Editing Vegetative state (section)

=== Misdiagnoses ===
Statistical PVS misdiagnosis is common. An example study with 40 patients in the [[United Kingdom]] diagnosed with PVS reported 43% of the patients were considered to have been misdiagnosed, and another 33% had recovered whilst the study was underway.<ref>{{cite journal | vauthors = Andrews K, Murphy L, Munday R, Littlewood C | title = Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit | journal = BMJ | volume = 313 | issue = 7048 | pages = 13–16 | date = July 1996 | pmid = 8664760 | pmc = 2351462 | doi = 10.1136/bmj.313.7048.13 }}</ref> Some PVS cases may actually be a misdiagnosis of patients being in an undiagnosed [[minimally conscious state]].<ref>{{cite journal | vauthors = Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND | display-authors = 6 | title = The minimally conscious state: definition and diagnostic criteria | journal = Neurology | volume = 58 | issue = 3 | pages = 349–53 | date = February 2002 | pmid = 11839831 | doi = 10.1212/wnl.58.3.349 | name-list-style = vanc | doi-access = free }}</ref> Since the exact diagnostic criteria of the minimally conscious state were only formulated in 2002, there may be chronic patients diagnosed as PVS before the secondary notion of the minimally conscious state became known.

Whether or not there is any conscious awareness with a patient's vegetative state is a prominent issue.  Three completely different aspects of this should be distinguished. First, some patients can be conscious simply because they are misdiagnosed (see above). In fact, they are not in vegetative states. Second, sometimes a patient was correctly diagnosed but is then examined during the early stages of recovery. Third, perhaps some day the notion itself of vegetative states will change so to include elements of conscious awareness. Inability to disentangle these three example cases causes confusion. An example of such confusion is the response to an experiment using [[functional magnetic resonance imaging]] which revealed that a woman diagnosed with PVS was able to activate predictable portions of her brain in response to the tester's requests that she imagine herself playing tennis or moving from room to room in her house. The brain activity in response to these instructions was indistinguishable from those of healthy patients.<ref>{{cite journal | vauthors = Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD | title = Detecting awareness in the vegetative state | journal = Science | volume = 313 | issue = 5792 | pages = 1402 | date = September 2006 | pmid = 16959998 | doi = 10.1126/science.1130197 | s2cid = 54524352 | citeseerx = 10.1.1.1022.2193 }}</ref><ref name="BBC news ">{{cite news | url=http://news.bbc.co.uk/2/hi/health/5320234.stm | title= Vegetative patient 'communicates': A patient in a vegetative state can communicate just through using her thoughts, according to research | date= September 7, 2006| work=BBC News | access-date=2008-08-14 }}</ref><ref name="Stein ">{{cite news | url=http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/09/08/MNGI9L1IM81.DTL | title=Vegetative patient's brain active in test: Unprecedented experiment shows response to instructions to imagine playing tennis | vauthors = Stein R | date=September 8, 2006 | newspaper= San Francisco Chronicle| access-date=2007-09-26 }}</ref>

In 2010, Martin Monti and fellow researchers, working at the MRC Cognition and Brain Sciences Unit at the [[University of Cambridge]], reported in an article in the ''[[New England Journal of Medicine]]''<ref>{{cite journal | vauthors = Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, Owen AM, Laureys S |title=Willful Modulation of Brain Activity in Disorders of Consciousness |journal=New England Journal of Medicine |date=18 February 2010 |volume=362 |issue=7 |pages=579–89 |doi=10.1056/NEJMoa0905370 |pmid=20130250 |s2cid=13358991 |doi-access=free }}</ref> that some patients in persistent vegetative states responded to verbal instructions by displaying different patterns of brain activity on [[fMRI]] scans. Five out of a total of 54 diagnosed patients were apparently able to respond when instructed to think about one of two different physical activities. One of these five was also able to "answer" yes or no questions, again by imagining one of these two activities.<ref name="alleynebeckford">{{cite web | vauthors = Alleyne R, Beckford M | url = https://www.telegraph.co.uk/health/healthnews/7150119/Patients-in-vegetative-state-can-think-and-communicate.html | archive-url = https://web.archive.org/web/20100206034817/http://www.telegraph.co.uk/health/healthnews/7150119/Patients-in-vegetative-state-can-think-and-communicate.html | url-status = dead | archive-date = 6 February 2010 | title = Patients in 'vegetative' state can think and communicate | work = Telegraph | location = United Kingdom | date = 4 February 2010 }}</ref> It is unclear, however, whether the fact that portions of the patients' brains light up on [[fMRI]] could help these patients assume their own medical decision making.<ref name="alleynebeckford"/>

In November 2011, a publication in ''The Lancet'' presented bedside EEG apparatus and indicated that its signal could be used to detect awareness in three of 16 patients diagnosed in the vegetative state.<ref>{{cite journal | vauthors = Cruse D, Chennu S, Chatelle C, Bekinschtein TA, Fernández-Espejo D, Pickard JD, Laureys S, Owen AM | display-authors = 6 | title = Bedside detection of awareness in the vegetative state: a cohort study | journal = Lancet | volume = 378 | issue = 9809 | pages = 2088–94 | date = December 2011 | pmid = 22078855 | doi = 10.1016/S0140-6736(11)61224-5 | s2cid = 1926221 | citeseerx = 10.1.1.368.3928 }}</ref>