GESTIÓN EN SALUD PÚBLICA: Coma victims, PVS patients, and waking the dead

domingo, 1 de octubre de 2017

Coma victims, PVS patients, and waking the dead

Coma victims, PVS patients, and waking the dead

Bioedge

Coma victims, PVS patients, and waking the dead

by Xavier Symons | 30 Sep 2017 |

A 35-year-old man who had been in a vegetative state for 15 years after a car accident has shown signs of consciousness after neurosurgeons implanted a nerve stimulator into his chest.

The findings, reported this week in the journal Current Biology, suggest that “vagus nerve stimulation” (VNS)—a treatment already in use for epilepsy and depression—can help to restore consciousness even after many years in a vegetative state.

The researchers, based in France, provided the unidentified patient with one month of vagal nerve stimulation. According to their study, the patient's attention, movements and brain activity significantly improved following ongoing stimulation. The man began responding to simple orders that had been impossible before. For example, he could follow an object with his eyes and turn his head upon request. His mother reported an improved ability to stay awake when listening to his therapist reading a book.

After stimulation, the researchers also observed responses to "threat" that had been absent. For instance, when the examiner's head suddenly approached the patient's face, he reacted with surprise by opening his eyes wide.

"Brain plasticity and brain repair are still possible even when hope seems to have vanished”, Angela Sirigu, a researcher at Institut des Sciences Cognitives Marc Jeannerod in Lyon and co-author on the study, told reporters.

Bioethicists are yet to comment on the research, though there would seem to be several ethical issues surrounding bringing patients back to consciousness.

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In addition to this study, several stories of comatose patients regaining consciousness have received media attention in recent weeks. One widely reported case involved a 47-year-old Arizona woman who regained consciousness following the withdrawal of life-support; she had been in a coma for several days after falling unconscious due to blood clots in her leg. Another case involved a 61-year-old British man who woke up just hours before life support was to be switched off. The man had been in a coma for a number of weeks following a blood clot and intracranial bleeding.

Most of us have an ambivalent attitude towards drug addicts. Can they stop? No, their will power is shot to pieces. Will you invite one home to dinner? No, he’s a drug addict. However inconsistent it might be, we manage to dismiss addiction as morally serious and stigmatize them at the same time.

The Massachusetts Supreme Court is due to hear a case on drug addiction which could have wide-ranging consequences. Julie Eldred, an addict, relapsed while on parole and was jailed. (See story below.) But jailing her was wrong, according to the Massachusetts Medical Society, because opioid use is a chronic illness, not a character defect.

The opposite point of view is represented by 11 addiction experts in an amicus curiae brief. They argue that “Most addicts quit and do so on their own. Addiction seems to be among the most spontaneously ‘remitting’ of all the conditions termed major mental disorders, which is a very inconvenient fact for the position that addiction is a ‘chronic and relapsing brain disease.’”

The outcome of the argument will have immense legal and social consequences. If the addict is helpless in the grip of his or her disease, punishment makes no sense. The whole criminal law would change. To be continued....