Using MRI brain scans to reach out to severely brain-injured patients

By Dave Andrusko

Genaro Molina / Los Angeles Times

Genaro Molina / Los Angeles Times

Maggie Fox is a medical reporter now working for NBC News. I have her name plugged into my “Google Alerts” so when she’s written something I will know virtually the minute it goes online. Often I learn a lot while disagreeing with much that appears in her stories.

The headline attached to a recent article of hers is both very helpful and grossly misleading –“Brain scans reveal which ‘vegetative’ patients are alert, trapped in bodies.”

Placing “vegetative” in quotes suggests to the reader (quite rightly) that diagnoses of brain-injured patients must be taken with a pound of salt. We’ve reported many, many times about patients who are misdiagnosed, usually as supposedly being in a “persistent vegetative state.” However mistakes are also made in diagnosing less compromised conditions such as “minimally conscious.”

But this story is not primarily about brain-injured patients “trapped” in their bodies. The word “trapped” invites “bioethicists” to shed crocodile tears for brain-injured patients. If they are unable to communicate but conscious, they tell us, wouldn’t it be more humane to kill them—excuse me, not “prolong” their lives.

A study by Canadian researchers appearing in the Journal of the American Medical Association (JAMA) found, according to Fox, that

“A man who had appeared to have been in a vegetative state for 12 years knew his name and knew where he was, Canadian researchers report in a study showing it’s possible to use MRI brain scans to establish communication with people who seem completely unconscious.

“Three people tested using a special form of MRI called functional magnetic resonance imaging were able to answer simple ‘yes’ or ‘no’ questions, the team at Western University in London, Ontario report.

“They say their findings don’t mean everyone in a coma or a persistent vegetative state is conscious, but it should help doctors find out who is and who isn’t .”

Writing in JAMA, the team (led by Lorina Naci) explained, “The technique may be useful in establishing basic communication with patients who appear unresponsive to bedside examinations and cannot respond with existing neuroimaging methods,” adding, “Although a clinical vegetative state diagnosis implies lack of consciousness and cognition, this is not necessarily always the case.”

Naci told Fox, “We want to give patients some autonomy in their lives.”

The greatest fault in the story is, as is almost always the case with these stories, is to make statements like this one from Fox: “But it doesn’t mean that some patients aren’t truly without hope.” And who might that supposedly be? Terri Schindler Schiavo, of course.

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Her brother, Bobby Schindler, challenged the myth that Terri was in a PVS for probably the gazillionth time in a fine piece that appeared at www.lifenews.com/2013/08/13/study-shows-people-in-vegetative-state-were-incorrectly-diagnosed. Bobby makes a number of important distinctions. To name just a few:

· Terri was not in a PVS , nor “unresponsive.”

· Even if she—or someone like her–WERE unresponsive that doesn’t justify starving and dehydrating them to death

· With respect to the JAMA study, early on when she was given aggressive rehabilitation, “Terri was improving, so much so, that she was beginning to form words.”

After a part of the story that is soaked in euphemisms for killing these patients, Fox ends her account on a justifiably much more positive note. With the use of MRI brain scans

“[P]atients might be able to play a more active role in their care, she [Lorina Naci] said.

“’There are a million questions one wants to ask,’ Naci says. Basic questions include whether a patient is in pain, but they could even be asked whether they want to hear music or the television.

“And the study shows something else. Patients may benefit from continued stimulation even if they don’t appear to be responding. Naci said the 38-year-old patient her team described had a dedicated family.

“’He is being treated as if he is aware and able to communicate,’ she said. ‘It’s probably not a coincidence that the person is like this.’”

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