Conscious Awareness in Patients in Vegetative States: Myth or Reality?

Conscious Awareness in Patients in Vegetative States: Myth or Reality? Gastone G. Celesia Curr Neurol Neurosci Rep (2013) 13:1-9 DOI 10.1007/s11910-013-0395-7 #Abstract Do vegetative state (VS) and minimally conscious state (MCS) patients experience emotions and have conscious awareness of themselves and their surroundings? Can neuroimaging clarify these questions? Neuroimaging responses to stimuli are classified into four levels: level 0 indicates no response; level 1 indicates responses limited to the primary sensory cortices; level 2 indicates activation of primary sensory cortices and higher-order associative areas; level 3 indicates activation of cortical regions to either mental imagery tasks or high-level language stimuli requiring distinction of ambiguous from unambiguous words. Level 0 or level 1 was noted in 125 of 193 VS patients (65 %) and 46 of 121 MCS patients (38 %), suggesting no evidence of conscious awareness. Level 2 or level 3 was observed in 68 of 193 VS patients (35 %) and 75 of 121 MCS patients (62 %), indicating some cognitive processing. These data may denote the presence of conscious awareness or may simply identify neuronal processing without phenomenological awareness. The pro and cons of these conflicting interpretations are discussed. #Ending comments: Let me quote David Brooks [5] of the New York Times: “An important task these days is to harvest the exciting gains made by science and data while understanding the limits of science and data. The next time somebody tells you what a brain scan says, be a little skeptical.” Behind many of these discussions is profound disagreement about the ethical dilemmas that the VS poses to the clinician and the family of the patient: namely, whether to continue or discontinue life support. This is not a medical/scientific issue, but is rather a personal and societal one. Neuroscientists may participate in the discussion but should not be the deciding judges. Physicians and neurologists should inform the families that there are no right or wrong decisions, but only diverse ones. Attending and caring for VS and MCS patients is difficult and challenging; no matter how we feel, the task should be approached with compassion and humanity, while making every effort to alleviate suffering.