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Drug Found to Aid Vegetative Patients
Oxygen99 writes "BBC News is reporting on some amazing effects of a drug called Zolpidem on patients suffering from persistent vegetative state. Apparently the drug, usually used to treat insomnia, activates dormant areas of the brain that can make patients aware of their surroundings and even hold conversations. This raises several interesting points including the diagnosis of PVS and the attendant ethics of the associated life support, as well as the way the brain responds to injury and damage."
Great!!! Finally they found medicine for my boss!!
FP, BTW?
hilarious
Most anti-anxiety medications work by fooling around with how Gaba is handled in the brain. I can't remember whether they inhibit it or make it more effective. Now here you have this thing saying that people in vegitative states have something wrong with their Gaba receptors.
Maybe someone who understands a little bit about brain chemistry (if such a person even exists) can shed some light on this. For instance, does this finding imply that you could induce a vegitative state in someone by stopping the action of Gaba in their brains, only to "restart" them once they're needed again?
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A person in a vegetative state will appear to be awake and may have their eyes open, but will show no awareness of their surroundings.
They will not be able to interact with other people, and will show no responses to sounds or things that happen around them.
But they will show signs of movement, and cycles of sleep and may be able to breathe on their own.
So what would happen if they would start to give these drugs to technical support people and system admins? Would they also start to show responses to their environment, and manage to hold a conversation?
fsckr.com - go fusk yourself!
Salad dressing always seems to bring my vegetables to life.
*cue cricket cheeps*
What?
the autopsy showed she was a vegetable and not just in a vegetative state.
She died years ago.
According to the autopsy, this drug would have had to have done a lot more than described here. Maybe if they'd given it to her when she first fell into a coma (we'll never know) but by the time she died, her brain was irreperable.
Am I part of the core demographic for Swedish Fish?
I seem to recall that her autopsy found what was essentially mush where her neocortex would be. I would tend to guess that that kind of damage really is irreparable - but IANANeurologist, so I don't know for sure.
Assuming we could fully repair braindeath (ie, restore the brain when higher functions have been lost), what would remain of the original person? Would we have an adult with infantile brain capabilities, a blank slate? How much of a person's identity is hardcoded? And what are the ethics of the situation - do we revive someone knowing that we'd be making them start over from scratch (and maybe not even that - most of early learning is made possible by infantile brain "plasticity", which an adult brain lacks).
It's not an easy question...
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If my brain has been damaged so much that I can only be roused to awareness of my surroundings by a drug that artificially and temporarily activates bits and pieces of my brain, I just want to die quickly and painlessly. As far as I'm concerned, the biggest crime against me would be to keep me alive.
This is great news, and fascinating from a technical standpoint. But I cringe to think of the unfortunate side effect of something like this: think of the countless grieving families who, on the advice of their doctors, pulled the plug. Particularly those who did so recently. Imagine the horror to imagine that this drug could have brought their loved ones back.
I'm not saying that the decision not to perpetuate the incurably brain dead is the wrong one, nor am I placing blame on the medical community in any way. But you can't expect laypeople to understand the difference, really, and the pain of not knowing if the decision was the right one... Of constantly wondering, down where logic doesn't really help, if there was a chance...
Aside from the obvious issues here of a very minimal sample size, it sounds like some doubts have been raised as to the accuracy of the original diagnosis of persistent vegetative state (PVS).
We understand very little of what causes a person to shutdown and go into PVS. As such, it is EXTREMELY hard to truly diagnosis and pinpoint what is going on. Normally, we wait. If they wake up, it wasn't PVS.
This is like a myriad of other diseases like SIDS that are vaguely defined. Many more incidents are attributed to the issue than are actually caused because we simply don't understand it.
Hyperactivity disorders in children are another perfect example of a rather subjective diagnosis leading to over-prescription and misunderstanding. All that said, hopefully another set of trials over a wider base of patients proves some hope. (insert the obligatory Robin Williams "awakenings" quote here).
No. Terry's cerebral cortex had completely disintegrated. There was nothing to re-activate. No amount of praying or injecting or stimulating her could have changed the fact that her brain was simply no longer capable of higher-level thoughts, as the part responsible for such thought had 'turned to jelly'.
until it's been replicated and the results published in a peer reviewed neurology journal.
Over the years there have been miraculous cures for diseases that didn't pan out because they couldn't be replicated. Reasons for this might be: the study patients weren't really cured, the study patients improved, but didn't have the disease in question, scientific fraud, simple chance. This is the kind of result that has to be looked at skeptically, because if it were true, it would be true it would mean the bulk of what we think we know about the brain and its function is wrong.
It's possible, of course. Such possibilities are part of what makes science and exciting pursuit. It's also possible that the authors didn't do their study correctly. It's your choice as to what is most likely. If I had to bet, it would be the study population was not selected properly (i.e. they were in a coma, but not a PVS).
I checked out the journal in question. It is peer reviewed, but it is not a neuroscience journal per se. It is an interdisciplinary for various disciplines involved around rehab of brain damage patients. Although it's perfectly erspectable to publish in such a journal, the article would have a lot more initial credibility if it had been published in a journal specializing in basic neuroscience research. It would have to convince reviewers who would be forced by the publication to admit that they hold some significant misconceptions. It's a tough standard of truth, and it slows the spread of Truth (if you will), but it slows the spread of Error more.
If this is a legitimate result, the publication activity will be, to borrow a metaphor from Shaw, like the first pea in a handful of peas thrown at a wall: first one hits, then a couple, then a whole mass of them. Afterwards, the state of science will have changed in a fundamental way.
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For those that didn't bother to read the medical reports and instead relied on the newspapers/media, Terri's brain had totally atrophied away, it was gone. Her skull contained the brain stem, a bit of shrivelled brain and an awful lot of fluid. There really was no hope, she was long gone.
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I was wondering the same thing. Like did "catch a basketball" mean a basketball thrown from across the room with the patient standing up, or dropped into his arms from a couple of inches with him sitting down. It's the usual frustrating lack of detail we get with mainstream media reporting of science issues. I understand they want to keep it simple, but make it too simple, and the report becomes almost meaningless.
Oh no... it's the future.
"Otherwise he could simply have divorced her and moved on with his life."
No, he couldn't.
Terry was legally incompetent to participaet in divorce (or any other) proceedings. Normally, this wouldn't be a big deal - just have her legal guardian represent her. Problem - her legal guardian was Mark. Mark couldn't try to divorce her - he'd be representing her against himself. It only became an "option" when her parents "offered" to take over her guardianship in a quid pro quo - he relinquishes his responsibility to his wife in return for not contresting a divorce.
Mark was Terry's legal guardian because she CHOSE it before she died, by marrying him. Her parents couldn't (and probably still can't) get that through their heads. They went to desperate lengths to override their daughter's wishes, denying her the very autonomy and choice she had made previously. She chose to leave them and put her care into the hands of another. Mark did the same thing - it's called marriage.
Mark discharged his responsibilities to his wife. Why couldn't her parents accept that?
"As God is my witness, I thought turkeys could fly." A. Carlson
Drugs to aid vegetative patients is ridiculous when you can simply cure them by feeding them meat.
My eldest child has an undiagnosed condition that has left her unable to walk, talk, move, eat etc. The condition developed gradually and doctors say that the problem seems to be in the brain stem. I gather that GABA affects the working of the brain stem.
Does anyone have a link to the actual paper, or more info on this? I hesitate to grind up an Ambien and put it in her G-tube, but even the thought of something that might help her brings tears to my eyes as I write this. You have no idea what it is like to watch your child essentially disintegrate right before your eyes -- it's been 18 years of torture.
Thanks in advance for any help.
It's probably more like
Researcher: Hi there, can you see me? Patient: BRAAAAAAIIIIINNNZZZZZZZZ
The study investigates the effect of zolpidem (CAS 82626-48-0) on brain injuries and cerebellar diaschisis. Four patients with varied brain injuries, three of them with cerebellar diaschisis, were imaged by 99mTc HMPAO Brain SPECT before and after application of zolpidem. The baseline SPECT before zolpidem showed poor tracer uptake in brain injury areas and cerebellar diaschisis. After zolpidem, cerebral perfusion through brain injury areas improved substantially in three patients and the cerebellar diaschisis was reversed. Observations point to a GABA based phenomenon that occurs in brain injury and diaschisis that is reversible by zolpidem.
The problem with this study is a small sample group and no control. You can't make many broad conclusions from that data.
Indications, efficacy and tolerance of drug therapy in view of improving recovery of consciousness following a traumatic brain injury
All of the drugs described in the above study have dopaminergic function; either indirectly increasing dopamine levels (amantadin, amphetamine, and methylphenidate) or directly agonizing the receptors (bromocriptine). It is interesting that GABA, an inhibitory rather than excitatory neurotransmitter in most cases, shows efficacy here as well.