DOI: 10.1097/01.NT.0000369548.36707.50

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Issn Print: 1533-7006

Publication Date: 2010/03/04


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NEUROLOGY TODAY EDITOR-IN-CHIEF STEVEN P. RINGEL, MD, COMMENTS ON “WILLFUL MODULATION OF BRAIN ACTIVITY IN DISORDERS OF CONSCIOUSNESS”

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The seven year long legal case of whether to disconnect the life support Terri Schiavo, a young woman in a persistent vegetative state (PVS), drew widespread media attention and involvement of politicians and advocacy groups. Since then, journalists have continued to report studies that shed light on whether there is any preserved cognition in patients diagnosed by neurologists to have PVS or a minimally conscious state.
The nuances of these conditions and of study findings are easily misinterpreted by the anxious families and friends, and neurologists are left to explain misunderstandings that follow these sensationalized news reports. Non-medical people who read Jean-Dominique Bauby's book The Diving Bell and the Butterfly or saw the movie version understandably have difficulty differentiating between their loved one with PVS and Bauby, who remained cognitively intact following a brainstem stroke that caused him to be “locked in.”
The Feb. 3 study in The New England Journal of Medicine, “Willful Modulation of Brain Activity in Disorders of Consciousness,” has once again been highlighted in news stories throughout the country. Because of the findings, which identified minimal signs of awareness in a small number of patients, it is likely that in the future neurologists will be asked to perform fMRI in severely brain injured patients and will have to interpret what the findings mean.
As pointed out by Allan H. Ropper, MD, in an accompanying editorial, this study provides important new information, but it is not likely to help neurologists at the bedside who must allay the angst of hopeful families and friends observing their loved one in a vegetative or minimal cognitive state.
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