This treatment has been a breakthrough discovery for neurologists, and opens up a new world of possible treatments. However, it is essential that as we discover more about consciousness and how it is regained, we continue to consider the ethical consequences of our actions.

#EmmaHazelwood #neurology

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