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Drug Found to Aid Vegetative Patients 353

Posted by ScuttleMonkey
from the super-smelling-salts dept.
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."
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Drug Found to Aid Vegetative Patients

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  • Great! (Score:5, Funny)

    by William Robinson (875390) on Wednesday May 24, 2006 @05:30AM (#15392594)
    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.

    Great!!! Finally they found medicine for my boss!!

    FP, BTW?

  • Gaba stuff (Score:5, Interesting)

    by jimmyhat3939 (931746) on Wednesday May 24, 2006 @05:35AM (#15392599) Homepage
    It's interesting to me that these things seem to always deal with Gaba. Is Gaba the only thing in our brains?

    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?

    • I found your hypothosis intruiging, so I went out to try it.

      I could not find a simple way to stop the action of the gaba in the brains without physically removing their head (a messy procedure).

      I did however find that if you remove the Gaba there is no way to restart the action afterwards.
    • by Mostly a lurker (634878) on Wednesday May 24, 2006 @06:00AM (#15392653)
      does this finding imply that you could induce a vegitative state in someone ... only to "restart" them once they're needed again?
      As most wives will tell you, this is eaily achieved by means of a TV remote control.
    • Re:Gaba stuff (Score:4, Informative)

      by dirtyhippie (259852) on Wednesday May 24, 2006 @06:23AM (#15392716) Homepage
      Neuropsychopharmacology [wikipedia.org] is what you speak of.

      GABA is far from the "only thing in our brains". Other neurotransmitters include serotonin (important in depression and hallucinogens), acetylcholine (why people smoke), dopamine (why some drugs are addictive), (nor)?epinephrine, glutamate and aspertate, etc. etc. The descriptions of what these chemicals do, of course, is vastly oversimplified here.

      As for what anti-anxiety meds do, they mimic the effect of the naturally occuring GABA neurotransmitter, and have an inhibitory affect on cells with GABA receptors.

      You *could* induce a vegitative state in someone by stopping the action of GABA, but it wouldn't exactly be "persistent" - GABA helps control some rather important functions in the brain stem, like breathing and heartbeat - in short, they'd die ;)

      • glutamate and aspertate

        Our brain is umami and sweet at the same time? Maybe zombies are just looking for low-calorie Oriental fare.

      • As for what anti-anxiety meds do, they mimic the effect of the naturally occuring GABA neurotransmitter, and have an inhibitory affect on cells with GABA receptors.

        You forgot a few of the more fun receptors like the canabinoid and opioid receptors!

        Because GABA is so wide-ranging in neurological function (one of the reasons why many nerve agents impact the GABA receptors as well as the acetylcholinesterase receptors and why many insecticides target the GABA receptors), GABA targeting has always led to drugs

    • I have found massive doses of grain alcohol in almost any form to very effectivly moderate my GABA system, and high enough a dose will indeed induce a vegitative state known as "being so freaking drunk I can't think, stand, or walk."
  • by s0l3d4d (932623) on Wednesday May 24, 2006 @05:54AM (#15392641) Homepage
    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?
  • by Anonymous Coward on Wednesday May 24, 2006 @06:19AM (#15392705)
    Salad dressing always seems to bring my vegetables to life.

    *cue cricket cheeps*

    What?
  • just kill me (Score:5, Interesting)

    by m874t232 (973431) on Wednesday May 24, 2006 @06:43AM (#15392762)
    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.
    • Re:just kill me (Score:2, Insightful)

      by aadvancedGIR (959466)
      I really agree, beside dignity issues, there truly are states worse than death. Too bad most doctors consider one more day of agony a great victory.
    • Re:just kill me (Score:5, Insightful)

      by Itchy Rich (818896) on Wednesday May 24, 2006 @07:11AM (#15392832)

      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.

      You say that now, but if it were to actually happen to you I very much doubt that you'd rather die than be dependent on that drug.

      It's like all the people that say they'd rather die young, and can't stand the thought of growing old. When it actually happens to you and you're faced with the prospect of death you'll change your mind pretty fast.

      • Re:just kill me (Score:5, Insightful)

        by YoungHack (36385) on Wednesday May 24, 2006 @12:15PM (#15394964)
        > You say that now, but if it were to actually happen to you I very much doubt that you'd rather die than be dependent on that drug.

        > It's like all the people that say they'd rather die young, and can't stand the thought of growing old. When it actually happens to you and you're faced with the prospect of death you'll change your mind pretty fast.

        That's totally true. Having watched my (young) wife go through stroke, I have to say that living wills make very little sense. You cannot predict while you are perfectly healthy and sitting at the kitchen table what choices you'll want when something happens.

        As it was, she refused treatment for a while and changed her mind later. Hard choices came day to day. More than once I believed I had made the hardest decisions my life would contain, only to be wrong the next day.

        I think the most useful document is a durable power of attorney document. Find someone you trust, who loves you (more important than the other way around). Talk about things some ahead, but tell them to make the best choices they can.

        It may mean a mistake. They might act to save your life when they shouldn't. Or they might act to let you go when they shouldn't. But at least they will be making the decisions with the information available then, when it counts. It's better than you can do in a living will.
    • 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...

      Eh? Sounds like my morning coffee after a night too much cheer! (not to make light of folks with real mental distress)

    • Re:just kill me (Score:3, Insightful)

      by MBGMorden (803437)
      That's nice to know. Be sure to tell them that on your first awakening so that they can carry our your wishes afterwards.

      That fact bears nothing on the usefulness of this drug though, as it's the lone opinion of yourself. Others may (and probably do) share that viewpoint, while still others will not. There are plenty of people who very much would like this, and as such it's a worthy pursuit.
    • Your opinion is self-contradictory. The drug would allow you to control yourself for a brief period, probably even commit suicide if that's what you wanted. You would have an improved chance to reach a state where the drug would not be required. Without the drug, you would be at the mercy of those taking care of you, with nothing but your "living will" document to protect you.
      • That is an incredibly selfish point of view. I agree with the grandparent. If I'm out of it and my chances aren't looking good, then I want it over, not just for my own sake, but for my loved ones as well. Every day I go on living would be another day of misery for them, not to mention hellacious hospital bills. Do you know how much a single day of intensive care costs? Try spreading that out over several years.

        The drug would allow you to control yourself for a brief period, probably even commit sui
    • Yeah. But what if the drug actually shows you were misdiagnosed PVS? And what if we develop an improved drug that has a longer effect? And what if we end up with some sort of a cure, in the end?

      It's always easy to say "I'd be better off dead". But you wouldn't be aware of your condition anyway. So hey, why not wait a few more years and risk being "revived"?

      • Re:just kill me (Score:4, Interesting)

        by vertinox (846076) on Wednesday May 24, 2006 @11:57AM (#15394801)
        So hey, why not wait a few more years and risk being "revived"?

        Judge: "All in favor of waiting a few years of being alive say "Aye""

        Doctors, Nurses, Lawyers, and Culture of Lifers at the bedside: "Aye!"

        Judge: "All those opposed... Say "Nay!""

        Patient: "..."

        Judge: "The "Ayes" have it!"
    • 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.

      If your brain is so badly damaged that you aren't aware, why do you care what happens to you afterwards ? After all, you won't be aware of it.

      Me, if I have to choose between depending on some chemical to s

    • > 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.

      You want to die if we run out of coffee? Geez.

  • Where's Robin Williams and Robert De Niro [imdb.com] when you need a movie made?
    • Unless I am mistaken Awakenings was based on real series of medical cases. In fact there was a documentary preceding the movie.
  • but... (Score:2, Funny)

    by Shivetya (243324)
    does it work on managers?
  • Cool, but... (Score:5, Insightful)

    by MWoody (222806) on Wednesday May 24, 2006 @07:08AM (#15392821)
    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...
    • Re:Cool, but... (Score:3, Interesting)

      by RsG (809189)
      Well, to point out the obvious, long term PVS leads to degradation of the brain. In the Schiavo case that's being brought up in this thread, what remained of her brain had severly atropied, and much of the higher brain centers had been replaced with spinal fluid.

      If someone's family memeber were brain dead, then waiting for a miracle cure might not be an option. After all, if it takes ten years for even a partial cure to become available, then that's ten years in which the afflicted is slipping further and
    • Re:Cool, but... (Score:5, Insightful)

      by plunge (27239) on Wednesday May 24, 2006 @10:08AM (#15393733)
      As we get more and technologically advanced, these what-if questions will always come up, and it's important to be serious about it.

      If we develop the technology do bring a truly dead person back to life: to re-animate a day old corpse, will cremation be murder?

      Or take the Schiavo case: it may one day be possible to insert new brain cells into someone like that and have them get up and be a person again. But they may not be the same person: the old brain matter that held their memories and personality may be gone. And yet, since we can do that, should we never pull the plug on a brain dead person?

      What makes you, you? And what rights do YOU have in determining whether medical science can essentially keep your body alive, forever, no matter what happens to that "you?"
    • That would be a case to consider if, for example, you're in the process of taking over the Enterprise by guilt tripping the Doc. [imdb.com]
  • by Puls4r (724907) on Wednesday May 24, 2006 @07:09AM (#15392829)
    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).
  • ...that can make patients aware of their surroundings and even hold conversations

    It could be argued that this could not only help those in a vegetative state, but our society in general. ;)
  • It's not news yet (Score:5, Insightful)

    by hey! (33014) on Wednesday May 24, 2006 @07:18AM (#15392855) Homepage Journal
    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.
    • by ChrisMaple (607946)
      News is precisely what this is. By the time it's become an established fact or established medical practice, it's long since stopped being news. Even by the time it's been replicated and published in the appropriate journal, it's fading from the news scene, although each new publication is a separate news item. The root of the word "news" is "new".
  • It'd be cool to know exactly what "simple questions" were asked and what their responses were. My definition of a "simple question" might differ from theirs. Even if they had asked /complex/ questions, that doesn't necessarily mean the answer was correct or even intelligible.

    Researcher: Hi there, can you see me? Patient: FFOOOOOOOOOMDE!

    Sure, they interacted with the researcher and they answered a simple question. Their response could even arguably be considered a word, perhaps poorly pronounced, but..
    • by Tx (96709) on Wednesday May 24, 2006 @07:47AM (#15392928) Journal
      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.
    • by KarmaMB84 (743001) on Wednesday May 24, 2006 @11:23AM (#15394470)
      It's probably more like
      Researcher: Hi there, can you see me? Patient: BRAAAAAAIIIIINNNZZZZZZZZ
    • Well, gathering from the article and a few other posts:

      There are two sides of the brain, the conscious and the subconscious, with a sort of database in the middle. The conscious mind is associated with meaning, emotion, deep thoughts. The subconscious is associated with motor skills, communication, and logical thoughts.

      There's a collection layer that handles getting data from your senses (eyes, ears, nose, etc.). The conscious mind is what you use for memories. It handles tagging data with meaning before
  • Bah (Score:5, Funny)

    by dumdeedum (150099) on Wednesday May 24, 2006 @09:50AM (#15393586)
    Drugs to aid vegetative patients is ridiculous when you can simply cure them by feeding them meat.
  • by dkf (304284) <donal.k.fellows@manchester.ac.uk> on Wednesday May 24, 2006 @09:56AM (#15393633) Homepage
    I read that article title and immediately wondered if the researchers were using BabyBio or MiracleGro...
  • by dzogchen (200579) on Wednesday May 24, 2006 @10:12AM (#15393793)
    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.
  • by Frangible (881728) on Wednesday May 24, 2006 @01:37PM (#15395686)
    Effect of zolpidem on brain injury and diaschisis as detected by 99mTc HMPAO brain SPECT in humans. [nih.gov]

    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 [nih.gov]

    ... RESULTS: The synthesis provides evidence about the theoretical actions and efficacy of the available pharmacological agents. The clinical studies are less convincing: indications and therapeutic choices are empirical. Studies report often single cases. Randomised studies are rare, often heterogeneous concerning the aetiology of the brain lesions. The evaluation scales are varied and too wide. In this context, amantadin, amphetamine, methylphenidate and bromocryptin showed some positive effects. ...

    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.

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