PVS: The Search for Consciousness

Synopsis

It was John Waite's coverage of the Tony Bland case which eventually led to the Law Lords giving permission for feeding to be withdrawn. He'd been in a persistent vegetative state for four years following the Hillsborough disaster and died nine days after that ruling. With the tubes and clinical paraphernalia removed his father, Allan, said it was: "the first time he's looked like our Tony since the day he set off for the football match."

It was Tony's parents wish that future medical efforts focused on trying to improve the diagnosis of PVS, and now Dr Adrian Owen and his fellow Cambridge researchers are using functional MRI scans to try to detect brain activity. They've been asking patients and healthy volunteers to imagine playing tennis to answer questions whilst being scanned. In each of the healthy volunteers this stimulated activity in the pre-motor cortex part of the brain which deals with movement. This also happened in four out of 23 of the patients presumed to be in a vegetative state.

These are not patients who show any signs of any physical recovery but the research raises the possibility that they might retain a degree of consciousness and there might be a way of communicating with them. Up to 12,000 people under 40 in this country suffer traumatic brain injury every year and, according to Professor John Pickard, head of neurosurgery at Addenbrooke's hospital in Cambridge, there are serious deficiencies in their care: "The tendency for patients to be left to languish on general medical, surgical and orthopaedic wards continues to their detriment."

The work might eventually lead to improved diagnosis and care for some patients. It started with the case of Kate Bainbridge, a 37 year old teacher thought to be in a vegetative state after contracting a viral infection. Dr Owen showed her photos of her parents whilst her brain was being scanned: "We found that areas of her brain burst into activity that accorded perfectly with the brain locators of healthy volunteers doing the same task." Today Kate sits in a wheelchair "speaking" with the aid of a letter-board and tells of her relief that doctors finally realised that she was conscious even though she could not speak or make any kind of signal.

Vegetative state and minimal-conscious state are different from brain death, which involves the total destruction of all brain areas and the consequent collapse of heart-lung function. If a vegetative state lasts for more than three months (longer in certain forms of brain insult) there is thought to be progressively less chance that the patient will return to even minimal consciousness.

Today Kate is grateful for the work going on at Cambridge University and credits neuroscientist Dr Owen with helping her communicate - she can send and recieve e-mails, watch television and listen to music. She would like to see much more done to help others diagnosed as being in a persistent vegetative state: "Not being able to communicate was awful - I felt trapped inside my body. I had loads of questions, like 'Where am I?', 'Why am I here?', 'What has happened?'.

"I just have to look and see what the scans did for me. They found I was there inside my body that did not respond.".