Another misdiagnosis? Man in “vegetative state” communicates he is “not in pain”

 

By Dave Andrusko

Scott Routley

Scott Routley

There was so much going on yesterday that I did not have a chance later in the day to add to a wonderful post written by our friend, Wesley J. Smith (“PVS” Patient Communicates “Not in Pain!”). And I did not want today to get past me by before commenting more in depth about the remarkable Scott Routley.

What happened with Routley, according to his doctor, “means medical textbooks will need rewriting.”

Scott had been diagnosed to be in a “vegetative state” for more than a decade. But according to Fergus Walsh, Medical correspondent for the BBC, Scott “has been able to tell scientists that he is not in any pain. It’s the first time an uncommunicative, severely brain-injured patient has been able to give answers clinically relevant to their care.” [1]

My first question would be…why? Why after more than a decade would doctors be asking questions while having his brain activity scanned in an fMRI (Functional Magnetic Resonance Imaging) machine?

Then I saw the name: British neuroscientist Prof Adrian Owen, who led the team at the Brain and Mind Institute, University of Western Ontario. NRL News Today has posted many a story that involved Prof. Owen (most recently nrlc.cc/1dT9DWG). As that story explained, Prof. Owen is planning to study 25 people in a “vegetative state” every year…One goal is to identify other brain systems, such as smell or taste, that might be intact and usable for communication.”

Prof. Owen stated flatly that Routley was clearly “not vegetative.” He told Walsh

“Scott has been able to show he has a conscious, thinking mind. We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is.”

Perhaps this would open the way in the future to asking “what we could do to improve their quality of life,” Prof. Owen said. “It could be simple things like the entertainment we provide or the times of day they are washed and fed.”

Three years ago Prof. Owen published research showing that nearly one in five of the patients diagnosed as “vegetative” were able to communicate using brain activity. A 2011 study published in “The Lancet “ began by noting that up to 43% of patients diagnosed to be in a vegetative state were discovered not to be when assessed by experienced teams.

But that’s not where it ended. “A further subset of conscious patients could exist who are undetected even after extensive clinical investigations in specialized centers.”

Routley’s neurologist for a decade, Prof. Bryan Young at University Hospital, London, said the scan results overturned all the behavioral assessments that had been made over the years. He told the BBC

“I was impressed and amazed that he was able to show these cognitive responses. He had the clinical picture of a typical vegetative patient and showed no spontaneous movements that looked meaningful.”

What makes that observation particularly important is that “Scott Routley’s parents say they always thought he was conscious and could communicate by lifting a thumb or moving his eyes,” the BBC’s Walsh wrote. “But this has never been accepted by medical staff.”

[1] The BBC included an explanation of how patients like Routley communicate.

Functional Magnetic Resonance Imaging measures the real-time activity of the brain by tracking the flow of oxygen-rich blood

The patients were repeatedly asked to imagine playing tennis or walking around their home

In healthy volunteers each produces a distinct pattern of activity, in the premotor cortex for the first task and the parahippocampal gyrus for the second

It allowed the researchers to put a series of yes or no questions to severely brain-injured patients. [Some] were able to answer by using the power of thought