Brain Scan gives Vegetative State Patient Power to Say Yes and No
A patient presumed to be in a vegetative state for five years can communicate ‘yes’ and ‘no’ using just his thoughts, according to new research from the Medical Research Council (MRC) and the University of Liège.
In 2003, the patient, a 29 year old man, sustained a severe traumatic brain injury in a road traffic accident. He remained physically unresponsive and was presumed to be in a vegetative state. Using a scanning technique called functional magnetic resonance imaging (fMRI), the patient’s brain activity was mapped while he was asked to answer ‘yes’ or ‘no’ to questions such as ‘Is your father’s name Thomas?’. The patient could communicate answers by willfully changing his brain activity.
In the three-year study, 23 patients diagnosed as being in a vegetative state were scanned using fMRI, which was able to detect signs of awareness in four of these cases (17 percent). The fMRI method used can decipher the brain’s answers to questions in healthy, non-vegetative, participants with 100 percent accuracy, but it has never before been tried in a patient who cannot move or speak.
This new method of using fMRI was developed by Adrian Owen and his team at the MRC Cognition and Brain Sciences Unit in Cambridge, an international center for research in cognitive sciences and neurosciences, with close links to clinical research.
Adrian Owen, co-author of the research from the Medical Research Council, said: “We were astonished when we saw the results of the patient’s scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts. Not only did these scans tell us that the patient was not in a vegetative state but, more importantly, for the first time in five years, it provided the patient with a way of communicating his thoughts to the outside world.”
Steven Laureys, co-author from the University of Liège, confirmed: “So far, these scans have proven to be the only viable method for this patient to communicate in any way since his accident. It’s early days but, in the future, we hope to develop this technique to allow some patients to express their feelings and thoughts, control their environment and increase their quality of life.”
Martin Monti, co-author from the Medical Research Council, added: “The fact that this patient was able to communicate with scientists using his brain activity suggests that this technique could be used to address important clinical questions. For example, patients who are aware, but cannot move or speak, could be asked if they are feeling any pain, allowing doctors to decide when painkillers should be administered.”
The study involved experts from the Medical Research Council Cognition and Brain Sciences Unit, the Wolfson Brain Imaging Centre in Cambridge and a Belgian team based at the University of Liège. The research is published in the New England Journal of Medicine and was part-funded by the Medical Research Council.
These studies are the culmination of a decade of collaborative effort in Cambridge and Liège. In Cambridge, the multidisciplinary team (Cognitive Neuroscience, Neurosurgery, Anaesthetics, Psychology, Clinical Neurophysiology, Rehabilitation Medicine, Neurology, Physiotherapy, Occupational Therapy, Neurodisability charities and visiting scholars) has been funded by Smiths Charity (Academic Neurosurgery) an MRC Acute Brain Injury Programme Grant, a Translational Grant from the MRC and a major award from the James S. McDonnell Foundation. The Wellcome Trust Clinical Research Facility at Addenbrookes Hospital has been key to the care of the patients with impaired consciousness recruited from many institutions in the UK.
In Liège, the Cyclotron Research Centre and Neurology Department of the Liège University Hospital are funded by the Belgian "Fonds National de la Recherche Scientifique" (FNRS), the University and University Hospital of Liège, European Commission (Decoder, Mindbridge, Discos & COST actions), Mind Science Foundation and the James S. McDonnell Foundation.