Comments on: More on fMRIs and the Comatose

By: HHC

HHC — Wed, 10 Feb 2010 17:30:51 +0000

bksea, Enjoyed the excellent Science news article,” Trawling the brain”. Its useful tool yo understand a past Neurologicablog post which showed a Chicago psychologist was a trying to map a personality factor to a fully conscious individual brain. The exceedingly complex statistical comparisons for the fMRI is beyond the current capacity of that psychologist’s knowledge about radiology.

By: kvsherry

kvsherry — Wed, 10 Feb 2010 10:57:12 +0000

I would hesitate to call this a use for allowing patients to determine their course of treatment. As it stands now, a consent is not valid if the patient has received narcotics or Ativan prior. These are adequate safety measures.

A simple yes/no question is much easier to comprehend than a complex question like “Do you want to continue on like this?” In my mind, the fact that these patients had a severe TBI immediately puts into doubt their ability to fully analyze problems at an adult level, and unfortunately, I don’t see how a battery of yes/no questions can prove just what their functional cognitive level is.

Do you have any ideas as to how we might go about proving the autonomy and competence?

By: BKsea

BKsea — Sat, 06 Feb 2010 00:54:43 +0000

In a recent Science News article, fMRI researchers were able to show that a dead salmon was minimally conscious:

http://www.sciencenews.org/view/feature/id/50295/title/Trawling_the_brain

Really a warning that some fMRI techniques are a little fishy.

By: inconscious

inconscious — Fri, 05 Feb 2010 17:57:20 +0000

This study was a tremendous improvement over the previous study published in 2006 in terms of decreasing doubts of the validity of the “imagery” methods used. Also, it’s interesting to see some media outlets, such as CNN, actually mention the skeptical backlash to the facilitated communication business/fiasco from months ago (which, of course, they helped create). As a burgeoning researcher who plans on studying patients with disorders of consciousness (DOCs) it’s also nice to see studies by Laureys’ and Owen’s lab come out of relative obscurity. Of course, the whole facilitated communication thing hasn’t helped, as the idea of there being “no such thing as bad publicity” doesn’t work well with science.

Hopefully, though, the publicity that’s been generated will lead the US advancing policies and infrastructure that allow for research/advancement of aid to this patient population (for example, a national patient registry of patients in a given DOC like the one in place in Belgium).

I have to admit, Dr. Novella, that having met Steven Laureys, making plans to visit his lab and learn some things, and being a likely future researcher in his field that some of your criticisms of him seemed harsh at first. Once I realized this, I found that the experience was, overall, a good exercise in removing myself from friendships/emotional attachment to really get at solid skepticism. I guess that’s really the point of why I read your blog! Bravo!

By: HHC

HHC — Thu, 04 Feb 2010 20:32:00 +0000

Its useful to have more rather than less information on the comatose. Personally faced a crisis this past week involving a traumatic brain injury to an elderly in-law. Unfortunately, elderly patients do not recover from an accelerating fall as young patients can. Though the hospital staff attempted to use a drug induced coma to facilitate recovery, there were no real signs of consciousness involving cortical functioning. It seemed to me that independent of the full life support equipment, the patient was in PVS, and the neurosurgeon agreed. There would not be any functional living beyond the traumatic accident. I appreciated the powerful words of the neurosurgeon in this ICU room prior to his final diagnosis. He emphasized that there were no gods in the room, and asked if anyone present felt they were one. No one present felt that way.

By: serv44

serv44 — Thu, 04 Feb 2010 20:17:25 +0000

i really appreciate this article. I saw the most basic version of this finding on CNN.com and a friend pointed me here for additional info.

I can think of no better definition of Hell than to be in a MCS and it not be recognized.

By: KathyO

KathyO — Thu, 04 Feb 2010 20:06:17 +0000

@ Daneel

Well, that didn’t take long. I wonder if families would accept that their loved ones really were gone and not coming back if this technique were performed and showed no signs of consciousness.

By: Daneel Olivaw

Daneel Olivaw — Thu, 04 Feb 2010 18:35:45 +0000

@sowellfan
It says, in the methods section, that “the nature of the questions ensured that the investigators would not know the correct answers before jugging the fMRI data.”

By: sowellfan

sowellfan — Thu, 04 Feb 2010 16:59:31 +0000

I read through the NEJM article, but I don’t see any mention of blinding the doctors to the answers that they were ‘supposed’ to go. It seems clear that this application of fMRI could be useful, but how reliable are these results, for indicating that the docs were getting through to a conscious person inside of that damaged body?

By: Daneel Olivaw

Daneel Olivaw — Thu, 04 Feb 2010 14:47:36 +0000

I saw this on a christian news blog with the title “Study published that assures that PVS people have some consciousness” (in spanish) with a photo of Terri Schiavo.