Recently I read about a man in Taiwan who regained consciousness after having lain comatose for six months in the intensive care unit at the Genesis Founda-tion (
People who, because of medical problems have been reduced to what is called a "vegetative state" are sometimes referred to as "human vegetables."
The Multi-Society Task Force of American Neurological Specialists on Persistent Vegetative State defines "vegetative state" as a condition in which a patient has lost all perception to himself (or herself) and their environment. This includes a lack of meaningful or active response to light, sound or touch and an absence of any evidence that the patient can express or understand communication.
Nevertheless, sleep/wake patterns of the electrical activity in the brain are still present. As the brainstem and hypothalamus are functional or are only partially damaged, reflexes of the central nervous system and the spinal cord are still preserved to various degrees.
A persistent vegetative state (PVS) is defined as a patient who has been in a vegetative state for more than a month due to a head injury, degenerative or metabolic diseases, or a congenital defect of the central nervous system.
An extensive review of the literature by The Multi-Society Task Force on Persistent Vegetative State in the June 1994 issue of the New England Journal of Medicine found the following: in a study of 434 adult patients in a vegetative state as a result of traumatic brain injury, 33 percent recovered consciousness three months after injury and 67 percent died or remained in a vegetative state.
The recovery rate rose to 46 percent after six months and 52 percent at 12 months, while recovery after 12 months was reported in only seven cases. One patient recovered consciousness after 30 months but remained severely disabled. Adults who fell into a comatose state immediately after a nontraumatic injury had a poorer prognosis than those who suffer from coma after a traumatic injury.
Of 169 patients who were in a vegetative state one month after a nontraumatic injury, only 11 percent recovered consciousness after three months; the rest remained in a vegetative state or died. Six months after injury, only two additional patients had recovered consciousness. One year after an injury, 15 percent of the 169 patients had recovered consciousness, 32 percent were in a persistent vegetative state and 53 percent had died.
Patients in a vegetative state due to degenerative or metabolic diseases have no possibility of recovery. Some patients may temporarily lapse into a vegetative state when systemic illness causes a reversible depression of the neural function. This possibility must be considered before determining that a patient's vegetative state is irreversible. Thus, PVS should not be confused as brain death.
Recovery of consciousness and function is still possible if the patients are properly managed. Recovery is not a miracle, but a result of good medical and nursing care.
Hsieh Yen-Yao, MD, is vice president of the Koo Founda-tion's Sun Yat-sen Cancer Center.
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