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."

Re:Oblig. Terri Schiavo comment.

[smcavoy]

the autopsy showed she was a vegetable and not just in a vegetative state.
She died years ago.

Re:Important distinction

[Anonymous Coward]

I have a living will which states I want to be shut off after 2 months unless there is good evidence I will recover over time without severe brain damage.
Trolling though you are , it does raise a few good issues. You should have a look into a few medical papers about PVS and higher brain function , may be an interesting read for you.

Re:just kill me

[aadvancedGIR]

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.

Cool, but...

[MWoody]

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:Important distinction

[Richard_at_work]

How long should they have kept her alive artificially? Until her parents had died? What then? Who makes the decision after that point? She cant afterall die naturally, the doctors could always keep the body functioning well past a normal lifetime, so when should treatment be withdrawn to allow her to die?

Point is, she was being kept alive artificially, she could not communicate and she showed no signs of intelligence. Her brain patterns were nowhere near normal. In these situations, people will believe out of desperation any little grunt or sniffle is an attempt to communicate.

All of the evidence presented by the postmortem showed that the husbands case was proven - she had no brain function to speak of.

Exciting... but unproven.

[Puls4r]

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).

Re:Terri Shivo

[vandan]

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'.

Re:just kill me

[Itchy Rich]

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.

It's not news yet

[hey!]

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.

Starving...

[electrosoccertux]

If she was dead, why not use a faster means of death? Like lethal injection or something. We wouldn't cruelly starve an animal to death. I think that would have been too quick; would have looked too much like murder (as if starving her were any better). It's odd that the painful of treatements was the more socially acceptable.

Re:Important distinction

[SatanicPuppy]

My mother recently died in a similar manner; she was non-responsive, but not brain dead, and I asked that tubes be removed. She had zero chance of short-term meaningful recovery, and the long term was terminal brain cancer (the survival rate 96% of healthy patients her age was 2-6 months. The other 4% were dead in 10 months). She left very specific instructions regarding this possible eventuality (they included the words "Get Dr. Kervorkian"), so there was little debate from the rest of the family (none from the doctors).

I think you'll find that most patients die of pneumonia brought on by the morphine, and not by starvation. I sat by her bed for 10 days, and I can vouch for the level of comfort provided by the physicians...if her body showed any signs of distress, and we're talking elevated heart rate here, they took steps.

It is only a cruel way to die for the people who have to watch.

Re:just kill me

[MBGMorden]

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.

Re:NOOOO!!!! TERRYYYYYYYYYY!!!!!!!!!!

[narcolepticjim]

It's unlikely anything would have helped her. The sheer amount of brain tissue that died as the result of her cardiac arrest probably precluded any treatment for her.

Re:Starving...

[Doc Ruby]

Because the same groups of theocrats trying to pray Mrs Schiavo's brain back from the dead have actually succeeded in thwarting America's euthanasia movement. Even people who face an horrible, immediate terminal condition ("certain agonizing death") with determination to spare themselves and their family the fear, pain and expense with dignity can't get help to kill themselves quickly and painlessly. Because America's Christaliban has already got more political power in shaping the laws.

Instead, "Compassionate Conservatism" demands people get tortured medically as long as pharmacos have a legal patient. When Republicans need political lifesupport, they'll move heaven and Earth to invade people's privacy even to interfere with what little protection we have for letting a dead person's body join them after a decade of medical and legal consensus.

Re:Terri Shivo

[R2.0]

"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?

Re:It's not news yet

[ChrisMaple]

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".

Re:Cool, but...

[plunge]

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?"

Re:Important distinction

[plunge]

Tom Delay, of course, before the controversy began and he put himself at the forefront of it, pulled the plug on his own comatose father.

The problem with the extreme pro-life position is that they don't really believe their own rhetoric when it comes to actually applying it to real situations affecting THEM instead of other people they can just rail against. Given the choice between saving a billion zygotes and a single human child, they'd all save the child, and they know it. For all the talk about killing zygotes being murder, or morally equivalent persons no matter what stage of development they are, they don't really believe it. Even the group of brothers who supported the Schiavo parents had basically allowed their own founder to die when they could have kept his body alive just like Schiavo's.

Re:Important distinction

[mdielmann]

I'm currently on what you called a "maintenance drug" for a long-term condition. I'm getting the results expected for the drug, with none of the side-effects (which can be bad). I've had varying qualities of diet and lifestyle over the duration of my condition while I wasn't taking medication and, while my symptoms were lower when my lifestyle was at its best, I've never felt as good as I do now. It's worth noting that my lifestyle is currently at a poorer state, close to the typical North American's.

What I'm getting at is that I agree with you, to a point. Like anything else, take the least invasive approach to solving a problem, so long as the problem is solved. Fortunately for you, that was merely (merely!) an overhaul of your lifestyle. Less fortunately for me, it may be a lifetime of medication. But frankly, if the improvement is as dramatic as it has been, that's a price I'm willing to pay. Not that I'm unwilling to see what difference a lifestyle change can add to (or maybe even replace) it.

Re:Important distinction

[Reservoir Penguin]

I wouldntgive it point #1. Approaching child birth as a desease that should be treated at the hospital is wrong and is entirely a Western invention.

Let's never talk of this again

[spun]

Or anything else that might offend anyone, anywhere. The most important thing is to put on a happy face and never disagree. Just nod and smile, there ya go, uuuhhh, let me wipe that drool off your chin...

Seriously, wtf? Just because an issue is controversial we can't talk about it? What kind of PC thought policing happy-happy joy-joy troll ARE you? Me, I only read the flamebait articles. Sure, there's lots of immature asshats, but the amazing thing is, on any issue with any kind of controversy, you also get plenty of thoughtful and interesting arguments from both sides. Which lets you strengthen your own arguments by responding to criticism from intelligent people. It's a little technique known as dialectic [wikipedia.org], you may have heard of it.

Re:Important distinction

[tgibbs]

Unfortunately, there are many conditions where none of the available drugs are entirely satisfactory. In psychiatric illnesses, especially, some people respond to one drug and not another, and some people find the side effects of one drug intolerable while others have no difficulty. Psychiatric illness is still poorly understood, but it's suspected that psychiatric illness can arise from multiple causes, and at present there is no good method other than trial and error to identify the best treatment for a particular individual. Current medications are largely derived from trial-and-error experimentation, because it is difficult to develop good animal models for psychiatric illness. Without a better understanding of how these illnesses arise, true cures, as opposed to palliative medications, are unlikely to arise.

Re:Starving...

[KarmaMB84]

Because eventually another family member with something to gain ($$$) from their death will gain the power to make medical decisions and argue they have the right to have them euthanized. I'm an atheist and I think the prospect of having people euthanize other people is horrendous. Abuse would be inevitable and you can't trust the courts not to throw out any provisions to stop the abuses.

Re:Important distinction

[SatanicPuppy]

I have a living will which says, that if I'm in a persistent vegitative state with no reasonable hope of recovery, I want my loved ones, or the goddamn government, to pull the plug. Because, at that point, I don't call it living.

My mother had the most straightforward approach to dying of anyone I've ever seen. She found out she had a tumor, she went out and got a living will and a medical power of attourney, and she gave them both to me and specifically told me under what circumstances I was allowed to put her on tubes. And by God I did exactly what she asked. She met her death with courage and dignity, and she trusted me to make that possible for her, and not to stick her on those goddamn machines.

And I don't need some filthy little quasi-moralistic cocksucker who has no fucking idea what he's talking about DARING to give me shit about it. I hope to God you end up trapped in a rotting shell of a body by your own goddamn living will that forbids anyone from touching your precious precious tubes.

Re:just kill me

[YoungHack]

> 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.

Re:Important distinction

[cellocgw]

Approaching child birth as a desease that should be treated at the hospital is wrong and is entirely a Western invention.

Since I have direct knowledge of cases where women chose to give birth at home, resulting in the death of their child due to simple, easily treated problems like myconium inhalation, I have no misgivings about calling you an uneducated fool.
Childbirth is not considered a "disease," but it is considered a potentially dangerous situation both for mother and infant.
Another case: woman with failure to completely expel the placenta starts a major bleed. Hospital care saves her easily. Try doing that at home.

Re:Oblig. Terri Schiavo comment.

[brouski]

They did do a CAT scan in '02 that showed severe cerebral atrophy.

All I am going to say

[majortom1981]

I know from real life experiences that some wierd things can go on in regards to comas.

I was in a coma for 5 weeks and woke up like nothing was wrong.

I also was in another one for a week. They had me on life support and everything. They didnt expect me to live.One day i woke up like nothing happened.That night I was complaining that I wanted to go home.

The mind still holds a lot of secrets.

I still have doctors who want to stick me in a hospital and run tests for months.

Re:This might help my daughter - more info?

[nbritton]

"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."

Try it, if you can get your hands on some. Ambien is a fairly mild drug in my book... read up on the prescribing information sheet and try it on yourself first to test for allergic reaction (rare) etc. Ambien CR is supposed to be a longer lasting version of this drug, the half-life for normal ambien is like 2.5 hours... BTW.. I'm not a doctor, but I did stay at a Holiday Inn Express last night :-).

Every time I've taken this drug, for sleep problems, I get amnesia from it. The best example I have for this was when I was in the hospital and was given this drug to help me sleep for the night, the nurses said I was up all night reading magazines when I 'knew' I had fallen asleep... I have also witnessed this side effect in other people, she was able to cook a meal on the stove and have a conversion with me but had absolutely no memory of this event, It's a common side effect for this drug but they like to down play it for sales... This I'm sure has something to do with the topic at hand...

Re:What simple questions?

[inKubus]

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 it's inserted into the database. If there is no meaning, it cannot be retrieved from the database. More on this in a second.

The subconscious is the section that's responsible for acting on things. You know how sometimes you just "get that feeling"? That's when you are sort of aware of your subconsious working. Your subconscious has read access to the database, so it can draw on all the stuff in there to run your body, even if you are no longer learning (conscious tagging and assigning meaning to sense data).

Ambien turns off the conscious mind and actually stimulates the other sections. So you hear stories of people on Ambien running tractors or cooking breakfast in their sleep and then having no recollection of it. Their subconsious mind is easily capable of performing these tasks, it can just refer back to the thousands of other times you've walked or driven or cooked eggs.

So, in people who's brain is damaged in such a way that their subconscious faculties are still working somewhat, if you stimulate what is still working, you can get a reasonable facsimile of a healthy person's behavior, as far as logical tasks are concerned.

But all this really does is explain why Ambien is a really really bad choice for a sleeping medication. I mean, it activates your mind and body but turns off it's ability to record. You are, in essence, a zombie.

Re:Important distinction

[Alsee]

I'm really afraid of people like you.

You're afraid of someone who went through the pain and suffering of faithfully following their loved one's last wishes?

I'm afraid that when time comes they will lie ... and expressed wisshes opposite to my real ones.

That's pretty pathetic if you can't find a single trusted loved one to home to give power of attorney for such cases. I sure as hell hope you're not married.

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