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Tests Find That Unresponsive Patient Exhibits Brain Activity

By Benedict Carey
THE NEW YORK TIMES

A severely brain-damaged woman in an unresponsive, vegetative state showed clear signs on brain imaging tests that she was aware of herself and her surroundings, researchers are reporting Friday, in a finding that could have far-reaching consequences for how unconscious patients are cared for and how their conditions are diagnosed.

In response to commands, the patient’s brain flared with activity, lighting the same language and movement-planning regions that are active when healthy people hear the commands. Previous studies had found similar activity in partly conscious patients, who occasionally respond to commands, but never before in someone who was totally unresponsive.

Neurologists cautioned that the new report characterized only a single, perhaps unique case and that it did not mean that unresponsive brain-damaged people were more likely to recover or that treatment was possible. The woman in the study could not communicate with the researchers, and there was no way to know whether her subjective experience was anything like what healthy people call consciousness. The woman was injured in a traffic accident in England last year.

Yet the study so drastically contradicted the woman’s diagnosed condition that it exposed the limitations of standard methods of bedside diagnosis. And its findings are bound to raise hopes for tens of thousands of families caring for unresponsive, brain-damaged patients around the world — whether those hopes are justified or not, experts said.

“One always hesitates to make a lot out of a single case, but what this study shows me is that there may be more going on in terms of patients’ self-awareness than we can learn at the bedside,” said Dr. James Bernat, a professor of neurology at the Dartmouth Medical School, who was not involved in the study. “Even though we might assume some patients are not aware, I think we should always talk to them, always explain what’s going on, always make them comfortable, because maybe they are there, inside, aware of everything.”

Bernat added that brain imaging promised to improve the diagnosis of unconscious states in certain patients, but that the prospect of imaging could also raise false hopes in cases like that of Terri Schiavo, the Florida woman who was removed from life support and died last year after a bitter national debate over patients’ rights.