Cognition demonstrated by fMRI in some apparently vegetative state patients

January 01, 0001

Cognition demonstrated by fMRI in some apparently vegetative state patients

These UK and Belgian authors performed a study involving 54 patients with disorders of consciousness. They used functional magnetic resonance imaging (MRI) to assess each patient's ability to generate willful, neuroanatomically specific, blood-oxygenation-level-dependent responses during two established mental-imagery tasks. A technique was then developed to determine whether such tasks could be used to communicate yes-or-no answers to simple questions.

They found: "Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment. One patient was able to use our technique to answer yes or no to questions during functional MRI. However, it remained impossible to establish any form of communication at the bedside."

The authors concluded: "These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive."

Functional MRI is entering new territory here, fascinating!

For the full abstract, click here.

N Engl J Med 362(7):579-589, 18 February 2010
© 2010 to the Massachusetts Medical Society
Willful Modulation of Brain Activity in Disorders of Consciousness. Martin M. Monti, Audrey Vanhaudenhuyse, Martin R. Coleman, et al. Correspondence to Adrian Owen: [email protected]

Category: N. Neurological. Keywords: functional magnetic resonance imaging, MRI, conciousness, vegetative state, cognition, case series, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 9 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.