Doggedly fighting the PVS dogma

By Dave Andrusko

Scott Routley was misdiagnosed as being in a PVS for more a decade, until his brain activity was scanned in an fMRI (Functional Magnetic Resonance Imaging) machine. Routley’s neurologist Prof. Bryan Young said the scan results overturned all the behavioral assessments that had been made over the years.

Our faithful readers know that we have posted many, many accounts not only of the recovery of individual patients in a so-called Persistent Vegetative State but also about how researchers are demonstrating how common it is to mis-categorize severely brain-injured patients as being in a PVS.

Of the former dimension–recovery–the best overview I believe I’ve ever read on the whole topic of how “a mind might be coaxed back into awareness” appeared in the British publication, The New Statesman. Written by Roger Highfield, who was the newspaper’s science editor for two decades, the piece is not perfect but nonetheless hugely impressive.

The science is remarkable complex, but because Highfield and the three scientists whose work he profiles are gifted communicators, laypeople (like yours truly) can grasp at least the outlines of the big picture. While I would strongly encourage you to read the analysis, because it is over 8,000 words, I’ll provide a summary overview.

  • “Medical doctors do not like to be told they are wrong,” neurologist Nicholas Schiff told Highfield. What was it that was ”condemned as a waste of time” by almost all their peers? Lots of things, starting with questioning the accuracy of sweeping in so many patients into the PVS category reserved for the “hopeless.”

And there was the dogma that since “no patient in a persistent vegetative state was conscious” (as Highfield puts it), “Doctors, with the best intentions, thought it was perfectly acceptable to end the life of a vegetative patient by starvation and the withdrawal of water. This was the age of what [Steven] Laureys calls ‘therapeutic nihilism.’” As a result, “Schiff, Laureys and [Adrian] Owen cut lonely and isolated figures at academic conferences, desperately trying to explain their findings to their peers, who remained unconvinced, even antagonistic.”

  • As the equipment becomes more sophisticated and the researchers more ingenious at using these (and older) techniques, there is an urgent need to rewrite textbooks. For example, Scott Routley was in a PVS for more a decade, at least according to the standard tests. But after doctors asked him questions while having his brain activity scanned in an fMRI (Functional Magnetic Resonance Imaging) machine, it turns out they were wrong all along! 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 [1]
  • One other of what could be many, many items. The British medical establishment is grudgingly coming to recognize that are ways that “might jump-start a stalled brain,” as Highfield describes it. “Over the years, a remarkable series of experiments have shown how a mind might be coaxed back into awareness” and “how a brain can rewire itself even decades after an injury.” So there has been progress; those who do not exactly embrace the work of Owen, Schiff, and Laureys insist they are no longer “skeptical,” only “cautious.”

Highfield ends his piece with an interesting twist, especially for pro-lifers:

“Back on Skype, Owen smiles, considering whether to tell me what he is planning next. Owen’s [wife], Jessica Grahn, also a neuroscientist, became pregnant at the start of 2013. What happens when consciousness winks on in the developing brain?

“He emails me a video of their unborn child, a montage of fMRI slices through their baby’s head, as it twists and turns in Jessica’s womb. ‘My colleagues have been doing fMRI on my wife’s tummy every week for a few weeks now to see if we can activate the fetus’s brain.’ he writes. ‘It is AMAZING.’”

[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.