Severe traumatic head injury is a devastating condition. Many patients never recover any consciousness and remain highly disabled. Some patients remain completely unresponsive and unable to communicate – the condition known as a vegetative state. Other patients show some signs of awareness, yet are unable to communicate interactively. This condition is known as minimally conscious state. Both conditions are highly disabling and often permanent.

Researchers in Britain and Belgium used a functional MRI study to obtain better insight into the level of consciousness in these patients. The results were published in the New England Journal of Medicine. Out of 54 patients in a vegetative and minimally conscious state, 5 patients were able to modulate their brain activity by generating voluntary responses to questions. This activity was detected by the functional MRI. Two out of those 5 patients were found to have some behavioral indicators of awareness when examined later at the bedside, “upgrading” them from vegetative to minimally conscious state. Interestingly, one patient was able to answer yes or no questions consistently by modulating the brain’s responses detectable by the functional MRI.

The study concludes that a minority of patients in a vegetative state have residual cognitive function and even conscious awareness. The motor function, in some patients, can be so impaired that a bedside evaluation of the behavioral responses may not reveal awareness. This could potentially lead to a “misdiagnosis” of a vegetative state.

For physicians treating patients with severe traumatic brain injury, this is a very interesting study. Making a diagnosis of a persistent vegetative state or minimally conscious state has huge implications for the patient’s quality of life. Many patients do not want to be resuscitated or kept alive if there is no possibility for a full functional recovery. The families of these patients often request to withdraw medical care if their loved one is unable to function or communicate effectively - meaning the patient is in a vegetative or minimally conscious state.

Even though, according to this study, we might be wrong about some patients being completely unresponsive, enjoying life is not about being able to elicit a brain response on a functional MRI. Enjoying life is all about things we do every day. Unless these scientific findings lead us to believe that we can determine which patients “will wake up from a coma”, the practical implications if it are quite limited.

Enjoying life is a very personal thing and it means different things for different patients. Yet, I have never heard anybody saying “keep me alive as long as I can elicit a brain response on a functional MRI”.