Fergus Walsh medical correspondent, Frank Simmonds deputy editor, Panorama, G Bryan Young professor, Department of Clinical Neurological Sciences, Adrian M Owen Canada excellence research chair in cognitive neuroscience and imaging
Walsh F, Simmonds F, Young G B, Owen A M.
Panorama responds to editorial on fMRI for vegetative and minimally conscious states
BMJ 2013; 346 :e8702
doi:10.1136/bmj.e8702
Re: Panorama responds to editorial on fMRI for vegetative and minimally conscious states
The BBC Panorama programme and the BMJ editorial1, 2 is a timely stimulant for the debate on this emotive condition called Minimally Conscious State (MCS). I would prefer the term “Unresponsive Wakeful Syndrome (UWS)”. Hopefully, the current work on developing national guidelines by UK & USA will make the multi-stakeholders’ interests into an opportunity to provide a comprehensive view reflecting not just medical perspective. I hope we will be better informed on other aspects of MCS / UWS eg:
• Not let diagnostic aspects overwhelm the discussions.
• Explore other imaging modalities eg Diffusion Tensor Imaging (DTI) which help visualise brain white- matter connectivity. A DTI may provide better information on thalamo-cortical connection (attributed to MCS) than fMRI.
• Serial Positron Emission Tomography and DTI may help track changes in patients.
• Explore actual treatment of the condition. Amantadine has shown some ray of hope. Neuro-modulation may help improve the condition.
• Crucially, Health Policy and legal debates on whether to provide such expensive service for MCS at all in these times of austerity!!!!!!!!! 3, 4
• Ethical, legal and political ramifications of MCS service.
• What kind of service should cater for these patients? The financial difficulties in Healthcare and reconfiguration of services coupled with “care near home” doctrine of NHS (UK) needs to be carefully considered.
References:
1. Panorama responds to editorial on fMRI for vegetative and minimally conscious states. BMJ 2013;346:e8702
2. Turner-Stokes L, Kitzinger J, Gill-Thwaites H, Playford ED, Wade D, Allanson J, et al; on behalf of the Royal College of Physicians’ Prolonged Disorders of Consciousness Guidelines Development Group. fMRI for vegetative and minimally conscious states. BMJ2012;345:e8045.
3. R Gillon. Sanctity of life law has gone too far. BMJ 2012;345:e4637
4. M Sakel. Hope hasn’t gone far enough! BMJ 2012. http://www.bmj.com/content/345/bmj.e4637/rr/595134
Competing interests: 1) My team provide clinical service to MCS patients. 2) I'm involved in interventional trial on MCS.