This is the
talk page for discussing improvements to the
Vegetative state article. This is not a forum for general discussion of the article's subject. |
Article policies
|
Find medical sources: Source guidelines · PubMed · Cochrane · DOAJ · Gale · OpenMD · ScienceDirect · Springer · Trip · Wiley · TWL |
Archives:
1Auto-archiving period: 90 days
![]() |
![]() | This ![]() It is of interest to the following WikiProjects: | |||||||||||||||||||||||||||||||||
|
![]() | Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Vegetative state.
|
Moved here for discussion; content was added here then re-added here by User: 97.91.202.83:
In addition, there have been several case studies analyzed that emphasize another pharmacological possibility of treatment for patients in a persistent vegetative state. Three patients whose brains had been damaged by severe head injury recovered from a persistent vegetative state after the administration of a drug called levodopa, which boosts the body's dopamine levels. In all three cases, the patients were deeply comatose on arrival to the hospital, remained unresponsive to simple verbal commands, and their condition was unchanged for a lengthy period of time even after intensive treatment including surgery. All three patients were diagnosed as being in a persistent vegetative state for three, seven, and twelve months respectively. [1]
Case 1 describes a 14 year old boy who, three months after his trauma, could not follow moving objects with his eyes and experienced tremor-like involuntary movements as well as hypertonicity (increased tension of the muscles, meaning the muscle tone is abnormally rigid, hampering proper movement). Levodopa was recommended to relieve the patient’s parkinsonian features. Surprisingly, after nine days of treatment the patient’s involuntary movements were reduced and he began to respond toward voices. Three months after treatment, he was able to walk and obtained the intelligence of an elementary school child. One year after his trauma, he was able to walk to high school by himself. Case 2 involves a young adult who underwent deep brain stimulation one year after the trauma and showed no improvement. Levodopa was administered and one year later, once his tubes were removed, he said, "I want to eat sushi and drink beer!" Case 3 describes a middle-aged man who experienced spasticity of his extremities, was administered levodopa, and was able to say his name and address correctly after only two months.
After neurological evaluation, all three cases revealed asymmetrical rigidity or tremor and presynaptic damage in the dopaminergic (uses dopamine as neurotransmitter) systems. In conclusion, levodopa should be considered for patients in a persistent vegetative state with atypical features in their limbs and who have MRI evidence of lesions in the dopaminergic pathway, particularly presynaptic lesions in areas such as the substantia nigra or ventral tegmentum. Data shows that only 6% of adult patients recover after being in a vegetative state for six to twelve months. This poor recovery rate demonstrates the significance in the rapid recovery of patients that begin levodopa treatment, particularly in those who were in a vegetative state for almost a year.
This unexpected and late recovery of consciousness raises an interesting hypothesis of possible effects of partially regained spinal cord outputs on reactivation of cognition. Other case studies have shown that recovery of consciousness with persistent severe disability 19 months after a non-traumatic brain injury was at least in part triggered and maintained by intrathecal baclofen administration [2]
Another documented case reports recovery of a small number of patients following the removal of assisted respiration with cold oxygen. The researchers found that in many nursing homes and hospitals unheated oxygen is given to non-responsive patients via tracheal intubation. This bypasses the warming of the upper respiratory tract and causes a chilling of aortic blood and chilling of the brain. The researchers describe a small number of cases in which removal of the chilled oxygen was followed by recovery from the PVS and recommend either warming of oxygen with a heated nebulizer or removal of the assisted oxygen if it is no longer needed. The authors further recommend additional research to determine if this chilling effect may either delay recovery or even may contribute to brain damage. [3]
In December 2008, Dr Sergio Canavero, Director of the Advanced Neuromodulation Group based in Turin, Italy and one of the leading experts in the field of cortical stimulation, announced that a girl (Greta) in the permanent vegetative state (i.e. vegetative state lasting more than 12 months), recovered consciousness and was regraded as minimally conscious following several months of bifocal extradural cortical stimulation, a minimally invasive neurosurgical technique he and others developed for the treatment of central pain, Parkinson's disease, stroke rehabilitation, depression, and other neurologic and psychiatric disorders. [4] Simultaneous stimulation of the fronto-parietal "consciousness" network achieved a marked improvement of the default network of the brain. A measure of voluntary responsiveness has been obtained. Previous attempts at deep brain stimulation - Terri Schiavo being one of the patients - failed to restore consciousness. This kind of stimulation can also be guided by results of Transcranial Magnetic Stimulation (TMS) as this was able to transitorily improve a patient in PVS. [5] [6]
References
{{
cite journal}}
: |access-date=
requires |url=
(
help); Check date values in: |accessdate=
(
help)
yes it will need to go into the research section, but the content basically the same, with the same old, primary sources and all too much WP:WEIGHT. Look i will try to find some time to find reviews and write appropriate encyclopedic content about this over the weekend. 19:21, 8 December 2016 (UTC)
Is that indended to be a serious reference? WTF? -- jae ( talk) 17:19, 15 January 2022 (UTC)
The result of the move request was: Moved ( non-admin closure) >>> Extorc. talk 14:39, 12 June 2023 (UTC)
Persistent vegetative state → Vegetative state – Vegetative states are a stage in emergence from coma, and can last for short or long periods both; persistent vegetative states are a subset of long-lasting VS. This article covers both (there's no separate article for VS, and IMO it would be inappropriately splitty to write it). More concerningly, the concept of PVS in this article isn't necessarily concordant with current neurological understanding, with current practice guidelines strongly recommending the use of 'chronic vegetative state' over the persistent/permanent terms tended towards in this article.
The article needs a fair bit of work, but both in its current state and in any viable future state it handles VS as a whole, and should have a title reflecting that. The current title implies a different and far narrower focus than both our present and ideal article on this have, and not a particularly viable focus anyway (because it's incoherent to talk about chronic VS without talking about VS in general). Vaticidal prophet 09:11, 5 June 2023 (UTC)
Hello, I just completed the page move that was decided above, via the request at Wikipedia:Requested moves/Technical requests. This required adjusting the "also known as..." language in the article's opening paragraph. I went with what I figured was best, but please correct my prose if it's wrong. --- DOOMSDAYER520 ( TALK| CONTRIBS) 14:51, 12 June 2023 (UTC)
This is the
talk page for discussing improvements to the
Vegetative state article. This is not a forum for general discussion of the article's subject. |
Article policies
|
Find medical sources: Source guidelines · PubMed · Cochrane · DOAJ · Gale · OpenMD · ScienceDirect · Springer · Trip · Wiley · TWL |
Archives:
1Auto-archiving period: 90 days
![]() |
![]() | This ![]() It is of interest to the following WikiProjects: | |||||||||||||||||||||||||||||||||
|
![]() | Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Vegetative state.
|
Moved here for discussion; content was added here then re-added here by User: 97.91.202.83:
In addition, there have been several case studies analyzed that emphasize another pharmacological possibility of treatment for patients in a persistent vegetative state. Three patients whose brains had been damaged by severe head injury recovered from a persistent vegetative state after the administration of a drug called levodopa, which boosts the body's dopamine levels. In all three cases, the patients were deeply comatose on arrival to the hospital, remained unresponsive to simple verbal commands, and their condition was unchanged for a lengthy period of time even after intensive treatment including surgery. All three patients were diagnosed as being in a persistent vegetative state for three, seven, and twelve months respectively. [1]
Case 1 describes a 14 year old boy who, three months after his trauma, could not follow moving objects with his eyes and experienced tremor-like involuntary movements as well as hypertonicity (increased tension of the muscles, meaning the muscle tone is abnormally rigid, hampering proper movement). Levodopa was recommended to relieve the patient’s parkinsonian features. Surprisingly, after nine days of treatment the patient’s involuntary movements were reduced and he began to respond toward voices. Three months after treatment, he was able to walk and obtained the intelligence of an elementary school child. One year after his trauma, he was able to walk to high school by himself. Case 2 involves a young adult who underwent deep brain stimulation one year after the trauma and showed no improvement. Levodopa was administered and one year later, once his tubes were removed, he said, "I want to eat sushi and drink beer!" Case 3 describes a middle-aged man who experienced spasticity of his extremities, was administered levodopa, and was able to say his name and address correctly after only two months.
After neurological evaluation, all three cases revealed asymmetrical rigidity or tremor and presynaptic damage in the dopaminergic (uses dopamine as neurotransmitter) systems. In conclusion, levodopa should be considered for patients in a persistent vegetative state with atypical features in their limbs and who have MRI evidence of lesions in the dopaminergic pathway, particularly presynaptic lesions in areas such as the substantia nigra or ventral tegmentum. Data shows that only 6% of adult patients recover after being in a vegetative state for six to twelve months. This poor recovery rate demonstrates the significance in the rapid recovery of patients that begin levodopa treatment, particularly in those who were in a vegetative state for almost a year.
This unexpected and late recovery of consciousness raises an interesting hypothesis of possible effects of partially regained spinal cord outputs on reactivation of cognition. Other case studies have shown that recovery of consciousness with persistent severe disability 19 months after a non-traumatic brain injury was at least in part triggered and maintained by intrathecal baclofen administration [2]
Another documented case reports recovery of a small number of patients following the removal of assisted respiration with cold oxygen. The researchers found that in many nursing homes and hospitals unheated oxygen is given to non-responsive patients via tracheal intubation. This bypasses the warming of the upper respiratory tract and causes a chilling of aortic blood and chilling of the brain. The researchers describe a small number of cases in which removal of the chilled oxygen was followed by recovery from the PVS and recommend either warming of oxygen with a heated nebulizer or removal of the assisted oxygen if it is no longer needed. The authors further recommend additional research to determine if this chilling effect may either delay recovery or even may contribute to brain damage. [3]
In December 2008, Dr Sergio Canavero, Director of the Advanced Neuromodulation Group based in Turin, Italy and one of the leading experts in the field of cortical stimulation, announced that a girl (Greta) in the permanent vegetative state (i.e. vegetative state lasting more than 12 months), recovered consciousness and was regraded as minimally conscious following several months of bifocal extradural cortical stimulation, a minimally invasive neurosurgical technique he and others developed for the treatment of central pain, Parkinson's disease, stroke rehabilitation, depression, and other neurologic and psychiatric disorders. [4] Simultaneous stimulation of the fronto-parietal "consciousness" network achieved a marked improvement of the default network of the brain. A measure of voluntary responsiveness has been obtained. Previous attempts at deep brain stimulation - Terri Schiavo being one of the patients - failed to restore consciousness. This kind of stimulation can also be guided by results of Transcranial Magnetic Stimulation (TMS) as this was able to transitorily improve a patient in PVS. [5] [6]
References
{{
cite journal}}
: |access-date=
requires |url=
(
help); Check date values in: |accessdate=
(
help)
yes it will need to go into the research section, but the content basically the same, with the same old, primary sources and all too much WP:WEIGHT. Look i will try to find some time to find reviews and write appropriate encyclopedic content about this over the weekend. 19:21, 8 December 2016 (UTC)
Is that indended to be a serious reference? WTF? -- jae ( talk) 17:19, 15 January 2022 (UTC)
The result of the move request was: Moved ( non-admin closure) >>> Extorc. talk 14:39, 12 June 2023 (UTC)
Persistent vegetative state → Vegetative state – Vegetative states are a stage in emergence from coma, and can last for short or long periods both; persistent vegetative states are a subset of long-lasting VS. This article covers both (there's no separate article for VS, and IMO it would be inappropriately splitty to write it). More concerningly, the concept of PVS in this article isn't necessarily concordant with current neurological understanding, with current practice guidelines strongly recommending the use of 'chronic vegetative state' over the persistent/permanent terms tended towards in this article.
The article needs a fair bit of work, but both in its current state and in any viable future state it handles VS as a whole, and should have a title reflecting that. The current title implies a different and far narrower focus than both our present and ideal article on this have, and not a particularly viable focus anyway (because it's incoherent to talk about chronic VS without talking about VS in general). Vaticidal prophet 09:11, 5 June 2023 (UTC)
Hello, I just completed the page move that was decided above, via the request at Wikipedia:Requested moves/Technical requests. This required adjusting the "also known as..." language in the article's opening paragraph. I went with what I figured was best, but please correct my prose if it's wrong. --- DOOMSDAYER520 ( TALK| CONTRIBS) 14:51, 12 June 2023 (UTC)