Awakening After 23 Years
A striking case affirms the paucity of care for people in a vegetative state.
Rom Houben, a 46 year
old Belgian man, made headlines around the world earlier this week when it came
to light that he had been mistakenly diagnosed as being in a persistent
vegetative state since a car accident 23 years ago. Houben, who is severely
paralyzed, appears to be entirely cognitively aware, and is now communicating
with his family and with journalists through a keyboard, his hand movements
aided by a therapist.
Most of the media attention, sparked by an article in the
German magazine Der Spiegel, has focused on Houben’s haunting messages describing
his decades-long imprisonment. But neurologist Steven Laureys, who first
noticed signs of consciousness in Houben three years ago, hopes the case will
bring attention to a broader plight–the lack of research and care for people
diagnosed as being in a vegetative or minimally conscious state. TR highlighted
some of Laureys research in a 2007 feature, Raising
Consciousness.
(These disorders, called disorders of consciousness, are
often mistakenly referred to as coma. However, comas typically last just days
or weeks–after that, patients either wake up or transition into a vegetative
state, those totally unaware of their environment, or a minimally conscious
state, in which patients may occasionally laugh or cry, reach for objects, or
even respond to simple questions.)
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The revelation of Houben’s state of mind was determined from
a number of medical tests, but one of the most striking was a type of brain
imaging called positron emission scanning (PET). According to this test, which
measures brain metabolism, Houben’s brain looked entirely normal. “Now we can
measure the brain’s activity with more and more detail,” says Laureys. “And we
see a big contrast between what we see at the bedside and what we see in
functional neuroimaging.”
While PET scanning technology has been available for
decades, it is only just starting to be applied to patients like Houben. That’s thanks
in part to a lack of research funding for this field, as well as the enormous
technical obstacles of performing brain imaging on patients who often cannot move or comply
with directions. Laureys and a handful of scientist around the world are now
studying whether PET scans and other brain imaging methods, such as functional
MRI, an indirect measure of brain activity, can help more accurately diagnose such
patients.
While Rom Houben’s case is an extreme example–very few
patients are likely to be as cognitively intact–Laureys says that in some ways,
it is not that unusual. According to a study he published earlier this year, as
many as 40 percent of patients diagnosed as vegetative are in fact minimally
conscious. “He is very exceptional in the sense that he was fully conscious,”
says Laureys. “But he is unfortunately not that exceptional in that he showed
clear signs of awareness,” such as following a moving mirror with his eyes.
Laureys says that this case and others demonstrate the need to use standardized
methods of assessing patients, and to assess them multiple times, since cognitive
function can vary widely day to day.