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Sunday, September 10, 2006

Audio: Estado Vegetal Persistente


Izquierda, Audio:Versión en español de Estado Vegetal Persistente.
Right: fMRI, images of a PVS affected young woman and from a normal person. Click to enlarge the image.
Persistent Vegetal State (PVS).
What type of lessons can we extract of the impacting online article of the neuroscientist Adrián Owen/Medical Research Council / University of Cambridge and collaborators of the University of Liege / Belgium, published in Science, related with the discovery of functionally brain active areas, in a 23 year-old woman affected of persistent vegetative state: PVS (before: apallisch syndrome, watch coma, cycles of unconsciousness-wake up - open eyes - that sometimes smile, cry, do they increase their pulse, breathings, etc), 5-14 months after suffering an accident of traffic that conditioned her a severe brain trauma?. The case, similar to that of Theresa Marie (Terry), Schiavo, Karen Quinlan, Nancy Cruzan, Kate Bainbridge, etc., discovered: I) the poverty of knowledge, around the the human brain's function, in different coma types, what doesn't impede that some Judicial Courts - with controversial evidences- decide in so delicate matters like life and death. Really, it is not advisable to apply the same therapy to all the cases of PVS. It is necessary to individualize each patient, optimizing their functional residual brain capacities. It is estimated that the number of cases affected of PVS, oscillates among 10 000-100 000 in USA, 8 000 in Germany and less than 1000 in Peru, result mostly of brain traumas, hemorrhages or, anoxic brain episodes.

Owen et al., stimulated with sentences (each/30 seconds), to a young woman with PVS to that she plays a tennis game and walked through living rooms of her house, while they carried out her snapshots with functional (fMRIf) Magnetic Resonance Images, recreating images (colored changes of blood flows), similar to those generated by normal people carrying out the same activities. Demonstrating that certain unconscious (that don't speak, don't respond or, exhibit limited body movements) people, maintain intact great part of their cerebral functions, being able to recover the normality, according to circumstances. To tell the truth, the conception of the work is not new, because de Jong et al (1997), stimulating with words and sounds to patients with PVS and Menon et al (1998), with family images, performed the same experience using Positron Emission Tomography (PET), determining changes of blood brain flow and diminished overall patterns of metabolism of glucose, in certain cerebral areas. II) the study, suggests to reclassify the comatose states in single 2 groups a) the unrecoverable ones, with brain death (total absence of cerebral functions for but of 1 year) and b) the rest of the comatose states, apparently mostly recoverable. Dramatic cases, inside these last ones, are those denominated: minimal concious state and the terrible locked in (caught: without or minimal external motor and sensitive activity, nevertheless to have a rich brain functionality). A case of locked in, is related in: Diving Bell and the Butterfly. A memoir of Life and Death, by the french affected of PVS: Jean-Dominique Bauby, dictated letter for letter, by means of blinks.

When on 2005, died Terry Schiavo, there were doubts about the solidity of demonstrative tests of an irreversible state of PVS. As it is known, the Supreme Court of USA, determined that they retired her the feeding tube, dying she, 13 days later. If to Schiavo, were carried out fRMI exams, perhaps the determinations had been others. It is not known well - if for then - in the decision of the Supreme Court, influenced the Schiavo's tomographic findings (2002) : extremely dilated brain ventricles and thinning of the external cerebral cortex or, those until then wornout: 9 million dollars (state funds), for her maintenance, throughout 15 years. III) the work of Owen et al, opening new treatment modalities for this coma type, that is to sow stem cells in certain brain's areas to reestablish deteriorated pathways among brain cortex/thalamus/brain hypothalamus/cortex, hiperbaric oxigen, but mainly stimulating and persistent visual, tactile and auditory techniques, praised by the neurosurgeon Andreas Zieger of the Protestant Hospital of Oldenburg / Germany.

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