Communication in minimal consciousness.

Communication in minimal consciousness

Magnetic resonance imaging, researchers have managed to communicate with a patient in a vegetative state for five years. The young man was able to answer yes or no to simple questions, say researchers in the New England Journal of Medicine.

These disturbing results obtained by the team of Adrian Owen (University of Cambridge, UK) and Steven Laureys (University of Liège, Belgium) consolidate their previous work. In 2006 they showed that a woman in a vegetative state had similar brain activity to a conscious and healthy person when asked to imagine playing tennis or walking in her house (read Being or not being conscious ).

Five good answers

Taking the basics of this experiment under functional MRI, Owen and Laureys tested 54 patients diagnosed in vegetative state or in minimum consciousness (in this case the patient can respond to orders but is unable to communicate). Five responded to requests - playing tennis or walking around a house. Two different brain areas are activated: one linked to motor movements for tennis, the other to spatialization.

Going further, the researchers selected one of five patients, a 22-year-old man who had been diagnosed in a vegetative state for five years following a traffic accident. To 'see' his answers on MRI, the researchers asked him to imagine playing tennis to say yes, walking in a house to say no. Of the six simple questions that were asked (your father is Alexander, do you have a sister ...), the patient answered five questions, with five correct answers. The sixth did not cause brain activity.

I have brain activity so am I?

Communicating in this way, using a code, suggests that the patient is aware, at least he has some form of consciousness. The definition of this term is complex and highly debated. The observation of a cerebral activity is not enough to conclude to a state of consciousness.

However, the more advanced the research on states of consciousness, the more the conscious / unconscious binary register seems limited. "A new vocabulary describing the loss of consciousness will be needed to replace the simplistic register used today," said Dr. Allan Ropper, neurologist (Boston, USA), in an editorial published by the NEJM.

Adrian Owen and Steven Laureys stress that their work does not yet allow use for clinical diagnosis. They will continue their investigations and try to design a simpler tool, the MRI not being available everywhere and requiring a long work of interpretation.

Being able to communicate with patients in an altered state of consciousness would ultimately raise complex ethical questions. The technique could be used to ask them to say if they feel the pain, or even if they want to continue living. For the moment, nothing says that a patient's ability to respond in a state of minimal consciousness allows him to solve such a difficult problem.

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