A joint team from Cambridge, UK and Liege, Belgium have discovered that a patient who was presumed vegetative for five years can communicate ‘yes’ and ‘no’ responses using just his thoughts. Researchers at the Medical Research Council’s Cognition and Brain Sciences Unit and at the Wolfson Brain Imaging Centre in Cambridge, collaborated with the Belgian team to develop the new method, which uses cutting-edge brain scanning technology to allow patients who can not move or speak to communicate with the outside world. The research is published today in New England Journal of Medicine.

In 2003, the man, who is 29, sustained a severe traumatic brain injury in a road traffic accident. He remained physically unresponsive and was presumed to be in a vegetative state for five years.

Using functional magnetic resonance imaging (fMRI), the patient’s brain activity was mapped while he was asked to answer ‘yes’ and ‘no’ questions such as ‘Is your father’s name Thomas?”. The new technique, developed by Dr Adrian Owen and his team in Cambridge, can decode the brain’s answers to such questions in healthy, non-vegetative, participants with 100% accuracy. But it has never before been tried in a patient who cannot move or speak.

Dr Owen said “We were astonished when we saw the results of the patient’s scan. He was able to correctly answer the questions that were asked by simply changing his thoughts, which we then decoded using our fMRI technique”. Dr Laureys, who examined the patient in Liège, assured that “Outside the scanner, the patient remained unable to communicate in any way”.

In the three-year study, 23 patients diagnosed as vegetative were scanned in Cambridge and Liege. The new fMRI technique was able to detect signs of awareness in 4 of these cases (17%). More surprisingly, when the scientists used this method to try to communicate with one of the patients, they discovered that he could answer  ‘yes’ and ‘no’ questions by changing his brain activity. Dr Martin Monti from the Cambridge team said, “Not only did the scans tell us that the patient was not in a vegetative state, but more importantly, for the first time in 5 years it provided him with a way of communicating his thoughts to the outside world”. The fact that this patient was able to communicate with the scientists using his brain activity suggests that this technique could be used to address important clinical questions “For example, patients who are aware, but cannot move or speak, could be asked if they are feeling any pain, allowing doctors to decide when painkillers should be administered” said Dr Monti neuropsychologist Audrey Vanhaudenhuyse from the Liège team. Dr Owen said. “It is important to emphasise that this does not mean that all patients who appear to be vegetative are aware. But in four of our patients the technique that we have developed was able to pick up signs of awareness that were not evident from close clinical examination”

Dr Steven Laureys who leads the Belgium team said, “It’s early days, but in future we hope to develop this technique to allow some patients to express their feelings and thoughts, control their environment and increase their quality of life”.