In following the scale of consciousness…
9/18/09

In this vegetative state, opening of the eyes is now possible, either spontaneously or in response to stimulation. Eye movements can also occur but without the gaze really tracking. In fact the reactions of the patient remain reflexes: he has no language or interaction with others. This vegetative state sometimes becomes permanent: any possibility of improvement is thus reduced to a minimum. ‘According to American studies, when the initial coma has been caused by cranial trauma, it is estimated that there is no longer any hope of the sufferer returning to himself after a year spent in a vegetative state. If the initial coma is caused by an anoxia, as for example after a cardiac arrest, this delay falls to three months. As far as I am concerned I have never seen an exception to this observation,’ stresses Professor Laureys, who knows how much this chronic altered state of consciousness can give rise to painful ethical dilemmas for the family and the medical team. At the moment one man has been living in such a condition for over 32 years.

As the chronic vegetative state is the bearer of a very sombre prognosis, what is it that affects these men and women whom the press sometimes announce, with much fanfare, have just emerged from a coma (sic!) after years and years of unconsciousness? Well, these sufferers find themselves in a higher state of consciousness: they are in what has been called, since 2002, a ‘minimally conscious state’.

A pale reflection of consciousness

The work by Professor Laureys on the behaviour of patients and on the functioning of their brain (through PET-scan) has contributed significantly to understanding and having this essential new classification accepted. The patients concerned, even if they do not communicate, do not only carry out reflex movements: sporadically they demonstrate a pale reflection of consciousness. Clearly, since this discovery, doctors who had wrongly judged that this new category of the state of consciousness had little interest or that it was all in all quite artificial have been compelled to think it through again. ‘In the eyes of the medical body, it is the whole image of ‘poor patients with no possible communication’ which has been turned upside down,’ admits Professor Laureys. Furthermore, invited to the Vatican a few years ago in order to present his work, Professor Laureys had to insist and clarify that the discovery of intentional reactions in people in minimally conscious states did not for all that justify ‘pro-life’ considerations in terms of all the other patients in a vegetative state, as his hosts would have wished…

‘In fact, these patients have minimal but precise behavioural reactions and significant interaction with their environment. They will for example shake hands on request, follow an object with their eyes, follow the mirror in which they see themselves, laugh or cry in an appropriate manner,’ specifies the neurologist. ‘Their brains react, as well, to the use of their first names: this element, which is it seems one of the markers of the consciousness of self, is now being studied in our centre in order to confirm its interest in the examination of patients. Even more fundamentally, the latter feel emotions – we have demonstrated so in a 2004 study – and they feel pain – Doctor Mélanie Boly has also proved it, at Liège in 2008 (see the images). And, above all, they are amongst those people who, one day, have a chance of waking up.’ Like Terry Wallis.

When this American, the victim of an accident close to twenty years previously, recently ‘returned to himself’, he pronounced – you couldn’t make it up! – the words ‘Mother’ and ‘Pepsi’! But contrary to what could be read in certain newspapers, Terry Wallis obviously did not come out of a coma. Joseph Giacino, who had the opportunity of examining him, confirmed that he had been well and truly plunged into a minimally conscious state. This man, whom certain images of American cars made groan when he was in an ‘unconscious’ state, had the rare luck to cross the stages which brought him back to consciousness. And which allowed him to discover that his daughter was now 20 years old…

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