PVS patient regains consciousness after 15 years, thanks to nerve stimulation

From The Guardian (September 25, 2017): Nerve implant ‘restores consciousness’ to man in vegetative state by science correspondent Hannah Devlin:

A 35-year-old man who had been in a vegetative state for 15 years has shown signs of consciousness after receiving a pioneering therapy involving nerve stimulation.

The treatment challenges a widely-accepted view that there is no prospect of a patient recovering consciousness if they have been in a vegetative state for longer than 12 months.

Since sustaining severe brain injuries in a car accident, the man had been completely unaware of the world around him. But when fitted with an implant to stimulate the vagus nerve, which travels into the brain stem, the man appeared to flicker back into a state of consciousness.

He started to track objects with his eyes, began to stay awake while being read a story and his eyes opened wide in surprise when the examiner suddenly moved her face close to the patient’s. He could even respond to some simple requests, such as turning his head when asked – although this took about a minute…

Readers may be wondering: why is the vagus nerve so important? Devlin explains:

The vagus nerve, which the treatment targeted, connects the brain to almost all the vital organs in the body, running from the brain stem down both sides of the neck, across the chest and into the abdomen. In the brain, it is linked directly to two regions known to play roles in alertness and consciousness.

In surgery lasting about 20 minutes, a small implant was placed around the vagus nerve in the man’s neck. After one month of vagal nerve stimulation, the patient’s attention, movements and brain activity significantly improved and he had shifted into a state of minimal consciousness…

The latest breakthrough adds to a growing volume of evidence that many PVS patients are capable of thinking and responding appropriately to people around them, if assisted in the right manner:

During the past decade, scientists have made major advances in communicating with “locked in” patients using various forms of brain-computer interface.

These have allowed paralysed patients, some of whom had been assumed to be in a vegetative state, to answer “yes” or “no” to questions to let their family and friends know their wishes and their state of wellbeing.

Here’s a question for readers to ponder: should we dispense with the term “permanent vegetative state” altogether? Why or why not?

14 Replies to “PVS patient regains consciousness after 15 years, thanks to nerve stimulation”

  1. Acartia Acartia
    Ignored
    says:

    Why is there a need to do away with a term that is not used in a clinical sense?

  2. Acartia Acartia
    Ignored
    says:

    PVS stands for “persistent vegetative state“, not permanent vegetative state. Persistent, as in ‘persistent cough’ and ‘persistent rash’ are not the same as ‘permanent’. Persistent means long lasting. Permanent means, well, for ever.

    This is obviously another of VJT’s sermons against the evils of doctor assisted suicide. Arguments fall flat when you start with the wrong definition of the state you are raising red flags against.

  3. Kantian Naturalist Kantian Naturalist
    Ignored
    says:

    Also, PVS and locked-in syndrome are not the same thing.

  4. Tom English Tom English
    Ignored
    says:

    The law should require that the brains of aborted fetuses be frozen, even if they are damaged, because we may yet have the technology to thaw them out, and bestow on them consciousness of some sort or another.

    Every thought is sacred.
    Every thought is great.
    If a thought is wasted,
    God gets quite irate.

    Of course, the government should not compel taxpayers to cover the costs. A woman who wants an abortion must first establish a trust fund for her pre-revived child-brain, under the assumption of an inflation-adjusted return of 0.27 percent per annum. (“Dynamic scoring,” the latest name for the brainchild of Discovery Institute founder George Gilder, must be reserved for use by the government in destroying millions of lives at a time.)

  5. OMagain
    Ignored
    says:

    Acartia: This is obviously another of VJT’s sermons against the evils of doctor assisted suicide.

    And yet this person was kept alive for 15 years. And the reason for that? It happened in France. With their pesky socialised medicine. I wonder how many such patients make it to 15 years in the USA. As such seems VJT would be better spending his time lobbying for single payer. The sheer numbers saved would vastly outweigh any number of locked in patients having their life support removed.

  6. Acartia Acartia
    Ignored
    says:

    OMagain: As such seems VJT would be better spending his time lobbying for single payer.

    Unless, of course, you happen to be that single payer.

    https://www.thebeaverton.com/2017/08/poll-canadians-love-single-payer-healthcare-except-alan-single-payer/

  7. Tom English Tom English
    Ignored
    says:

    Acartia: Unless, of course, you happen to be that single payer.

    We don’t have single payer in the US. We have two payers named Koch. They believe that it’s immoral for the government to make them pay for all of the unhealthy people in the country, and that it’s moral for them to counter the immorality by paying politicians to ignore the will of the electorate. Fortunately, they haven’t yet managed to buy enough politicians. Unfortunately, they may succeed soon enough.

  8. Acartia Acartia
    Ignored
    says:

    Tom, I find it interesting when the right brings up misinformation about the Canadian system to argue against universal health care. Yet they never bring up the fact that Canadians, in spite of the problems with our system, would vote out any government that proposed adopting a US style system.

  9. Tom English Tom English
    Ignored
    says:

    Acartia: Tom, I find it interesting when the right brings up misinformation about the Canadian system to argue against universal health care. Yet they never bring up the fact that Canadians, in spite of the problems with our system, would vote out any government that proposed adopting a US style system.

    1. I find it odd when people refer to our healthcare chaos as a system.

    2. About 53 percent of Canadians, compared to 33 percent of Americans, have tertiary degrees.

    3. Would that our government were parliamentary rather than presidential, and that “vote out the government” meant for us what it does for you.

    4. Our biggest problem is neither poor education nor a poor form of government. It’s poor regulation of campaign finance. (Only a constitutional amendment will fix the problem, and it’s not even on the radar.) Right now, big money on the far right has huge power over Congress. In the unlikely event that the Democrats regain control, their donors, including the insurance industry, will have huge power over Congress. Six percent of American GDP (one-third of 18 percent) goes to overhead in the healthcare “system.” That portion of the economy is not going to say, “Everyone can see that extension of Medicare to cover all is the best solution. We’re going to shut down operations and go into business / find work in other sectors of the economy.” Medicare is unarguably the best system that we have to build upon in the U.S. But as for Medicare for All, there’s no way to get there from here.

  10. Robert Byers
    Ignored
    says:

    The reason there is no vegatative state is because all that happens is the triggering mechanism for the memory gets interfered with. possibly the memory itself but unlikely.
    The soul is never knocked out. only the memory.
    so yes the memory can be restored, the triggering, and hopefully this is a positive new way.
    It shows how errors in ideeas on the BRAIN and man interfere with healing. If they a SOUL then they always would expect to figure out how to break through. Also figure out its just a memory system one works with.

  11. J-Mac
    Ignored
    says:

    VJ,

    I have read the article and other similar ones and I have my doubts that the nerve stimulation has restored the man’s consciousness…I think he could have been conscious before the procedure but couldn’t communicate it… Just because his brain activity improved, it doesn’t mean he became conscious… IMV…

  12. vjtorley
    Ignored
    says:

    Acartia,

    PVS stands for “persistent vegetative state“, not permanent vegetative state

    You are correct, although the term “permanent vegetative state” is also used by the medical profession, as well as by the public at large. Here’s Wikipedia:

    A persistent vegetative state (PVS) is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. After four weeks in a vegetative state (VS), the patient is classified as in a persistent vegetative state. This diagnosis is classified as a permanent vegetative state some months (3 in the US and 6 in the UK) after a non-traumatic brain injury or one year after a traumatic injury…

    In the UK, the term ‘persistent vegetative state’ is discouraged in favor of two more precisely defined terms that have been strongly recommended by the Royal College of Physicians (RCP). These guidelines recommend using a continuous vegetative state for patients in a vegetative state for more than four weeks. A medical definition of a permanent vegetative state can be made if, after exhaustive testing and a customary 12 months of observation,[9] a medical diagnosis that it is impossible by any informed medical expectations that the mental condition will ever improve.[10] Hence, a “continuous vegetative state” in the UK may remain the diagnosis in cases that would be called “persistent” in the US or elsewhere…

    In common usage, the “permanent” and “persistent” definitions are sometimes conflated and used interchangeably. However, the acronym “PVS” is intended to define a “persistent vegetative state”, without necessarily the connotations of permanence, and is used as such throughout this article.

    Bryan Jennett, who originally coined the term “persistent vegetative state”, has now recommended using the UK division between continuous and permanent in his most recent book The Vegetative State. This is one for purposes of precision, on the grounds that “the ‘persistent’ component of this term … may seem to suggest irreversibility”.[11]

    The BBC has also used the term “permanent vegetative state” in a report, as has The Independent, which reported on the case described in my OP. The British Medical Journal uses the term too (see here and here, for instance).

    Finally, the article in Current Biology which describes the case in detail concludes:

    These findings show that stimulation of the vagus nerve promoted the spread of cortical signals and caused an increase of metabolic activity leading to behavioral improvement as measured with the CRS-R scale and as reported by clinicians and family members. Thus, potentiating vagus nerve inputs to the brain helps to restore consciousness even after many years of being in a vegetative state, thus challenging the belief that disorders of consciousness persisting after 12 months are irreversible [1].

    You write:

    This is obviously another of VJT’s sermons against the evils of doctor assisted suicide.

    Actually, no. It’s not a sermon, as I didn’t put forward any point of view. And the issue of suicide wasn’t even on my mind when I put this up. What I wanted people to do was to question the widely held assumption that (most or all) individuals who are in a persistent vegetative state for a long period of time are “vegetables,” mentally speaking: in other words, they have no minds at all.

    J-Mac,

    I have read the article and other similar ones and I have my doubts that the nerve stimulation has restored the man’s consciousness…I think he could have been conscious before the procedure but couldn’t communicate it… Just because his brain activity improved, it doesn’t mean he became conscious… IMV

    Well, you may be right. Time will tell. I guess we need to see more cases like this one.

    Tome English,

    About 53 percent of Canadians, compared to 33 percent of Americans, have tertiary degrees.

    I suggest you have a look here: List of countries by tertiary education attainment.

    According to 2014 OECD data, 54% of Canadians aged 25-64 have completed some form of tertiary education, versus 44% (not 33%) in the U.S.A.

    And according to more recent 2016 data, the figures are 57% for Canada and 46% for the U.S.A.

    However, if we’re talking about people with a bachelor’s degree or higher, OECD statistics for 2016 reveal that 31% of Canadians aged 25-64 have reached this level, compared to 35% in the U.S.A. (The corresponding figures for the U.K. and Australia are 36% and 32%, respectively.)

    It may be fashionable in certain intellectual circles to criticize Americans as being dumb, but it’s inaccurate.

    I have no intention of discussing the issues of abortion and single-payer health care on this thread, as it’s about PVS, and frankly, health care is a subject in which I claim no expertise. For anyone who’s interested, I’ll just point them to this article, which seems reasonably balanced: Is Canada the Right Model for a Better U.S. Health Care System?

  13. J-Mac
    Ignored
    says:

    vjtorley: Well, you may be right. Time will tell. I guess we need to see more cases like this one.

    Welcome back VJT!
    I hope you are well…

    I have been doing some research on near-death-experiences and came across an experiment where a brain stimulation (nerve?) caused the patients to have out of body experiences… similar to the ones some people have when their heart stops and they experience NDE.

    Interestingly, unconscious people, like under anesthetic, almost always have normal brain functions…

    That is why I expressed my doubts about the case you explored…

  14. Acartia Acartia
    Ignored
    says:

    vjtorley,

    What I wanted people to do was to question the widely held assumption that (most or all) individuals who are in a persistent vegetative state for a long period of time are “vegetables,” mentally speaking: in other words, they have no minds at all.

    The “belief” that people in PVS for long periods of time are “vegetables” is just a probability conclusion. There are plenty of examples of people coming out of PVS after a long time, put the percentage is extremely low.

    It may be fashionable in certain intellectual circles to criticize Americans as being dumb, but it’s inaccurate.”

    But you did elect Donald Trump. Not exactly an indication of intelligence.

    I have no intention of discussing the issues of abortion and single-payer health care on this thread, as it’s about PVS, and frankly, health care is a subject in which I claim no expertise.”

    PVS is a health care issue.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.