'Vegetative' Woman's Brain Shows Surprising Activity

Signs of Awareness
By Rob Stein
Washington Post Staff Writer
Friday, September 8, 2006

According to all the tests, the young woman was deep in a "vegetative state" -- completely unresponsive and unaware of her surroundings. But then a team of scientists decided to do an unprecedented experiment, employing sophisticated technology to try to peer behind the veil of her brain injury for any signs of conscious awareness.

Without any hint that she might have a sense of what was happening, the researchers put the woman in a scanner that detects brain activity and told her that in a few minutes they would say the word "tennis," signaling her to imagine she was serving, volleying and chasing down balls. When they did, the neurologists were shocked to see her brain "light up" exactly as an uninjured person's would. It happened again and again. And the doctors got the same result when they repeatedly cued her to picture herself wandering, room to room, through her own home.

"I was absolutely stunned," said Adrian M. Owen, a British neurologist who led the team reporting the case in today's issue of the journal Science. "We had no idea whether she would understand our instructions. But this showed that she is aware."

While cautioning that the study involved just one patient who had been in a vegetative state for a relatively short time, the researchers said it could force a rethinking of how medicine evaluates brain-damaged patients.

"We have found a method for determining if a patient is aware," Owen said. "It provides us with a tool that may be able to help make difficult decisions about these patients."

Other researchers were cautious but praised the research as groundbreaking with potentially profound implications. The work could lead to crucial new insights into human consciousness, one of the most daunting scientific mysteries, and to new ways to improve the diagnosis and treatment of tens of thousands of brain injury patients.

"This is a very important study," said Nicholas D. Schiff, a neurologist at the Weill Cornell Medical College in New York. "It's the first time we've ever seen something like this. It really is kind of shocking."

But Schiff and others stressed that much more work is needed.

"It raises a lot of questions," Schiff said. "At what level is she conscious? Is she really imagining she is playing tennis? Is it possible to communicate with this person? At this point, this doesn't allow us to make any inference about where this patient's consciousness might be."

The research inevitably renewed questions about patients such as Terri Schiavo, the Florida woman in a persistent vegetative state whose family dispute over whether to discontinue her care ignited a national debate over the right-to-die issue. Schiavo's brother, Bobby Schindler, said the study underscores the uncertainties in diagnosing brain injury patients.

"Things are changing almost every day with what they're finding out about the brain," he said. "The technology they're creating could help people like my sister."

But Owen, Schiff and others stressed that the research does not indicate that many patients in vegetative states are necessarily aware or likely to recover. Schiavo, in particular, had suffered much more massive brain damage for far longer than the patient in Britain, making awareness or recovery impossible, they said.

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