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EEG can pick up brain activity in people in vegetative state, shows study

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7332 (Published 11 November 2011) Cite this as: BMJ 2011;343:d7332

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Re: EEG can pick up brain activity in people in vegetative state, shows study

Sir

The recent paper by Cruse et al [1], reviewed by Hawkes [2], demonstrated that 3/16 (approximately 10-25%) of patients clinically diagnosed as being in the vegetative state (VS)[3] had cognitive function and will, enabling them to understand instructions and make a choice and imagine a movement These were not misdiagnosed cases, although in inexpert hands misdiagnosis rates are high. These were carefully assessed and diagnosed according to the coma recovery scale-revised (CRS-R) [4]. This is similar to the 4/23 (approximately 10-25%) that has been reported in fMRI studies [5] and undermines the concept of a VS, as a clinical and legal entity.

Furthermore, traditional medical terminology evolves not just with the evolution of our understanding, but also with social and political sensibilities. Terms such as “Happy Puppet” (Angelman syndrome), “Mongol” (Down syndrome), “salaam attack” (infantile spasm), even “Hallervorden-Spatz disease” (Pantothenate kinase-associated neurodegeneration) have been recognised as potentially offensive and dropped.

However, experts working in a field will become used to their terminology, and comfortable with it and so can be blind to, e.g. the notion that saying a brain injured loved-one is in a VS can be felt as if the patient is no longer a human being, even though that is not implied by the strict physiological sense of “vegetative”.

I believe it is time for us to abandon the term VS, and probably also the concept, in favour of the term “Minimally Conscious State” (MCS), already in use for patients demonstrating some clinical behavioural responsiveness.

This should not affect the medical and basic care patients receive, which should continue to be based on what is in their best interests.

References
1. Cruse D, Chennu S, Chatelle C, . Bedside detection of awareness in the vegetative state: a cohort study. Lancet 2011; 378: 2088-94.
2. Hawkes N. EEG can pick up brain activity in people in vegetative state, shows study. British Medical Journal 2011; 343: d7332.
3. Monti MM, Laureys S, Owen AM. The vegetative state. British Medical Journal 2010; 341: 292-96.
4. Kalmar K, Giacino TJ. The JFK Coma Recovery Scale-Revised. Neuropsychological Rehabilitation 2005; 15: 454-60.
5. Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD. Detecting awareness in the vegetative state. Science 2006; 313: 1402.

Competing interests: No competing interests

24 January 2012
William P Whitehouse
Clinical Associate Professor & Paediatric Neurologist
University of Nottingham & Nottingham Children's Hospital
E Floor East Block, Queen's Medical Centre, Nottingham NG7 2UH, UK