Functional neuroimaging of the vegetative state

• Published in: Nature reviews. Neuroscience Vol. 9; no. 3; pp. 235 - 243
• Main Authors: Owen, Adrian M, Coleman, Martin R
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2008; Nature Publishing Group
• Subjects: Animal Genetics and Genomics; Awareness - physiology; Behavioral Sciences; Biological and medical sciences; Biological Techniques; Biomedical and Life Sciences; Biomedicine; Brain; Brain - blood supply; Brain - pathology; Brain - physiopathology; Brain Mapping; Cognition & reasoning; Cognitive ability; Consciousness; Diagnostic Imaging - methods; Eye and associated structures. Visual pathways and centers. Vision; Fundamental and applied biological sciences. Psychology; Humans; Image Processing, Computer-Assisted - methods; Injuries; Medical imaging; Medical sciences; Metabolism; Methods; Neurobiology; Neuroimaging; Neurosciences; Patient assessment; Persistent Vegetative State - pathology; Persistent Vegetative State - physiopathology; science-and-society; Tobacco, tobacco smoking; Toxicology; Traumatic brain injury; Vertebrates: nervous system and sense organs; United Kingdom; Coma; Human; Nervous system diseases; Prognosis; Decision making; Consciousness impairment; Awareness; Central nervous system; Representation; Vegetative state; Nuclear magnetic resonance imaging; Care; Encephalon; Language; Intention; Speech; Perception; Diagnosis; Neurological disorder
• ISSN: 1471-003X; 1471-0048; 1469-3178
• DOI: 10.1038/nrn2330

Functional MRI has shown that aspects of cognitive and emotional processing and even conscious awareness might be retained in some patients who have been diagnosed as vegetative. Owen and Coleman discuss the clinical, legal and scientific implications of these findings. A number of recent studies have demonstrated a role for state-of-the-art neuroimaging methods in the assessment of patients in the vegetative state and other so-called 'disorders of consciousness'. In several cases, functional MRI has been used to show that aspects of speech perception, emotional processing, language comprehension and even conscious awareness might be retained in some patients who behaviourally meet all of the criteria that define the vegetative state. This work has profound implications for clinical care, diagnosis, prognosis and medical–legal decision making (relating to the prolongation, or otherwise, of life after severe brain injury), as well as for more basic scientific questions about the nature of consciousness and the neural representation of our own thoughts and intentions.