10 ms·

Nerve implant 'restores consciousness' to man in vegetative state (2017)

198 points by Jaruzel 8y ago

xtracto 8y ago
Reminded me of the controversial Terri Shiavo case(1), where the parents fought till the end to avoid her death. (1) https://en.wikipedia.org/wiki/Terri_Schiavo_case https://en.wikipedia.org/wiki/Terri_Schiavo_case
- acchow 8y ago
  > "staff at the Pinellas Park hospice facility disconnected the feeding tube on March 18, 2005, and Schiavo died on March 31, 2005." So, they starved her to death over 13 days? How do they know she wasn't experiencing this as torture?
  - arthurcolle 8y ago
    I'm baffled that disconnection of a feeding tube seems like a reasonable way to interrupt life-sustaining processes
    - woofyman 8y ago
      Euthanasia is illegal in the US. The only thing you can do is remove artificial means of life support. It’s in humane. People should be able to die with dignity. We treat our pets better.
      - wahern 8y ago
        I don't disagree, but this recent assisted suicide story certainly has added some complexity to the debate: https://www.theguardian.com/society/2018/mar/17/assisted-dying-euthanasia-netherlands https://www.theguardian.com/society/2018/mar/17/assisted-dyi... TL;DR: Assisted suicide approved and performed for woman suffering from depression and psychosis. Actually, it wasn't the first non-terminal assisted suicide. I remember a 2009 story involving a man who decided to die with his wife. The wife had terminal cancer, he was healthy, albeit 80 years old. https://www.theguardian.com/society/2009/jul/14/assisted-suicide-dignitas https://www.theguardian.com/society/2009/jul/14/assisted-sui... That article also discusses another couple suffering from non-terminal but chronic illness and chronic pain. I don't remember reading about that couple at the time.
        hanniabu 8y ago
        Yeah, but you know what? That's was their choice
        wahern 8y ago
        Yes. I don't mean to be critical of those decisions. But assisted suicide is often pitched to the public as a compassionate treatment to terminal illness. Being narrowly circumscribed is supposed to minimize the potential for abuse and coercion. So when I say those stories add complexity, I mean to say they create fodder for those opposing assisted suicide.
        mijamo 8y ago
        Not really, you just have to write the law to allow what you think should be allowed. Some countries allow assisted suicide in non critical conditions, some allow it only for critical conditions, and some never allow it. I don't see why it would give any weight to those opposing assisted suicide. And TBH I don't understand what is the problem with assisted suicide for non critical conditions in the first place. People get to chose their life, and should be able to end it if they want to. The only alternative as I see it would be to put on the state the responsibility to make everyone so happy they would never want to die, which does not sound like something those opposing assisted suicide would want either. Why would we force people to live miserable lives?
        jacobush 8y ago
        Please at least try to see the other side of the argument. Or we could replace a large chunk of depression treatment with firing squads and it would be fine your argument above. After all, they wanted to die.
        AnIdiotOnTheNet 8y ago
        You would prefer suicide by cop?
        8y ago
  - wahern 8y ago
    Because it was repeatedly and conclusively shown at that point that her brain had atrophied to half its size. She was gone. The reason the situation almost devolved into an armed stand-off between the courts and the executive branch is because every judge (Florida and Federal) who looked at the case--that is, those officials presented with all the evidence from both sides--quickly understood the reality; whereas the politicians hundreds and thousands of miles away who hadn't the first clue about the facts had other objectives in mind. The subsequent autopsy confirmed what was already known. But there was never any accountability because by then the media had moved on. Terry Schiavo is not the case to point to when questioning the science and treatment of PVS.
    - sandworm101 8y ago
      It was a fight between scientists and non-scientists. The scientists saw the scans of her head that showed a void where there should have been brain. The non-scientists looked at a handful of home movies where here random movements and facial expressions occasionally lined up to make her look aware. Such debate between scientific evaluation and layperson "gut feelings" predate so many of today's debates re climate. It was also a generational fight. Her husband, the normal go-to for medical decisions was on one side, and her parents on the other. The parents wanted control over their daughter. They could not accept the widespread default that, for most all medical/legal matters, spouses trump parents. And this was Florida. So the "rights" of the older generation were given greater play in the courts than would have happened in other states.
      - deleted 8y ago
        [deleted]
      - nonbel 8y ago
        >"The scientists saw the scans of her head that showed a void where there should have been brain." People with "no" (very small) brains due to hydrocephalus have been discovered who are successful mathematics students and public servants. So, not sure the scientists are right here. As long as the brain is shrinking slow enough it may not be a huge deal in terms of mental ability. http://mentalfloss.com/article/70204/man-without-brain http://mentalfloss.com/article/70204/man-without-brain https://www.theguardian.com/education/2003/oct/02/research.highereducation1 https://www.theguardian.com/education/2003/oct/02/research.h...
  - mikeash 8y ago
    It doesn’t matter. Starving a bedridden patient to death is a passive activity, and is hence defined as “moral.” In contrast, giving them a morphine overdose so they die quickly and painlessly is an active measure and thus defined as “immoral.”
    - HillaryBriss 8y ago
      > giving them a morphine overdose so they die quickly and painfully ? wait. is a morphine overdose painful?
      - JshWright 8y ago
        No, that was surely a typo
        mikeash 8y ago
        More like a sudden brain malfunction, but yeah.
    - sulam 8y ago
      I think you meant "painlessly".
      - mikeash 8y ago
        Uh, yeah, I kinda did. Thanks.
    - HillaryBriss 8y ago
      I'm not taking a position on this or trying to argue. I'm truly somewhat confused by it all. I'm not sure I agree with this, as I find it, honestly, rather frightening in practice, but it seems like painkiller administration is a kind of euthanasia loophole, even in places where euthanasia is not legal: Passive euthanasia is the withholding of treatments necessary for the continuance of life. Whether the administration of increasingly necessary, albeit toxic doses of opioid analgesia is regarded as active or passive euthanasia is a matter of moral interpretation, but in order to pacify doctors’ consciences, it is usually regarded as a passive measure. Many people, therefore, regard it as an acceptable facet of good professional practice. https://jramc.bmj.com/content/147/3/367 https://jramc.bmj.com/content/147/3/367
finnh 8y ago
Amazingly, ambien has had a similar effect for a small group of patients, returning them to consciousness for hours at a time after months or years of coma https://www.nytimes.com/2011/12/04/magazine/can-ambien-wake-minimally-conscious.html https://www.nytimes.com/2011/12/04/magazine/can-ambien-wake-...
- anon49124 8y ago
  Yup, basically the movie plot of Awakenings. Also, a family member of mine, whom was not catatonic, tried it for post-stroke fatigue/pain/neuropathy/brain fog to get away from gabapentin&pregabalin.
  - caycep 8y ago
    It was levodopa for Awakenings, no? Unless I'm remembering the scene w/ Robin Williams and the lecturer wrong
    - finnh 8y ago
      L-dopa, yup. I don’t think GP meant actually ambien. Also GP if you check this - what are the downsides of gabapentin your relative was trying to get away from? I thought that was a fairly benign drug, even for long-term use.
      - philote 8y ago
        I knew someone who took it for a while, and drowsiness, memory issues, balance issues, and depression were all pretty bad alone, much less combined. And getting off of it has to be gradual due to rebound pain.
hprotagonist 8y ago
Or maybe not: The neuroimaging work is interesting from a research point of view, but what ultimately matters in a study like this are the clinical results. These were promising, but I think the headlines are over-optimistic. This is very much a preliminary study and the results seem mixed to me. http://blogs.discovermagazine.com/neuroskeptic/2017/09/28/consciousness-vagus-stimulation/ http://blogs.discovermagazine.com/neuroskeptic/2017/09/28/co...
- nonbel 8y ago
  Yea, after learning that the patient died a few months later from a lung infection (after being kept alive for 15 years) yet the doctors/researchers claim there is "no link", it makes this whole story sound like BS. I could see "a link is unknown", or something like that but concluding "no link" from that info is impossible and even unreasonable. I'll even allow that by stimulating the vagus nerve he had more unconscious movements than before and they misinterpreted it as responding to the environment, so its not totally malicious. But that team has given a very strong reason not to trust anything they say.
  - nonbel 8y ago
    I said nearly the exact same thing upthread. I don't get the difference.
rootusrootus 8y ago
This serves as a reminder that I need to make sure my wishes are well documented and understood by my family that under no circumstances should they keep my body alive for 15 years in similar circumstances. And especially don't try to give me a tiny bit more consciousness, so that I may suffer.
- acchow 8y ago
  I'm terrified to think this person may be conscious enough to be experiencing the equivalent of 15 years of sleep paralysis. Fuck. That.
  - jacobwilliamroy 8y ago
    This train of thought does not lead to a good place. https://www.youtube.com/watch?v=mgKoCppbGFI https://www.youtube.com/watch?v=mgKoCppbGFI
    - toxik 8y ago
      I don’t understand the relevancy of this game demo you linked.
      - jacobush 8y ago
        Trapped in a body
  - sbjustin 8y ago
    This exactly. I've been very clear to my wife I don't want that at all.
- jarfil 8y ago
  If I had a choice between suffering and dying... I'd pick whichever had a greater chance of letting me achieve any of my goals. Maybe seeing my family one more time would be a worthy goal, or maybe sparing them some suffering would be a better one, but I'd rather make that choice myself.
largbae 8y ago
This article is about a year old. Here is a later article about the patient's death a few months after treatment. https://www.theguardian.com/science/2017/oct/05/scientists-concealed-death-of-patient-at-centre-of-vegetative-state-breakthrough https://www.theguardian.com/science/2017/oct/05/scientists-c...
- browsercoin 8y ago
  it was no linked to the protocol and they wanted to keep it under wraps for a good reason.
  - nonbel 8y ago
    From that link: >"a concern that people might have wrongly linked the therapy, which involved nerve stimulation, to the 35-year-old’s death from a lung infection." The vagus nerve also innervates the lungs, and performing a surgery to stimulate it could impact the lungs or immune system in general... so there is definitely reason to suspect a link. I mean he was kept alive for 15 years apparently and then died relatively shortly after this procedure. Just because there is no way to verify anything doesn't mean you can conclude "no link". If the doctors/researchers did actually make this claim (as opposed to the journalist), I would suspect this story about restored consciousness is more likely total BS than not. EDIT: There is a quote later on coming directly from the doctor, so looks like this study is probably BS.
    - thomasfedb 8y ago
      I think you're wrong to link the implant to the lung infection on the basis that the vagus nerve "innervates the lungs" - which is a best an oversimplification. It's a very unlikely route for infection compared to standard hospital acquired or ventilator associated pneumonia. I'm a student doctor.
      - nonbel 8y ago
        I didn't "link" anything. I proposed a few possible links. And you don't think stimulating the vagus nerve could have some effect on the lung (eg secretions) which can result in infection? Here is a random article that gives plausibility to such a link: Vagus Nerve through α7 nAChR Modulates Lung Infection and Inflammation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127262/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127262/ I am certain there are many, many research articles like that.
aaron695 8y ago
Obviously fake news, they never 'restores consciousness' and they lied, which is not unusual since we see time after time these 'vegetative state' stories are simply made up. "The results seemed promising. As Newsweek (and many other publications) reported, although Guillaume did not fully recover consciousness, he showed signs of what’s called minimal consciousness—a significant improvement. He could follow objects with his gaze and move his head on command. " https://www.newsweek.com/man-vegetative-state-woken-scientists-died-june-heres-why-they-withheld-news-679001 https://www.newsweek.com/man-vegetative-state-woken-scientis... There's no evidence it was anything more than an automaton. Comments like this could not be more unprofessional as a scientist "His mother reported that he was more awake when a therapist read him a book. "We saw a tear on his cheek when he listened to a music he loved," adds Angela Sirigu, about emotional reactions. "
nihil75 8y ago
I wonder if it really is his consciousness or just automated responses from a juiced-up brain.
- cambaceres 8y ago
  So are you

198 points by Jaruzel 8y ago

Reminded me of the controversial Terri Shiavo case(1), where the parents fought till the end to avoid her death. (1) https://en.wikipedia.org/wiki/Terri_Schiavo_case https://en.wikipedia.org/wiki/Terri_Schiavo_case

acchow 8y ago
> "staff at the Pinellas Park hospice facility disconnected the feeding tube on March 18, 2005, and Schiavo died on March 31, 2005." So, they starved her to death over 13 days? How do they know she wasn't experiencing this as torture?
- arthurcolle 8y ago
  I'm baffled that disconnection of a feeding tube seems like a reasonable way to interrupt life-sustaining processes
  - woofyman 8y ago
    Euthanasia is illegal in the US. The only thing you can do is remove artificial means of life support. It’s in humane. People should be able to die with dignity. We treat our pets better.
    - wahern 8y ago
      I don't disagree, but this recent assisted suicide story certainly has added some complexity to the debate: https://www.theguardian.com/society/2018/mar/17/assisted-dying-euthanasia-netherlands https://www.theguardian.com/society/2018/mar/17/assisted-dyi... TL;DR: Assisted suicide approved and performed for woman suffering from depression and psychosis. Actually, it wasn't the first non-terminal assisted suicide. I remember a 2009 story involving a man who decided to die with his wife. The wife had terminal cancer, he was healthy, albeit 80 years old. https://www.theguardian.com/society/2009/jul/14/assisted-suicide-dignitas https://www.theguardian.com/society/2009/jul/14/assisted-sui... That article also discusses another couple suffering from non-terminal but chronic illness and chronic pain. I don't remember reading about that couple at the time.
      - hanniabu 8y ago
        Yeah, but you know what? That's was their choice
        wahern 8y ago
        Yes. I don't mean to be critical of those decisions. But assisted suicide is often pitched to the public as a compassionate treatment to terminal illness. Being narrowly circumscribed is supposed to minimize the potential for abuse and coercion. So when I say those stories add complexity, I mean to say they create fodder for those opposing assisted suicide.
        mijamo 8y ago
        Not really, you just have to write the law to allow what you think should be allowed. Some countries allow assisted suicide in non critical conditions, some allow it only for critical conditions, and some never allow it. I don't see why it would give any weight to those opposing assisted suicide. And TBH I don't understand what is the problem with assisted suicide for non critical conditions in the first place. People get to chose their life, and should be able to end it if they want to. The only alternative as I see it would be to put on the state the responsibility to make everyone so happy they would never want to die, which does not sound like something those opposing assisted suicide would want either. Why would we force people to live miserable lives?
        jacobush 8y ago
        Please at least try to see the other side of the argument. Or we could replace a large chunk of depression treatment with firing squads and it would be fine your argument above. After all, they wanted to die.
        AnIdiotOnTheNet 8y ago
        You would prefer suicide by cop?
        8y ago
- wahern 8y ago
  Because it was repeatedly and conclusively shown at that point that her brain had atrophied to half its size. She was gone. The reason the situation almost devolved into an armed stand-off between the courts and the executive branch is because every judge (Florida and Federal) who looked at the case--that is, those officials presented with all the evidence from both sides--quickly understood the reality; whereas the politicians hundreds and thousands of miles away who hadn't the first clue about the facts had other objectives in mind. The subsequent autopsy confirmed what was already known. But there was never any accountability because by then the media had moved on. Terry Schiavo is not the case to point to when questioning the science and treatment of PVS.
  - sandworm101 8y ago
    It was a fight between scientists and non-scientists. The scientists saw the scans of her head that showed a void where there should have been brain. The non-scientists looked at a handful of home movies where here random movements and facial expressions occasionally lined up to make her look aware. Such debate between scientific evaluation and layperson "gut feelings" predate so many of today's debates re climate. It was also a generational fight. Her husband, the normal go-to for medical decisions was on one side, and her parents on the other. The parents wanted control over their daughter. They could not accept the widespread default that, for most all medical/legal matters, spouses trump parents. And this was Florida. So the "rights" of the older generation were given greater play in the courts than would have happened in other states.
    - deleted 8y ago
      [deleted]
    - nonbel 8y ago
      >"The scientists saw the scans of her head that showed a void where there should have been brain." People with "no" (very small) brains due to hydrocephalus have been discovered who are successful mathematics students and public servants. So, not sure the scientists are right here. As long as the brain is shrinking slow enough it may not be a huge deal in terms of mental ability. http://mentalfloss.com/article/70204/man-without-brain http://mentalfloss.com/article/70204/man-without-brain https://www.theguardian.com/education/2003/oct/02/research.highereducation1 https://www.theguardian.com/education/2003/oct/02/research.h...
- mikeash 8y ago
  It doesn’t matter. Starving a bedridden patient to death is a passive activity, and is hence defined as “moral.” In contrast, giving them a morphine overdose so they die quickly and painlessly is an active measure and thus defined as “immoral.”
  - HillaryBriss 8y ago
    > giving them a morphine overdose so they die quickly and painfully ? wait. is a morphine overdose painful?
    - JshWright 8y ago
      No, that was surely a typo
      - mikeash 8y ago
        More like a sudden brain malfunction, but yeah.
  - sulam 8y ago
    I think you meant "painlessly".
    - mikeash 8y ago
      Uh, yeah, I kinda did. Thanks.
  - HillaryBriss 8y ago
    I'm not taking a position on this or trying to argue. I'm truly somewhat confused by it all. I'm not sure I agree with this, as I find it, honestly, rather frightening in practice, but it seems like painkiller administration is a kind of euthanasia loophole, even in places where euthanasia is not legal: Passive euthanasia is the withholding of treatments necessary for the continuance of life. Whether the administration of increasingly necessary, albeit toxic doses of opioid analgesia is regarded as active or passive euthanasia is a matter of moral interpretation, but in order to pacify doctors’ consciences, it is usually regarded as a passive measure. Many people, therefore, regard it as an acceptable facet of good professional practice. https://jramc.bmj.com/content/147/3/367 https://jramc.bmj.com/content/147/3/367

finnh 8y ago

Amazingly, ambien has had a similar effect for a small group of patients, returning them to consciousness for hours at a time after months or years of coma https://www.nytimes.com/2011/12/04/magazine/can-ambien-wake-minimally-conscious.html https://www.nytimes.com/2011/12/04/magazine/can-ambien-wake-...

anon49124 8y ago
Yup, basically the movie plot of Awakenings. Also, a family member of mine, whom was not catatonic, tried it for post-stroke fatigue/pain/neuropathy/brain fog to get away from gabapentin&pregabalin.
- caycep 8y ago
  It was levodopa for Awakenings, no? Unless I'm remembering the scene w/ Robin Williams and the lecturer wrong
  - finnh 8y ago
    L-dopa, yup. I don’t think GP meant actually ambien. Also GP if you check this - what are the downsides of gabapentin your relative was trying to get away from? I thought that was a fairly benign drug, even for long-term use.
    - philote 8y ago
      I knew someone who took it for a while, and drowsiness, memory issues, balance issues, and depression were all pretty bad alone, much less combined. And getting off of it has to be gradual due to rebound pain.

hprotagonist 8y ago

Or maybe not: The neuroimaging work is interesting from a research point of view, but what ultimately matters in a study like this are the clinical results. These were promising, but I think the headlines are over-optimistic. This is very much a preliminary study and the results seem mixed to me. http://blogs.discovermagazine.com/neuroskeptic/2017/09/28/consciousness-vagus-stimulation/ http://blogs.discovermagazine.com/neuroskeptic/2017/09/28/co...

nonbel 8y ago
Yea, after learning that the patient died a few months later from a lung infection (after being kept alive for 15 years) yet the doctors/researchers claim there is "no link", it makes this whole story sound like BS. I could see "a link is unknown", or something like that but concluding "no link" from that info is impossible and even unreasonable. I'll even allow that by stimulating the vagus nerve he had more unconscious movements than before and they misinterpreted it as responding to the environment, so its not totally malicious. But that team has given a very strong reason not to trust anything they say.
- nonbel 8y ago
  I said nearly the exact same thing upthread. I don't get the difference.

rootusrootus 8y ago

This serves as a reminder that I need to make sure my wishes are well documented and understood by my family that under no circumstances should they keep my body alive for 15 years in similar circumstances. And especially don't try to give me a tiny bit more consciousness, so that I may suffer.

acchow 8y ago
I'm terrified to think this person may be conscious enough to be experiencing the equivalent of 15 years of sleep paralysis. Fuck. That.
- jacobwilliamroy 8y ago
  This train of thought does not lead to a good place. https://www.youtube.com/watch?v=mgKoCppbGFI https://www.youtube.com/watch?v=mgKoCppbGFI
  - toxik 8y ago
    I don’t understand the relevancy of this game demo you linked.
    - jacobush 8y ago
      Trapped in a body
- sbjustin 8y ago
  This exactly. I've been very clear to my wife I don't want that at all.
jarfil 8y ago
If I had a choice between suffering and dying... I'd pick whichever had a greater chance of letting me achieve any of my goals. Maybe seeing my family one more time would be a worthy goal, or maybe sparing them some suffering would be a better one, but I'd rather make that choice myself.

largbae 8y ago

This article is about a year old. Here is a later article about the patient's death a few months after treatment. https://www.theguardian.com/science/2017/oct/05/scientists-concealed-death-of-patient-at-centre-of-vegetative-state-breakthrough https://www.theguardian.com/science/2017/oct/05/scientists-c...

browsercoin 8y ago
it was no linked to the protocol and they wanted to keep it under wraps for a good reason.
- nonbel 8y ago
  From that link: >"a concern that people might have wrongly linked the therapy, which involved nerve stimulation, to the 35-year-old’s death from a lung infection." The vagus nerve also innervates the lungs, and performing a surgery to stimulate it could impact the lungs or immune system in general... so there is definitely reason to suspect a link. I mean he was kept alive for 15 years apparently and then died relatively shortly after this procedure. Just because there is no way to verify anything doesn't mean you can conclude "no link". If the doctors/researchers did actually make this claim (as opposed to the journalist), I would suspect this story about restored consciousness is more likely total BS than not. EDIT: There is a quote later on coming directly from the doctor, so looks like this study is probably BS.
  - thomasfedb 8y ago
    I think you're wrong to link the implant to the lung infection on the basis that the vagus nerve "innervates the lungs" - which is a best an oversimplification. It's a very unlikely route for infection compared to standard hospital acquired or ventilator associated pneumonia. I'm a student doctor.
    - nonbel 8y ago
      I didn't "link" anything. I proposed a few possible links. And you don't think stimulating the vagus nerve could have some effect on the lung (eg secretions) which can result in infection? Here is a random article that gives plausibility to such a link: Vagus Nerve through α7 nAChR Modulates Lung Infection and Inflammation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127262/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127262/ I am certain there are many, many research articles like that.

aaron695 8y ago

Obviously fake news, they never 'restores consciousness' and they lied, which is not unusual since we see time after time these 'vegetative state' stories are simply made up. "The results seemed promising. As Newsweek (and many other publications) reported, although Guillaume did not fully recover consciousness, he showed signs of what’s called minimal consciousness—a significant improvement. He could follow objects with his gaze and move his head on command. " https://www.newsweek.com/man-vegetative-state-woken-scientists-died-june-heres-why-they-withheld-news-679001 https://www.newsweek.com/man-vegetative-state-woken-scientis... There's no evidence it was anything more than an automaton. Comments like this could not be more unprofessional as a scientist "His mother reported that he was more awake when a therapist read him a book. "We saw a tear on his cheek when he listened to a music he loved," adds Angela Sirigu, about emotional reactions. "

nihil75 8y ago

I wonder if it really is his consciousness or just automated responses from a juiced-up brain.

cambaceres 8y ago
So are you