In a study certain to rekindle debate over switch off life support machines for those with grievous brain injuries, researchers report that five out of 54 patients thought to be in a persistent vegetative state showed brain activity indicating awareness, intent and, in at least one case, a wish to communicate.source
One of those patients — a 22-year-old man who had been unresponsive for five years after an automobile crash — went on to respond to a series of simple questions with brain activity that clearly indicated yes or no answers, researchers said.
Not only can those in persistent vegetative states (PVS) understand what others are saying, but they can also offer simple responses to basic biographical questions. Experts using brain scans called functional magnetic resonance imaging at medical centers in England and Belgium, found five vegetative state patients who appeared able, when prompted by researchers, to imagine themselves playing tennis, and four of them demonstrated the ability to imagine themselves walking through the rooms of their homes.
Many parents, many husbands, wives and children, insist they can 'feel' that their loved one is 'still in there' but get hammered by the 'clinically detached' and 'pragmatic' professionals that there is no hope....
'It was terribly lonely, but my family was there, they believed in me...'
Originally posted by loner007
This has been already been posted here....
Abovetopsecret
www.medscape.com...
Medscape Today
February 4, 2010 — Researchers are reporting evidence of willful brain activation in a small number of patients in vegetative or minimally conscious states using functional magnetic resonance imaging (fMRI). Further, 1 patient with a diagnosis of vegetative state was able to correctly answer yes or no questions by activating different areas of his brain through visualization of different activities while he was undergoing fMRI, this despite being unable to show any signs of consciousness at the bedside.
The lead author on the paper is Martin M. Monti, PhD, from the Medical Research Council (MRC) Cognition and Brain Sciences Unit and the Wolfson Brain Imaging Center at the University of Cambridge in the United Kingdom.
"Normally, for family and medical staff, the best practice is always to act with these patients as if they were conscious, because we never know," Dr. Monti told Medscape Neurology. "But, of course, here we have proof; we do know."
Still, he cautioned, their work is preliminary. "This is 1 patient. This does not tell us about whether other patients can communicate in this way or not."
In this series of 54 such patients, they have found 5 who can modulate their brain activity in this way and 4 with a diagnosis of vegetative state, all stemming from traumatic brain injuries. Their work was published online February 3 in the New England Journal of Medicine.
Willful Modulation of Brain Activity
This group, with coauthors that include Adrian M. Owen, PhD, also at the MRC Cognition and Brain Sciences Unit, and Steven Laureys, MD, PhD, at the University of Liege in Belgium, have previously reported exciting work using fMRI in brain injured patients.
In 2006, Dr. Owen and colleagues reported a single case of a woman who was in a vegetative state after a car crash in 2005 (Owen AM, et al. Science. 2006;313:1402). Five months after her car crash, the researchers scanned her brain using fMRI, asking her to visualize herself playing tennis, hitting a ball with an instructor, or navigating familiar streets of a city or the rooms of her home, standard tasks known to produce activation in specific areas of the brain.
"When we did this, we saw that she would activate during several tasks in a way that was indistinguishable from a normal, healthy, awake individual," Dr. Owen told Medscape Neurology at that time.
In 2007, they reported results from scanning 10 such patients and found among these 1 more patient who could produce willful brain activation in this way but no sign of activation in the others. Their findings indicated this type of patient is in the minority, they noted (Arch Neurol. 2007;64:1098-1102).
In the new paper, Dr. Monti and colleagues have now scanned 54 patients using fMRI, 23 with a diagnosis of vegetative state and 31 in a minimally conscious state. Among these, they found 5 patients who were able to modulate their brain activity. Four of these, including the patient described in 2006, had a diagnosis of vegetative state vs 1 considered in a minimally conscious state, and all had experienced traumatic brain injury.
When they retested these 5 patients using standard bedside clinical tests, some behavioral indicators of awareness could be detected in 2, but in the others, no such signs could be found.
"Even though they could never do anything to indicate consciousness in these tests at the bedside, in the fMRI machine they could unambiguously tell us that they were conscious," Dr. Monti said.
... in the fMRI machine they could unambiguously tell us that they were conscious.
Finally, the researchers assigned yes or no responses to these different areas of activation, "tennis" for the motor imagery task, and "navigation" for the task visualizing walking through familiar rooms.
In 1 patient, a 22-year-old man from Liege who responded reliably on these tasks, investigators asked 6 yes or no autobiographical questions and instructed him to respond by thinking of the task assigned to the yes or no answers.
He was able to respond in a factually correct way to 5 of the 6 questions; the answer to the last question was not incorrect, they note, but rather "virtually no activity was observed in the regions of interest."
Dr. Monti emphasized that it is not clear at this point how many patients may be able to respond in this way. Further, fMRI is a technically intensive technique that is not available at all hospitals and cannot be used on any patient who requires the presence of metal medical apparatus.
Still, if replicated, he concluded, this may be "an additional way to help us understand if a patient who doesn't give us any clear sign of consciousness when we test at the bedside is conscious or not."
"Descartes Before the Horse"
In an editorial accompanying the publication, Allan H. Ropper, MD, from the Department of Neurology at Brigham and Women's Hospital, Boston, Massachusetts, calls the work an "imaginative" series of experiments that "has revealed a form of preserved cognition in ostensibly unconscious patients."
However, he is cautious in his assessment of what this willful activation may mean.
"Research on clinically undetected consciousness is easily subject to overinterpretation and sensationalism that the authors certainly do not intend," Dr. Ropper writes. For physicians discussing these findings with families and wider society, 3 points should be borne in mind, he notes.
"First, in this study, brain activation was detected in very few patients. Second, activation was found only in some patients with traumatic brain injury, not in patients with global ischemia or anoxia," Dr. Ropper writes.
"Third, cortical activation does not provide evidence of an internal 'stream of thought' (William James' term), memory, self-awareness, reflection, synthesis of experience, symbolic representations or — just as important — anxiety, despair, or awareness of one's predicament. Without judging the quality of any person's inner life, we cannot be certain whether we are interacting with a sentient, much less a competent, person," he adds.
... physicians and society are not ready for 'I have brain activation, therefore I am.'
Further, anyone who would use this to justify continued life support for all unresponsive patients "is missing the focus of the findings."
"The mind is an emergent property of the brain and cannot be 'seen' in images," Dr. Ropper concludes. "The article by Monti et al is provocative; however, physicians and society are not ready for 'I have brain activation, therefore I am.' That would seriously put Descartes before the horse."
The study was supported by grants from the MRC; the European Commission (Disorders and Coherence of the Embodied Self, Mindbridge, Deployment of the Brain – Computer Interfaces for the Detection of Consciousness: A Transdisciplinary, Integrated Approach); Fonds de la Recherche Scientifique; the James S. McDonnell Foundation; the Mind Science Foundation; the Reine Elisabeth Medical Foundation; the Belgian French-Speaking Community Concerted Research Action; University Hospital of Liege, the University of Liege; and the National Institute for Health Research Biomedical Research Center (Neurosciences Theme). The study authors have disclosed no relevant financial relationships.
N Engl J Med. Published online February 3, 2010.
Originally posted by Thill
reply to post by silo13
Emotiv <--- take this headset , configure it for every patient , upload a simple text to voice program and You have a tool that lets every patient that is brain locked communicate under 300$
I even posted this new tech on the science forum but nobody seemed interested in the potential huge applications of it
From the American Journal of Psychiatry
Medscape Today
www.medscape.com...
Neuroimaging May Help Distinguish ADHD and Severe Mood Dysregulation From Bipolar Disorder in Youth
Pauline Anderson
February 4, 2010 — Functional magnetic resonance imaging (fMRI) may help distinguish attention-deficit/hyperactivity disorder (ADHD) and severe mood dysregulation (SMD) from bipolar disorder in young patients with overlapping behavioral and clinical symptoms, new research suggests.
A new imaging study comparing amygdala activity in children with overlapping psychiatric symptoms shows hyperactivity during face emotion processing in those with ADHD but hypoactivity in those with SMD and symptoms of ADHD, compared with their counterparts with classic, episodic bipolar disorder or typically developing children.
The new observation highlights some of the differences in brain function among 4 groups of youth —those with classic episodic bipolar disorder, those with SMD, a syndrome characterized by severe nonepisodic irritability, those with ADHD but no irritability, and healthy youth.
The study is published in the January issue of the American Journal of Psychiatry.
Need for Correct Classification
The research is the latest step in the quest to determine whether youth with severe, nonepisodic irritability, accompanied by symptoms of ADHD, have a pediatric form of mania. Previous work by researchers at the National Institutes of Mental Health defined SMD.
It is unclear where youth with SMD should fit diagnostically, and studies such as this one could set the stage for correctly classifying them in the future, lead study author Melissa A. Brotman, PhD, National Institute of Mental Health in Bethesda, Maryland, told Medscape Psychiatry.
"The study demonstrates that children who present with severe, nonepisodic irritability and hyperarousal symptoms, or severe mood dysregulation, differ in terms of brain function from those with classic, episodic bipolar disorder," she said.
The study included 18 youths with ADHD, 43 with bipolar disorder, 29 with SMD, and 37 healthy controls. The study subjects were aged 8 to 17 years.
Researchers used fMRI to compare activation in the amygdala, whereas patients rated facial emotions. Subjects were shown a random selection of 32 adult faces of different races, facial features, and sexes — an equal number of happy, angry, fearful, and neutral faces. Study participants were asked to rate the various faces in terms of perceived threat, subjective fear, and nose width.
Similar but Different
The current analysis focused on the neutral faces — that is, those not explicitly showing fear, anger, or happiness.
The study found that compared with healthy subjects and those with bipolar disorder or SMD, ADHD patients manifested hyperactivation in the amygdala (P = .05) when rating how scared they were of neutral faces. In contrast, those with severe SMD demonstrated hypoactivation (P = .04) compared with healthy youth and those with bipolar disorder or ADHD.
Earlier research had shown that both youth with classic, episodic bipolar and those with nonepisodic irritability have difficulty labeling face emotions. "Both need more intense emotional information to correctly identify face emotions," said Dr. Brotman.
Previous research also shows that children with ADHD, conduct disorder, depression, and anxiety do not necessarily have these deficits in face emotion labeling. But, despite the fact that both youth with bipolar disorder and those with SMD have deficits labeling face emotions, it appears that the brain dysfunction underlying that problem differs between the 2 groups.
Decreased Activation in Depression
The same decreased amygdala activation that was found in youth with SMD has also been observed in children with depression. "This is particularly interesting given epidemiological and clinical studies demonstrating that children with severe irritability are at risk to develop depression as they grow up," said Dr. Brotman.
Contrary to what she and her colleagues expected, the study shows that patients with bipolar disorder did not differ significantly from healthy comparison subjects in amygdala activation. However, this could be due to some limitations in the task used in the scanner, said Dr. Brotman.
It is interesting to note that the neural correlates of face emotion processing differ so markedly between young people with ADHD and those with SMD, given the high rate of ADHD in youngsters with SMD, the study authors note. One characteristic that sets these 2 groups apart is the presence of irritability in those with SMD but not in those with ADHD.
Dr. Brotman said the study adds to earlier research that showed differences in clinical presentation and family history between children with classic episodic bipolar disorder and those with a more chronically irritable pattern and ADHD-like symptoms.
Future Promise
However, more research needs to be done before these imaging differences can be used in a clinical setting.
"We’re not at a state yet where imaging data can be used for diagnosis or to inform treatment. But things are changing, and we’re looking forward to a time when we can not only diagnose these children accurately but also use this type of technology to inform treatment. The ultimate goal is to prevent these illnesses if possible or have the earliest possible intervention.”
In an accompanying editorial, Mary L. Phillips, MD, University of Pittsburgh Medical Center in Pennsylvania, said the findings "highlight the future promise of neuroimaging to identify biomarkers of psychiatric illness in youth."
The study indicates that neuroimaging techniques have the potential to be used to help identify biomarkers that may reflect underlying pathophysiologic illness processes to discriminate youth with different psychiatric illnesses, Dr. Phillips writes.
She adds that it is important to distinguish between youth with bipolar disorder from those with ADHD and SMD. Misdiagnosing bipolar disorder as ADHD could result in exposure to stimulant medication without mood stabilizing, and misdiagnosing bipolar disorder could lead to inappropriate treatment with mood stabilizers.
It is also important to find objective biomarkers of bipolar disorder to help differentiate youth who will clearly progress to bipolar disorder, and the pivotal role of the amygdala in emotion and face processing makes it an important region to examine in neuroimaging studies of psychiatric populations, Dr. Phillips points out.
"It is encouraging that simple measures of activity in this region can differentiate different psychiatric illness groups, and findings suggest that amygdala activity in response to specific face or emotional stimuli may be a useful neuroimaging measure to include in future studies aiming to identify potential biomarkers of psychiatric illnesses across the lifespan," Dr. Phillips writes.
The study authors and the editorialist have disclosed no relevant financial relationships.
Am J Psychiatry. 2010;167:61-69.
