Vegetative state patients can respond to questions

Scientists have been able to reach into the mind of a brain-damaged man and communicate with his thoughts.

The research, carried out in the UK and Belgium, involved a new brain scanning method.

Awareness was detected in three other patients previously diagnosed as being in a vegetative state.

The study in the New England Journal of Medicine shows that scans can detect signs of awareness in patients thought to be closed off from the world.

Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage.

Scanning technique

The scientists used functional magnetic resonance imaging (fMRI) which shows brain activity in real time.

They asked patients and healthy volunteers to imagine playing tennis while they were being scanned.

In each of the volunteers this stimulated activity in the pre-motor cortex, part of the brain which deals with movement.

This also happened in four out of 23 of the patients presumed to be in a vegetative state.

The BBC's Fergus Walsh tests the new brain scanning technique

I volunteered to test out the scanning technique.

I gave the scientists two women's names, one of which was my mother's.

I imagined playing tennis when they said the right name, and within a minute they had worked out her name.

They were also able to guess correctly whether I had children.

Questions

This is a continuation of research published three years ago, when the team used the same technique to establish initial contact with a patient diagnosed as vegetative.

But this time they went further.

With one patient - a Belgian man injured in a traffic accident seven years ago - they asked a series of questions.

He was able to communicate "yes" and "no" using just his thoughts.

The team told him to use "motor" imagery like a tennis match to indicate "yes" and "spatial" imagery like thinking about roaming the streets for a "no".

The patient responded accurately to five out of six autobiographical questions posed by the scientists.

For example, he confirmed that his father's name was Alexander.

The study involved scientists from the Medical Research Council (MRC), the Wolfson Brain Imaging Centre in Cambridge and a Belgian team at the University of Liege.

Dr Adrian Owen from the MRC in Cambridge co-authored the report:

"We were astonished when we saw the results of the patient's scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts."

Dr Owen says this opens the way to involving such patients in their future treatment decisions: "You could ask if patients were in pain and if so prescribe painkillers and you could go on to ask them about their emotional state."

It does raise many ethical issues - for example - it is lawful to allow patients in a permanent vegetative state to die by withdrawing all treatment, but if a patient showed they could respond it would not be, even if they made it clear that was what they wanted.

The Royal Hospital for Neurodisability in London is a leading assessment and treatment centre for adults with brain injuries.

Helen Gill, a consultant in low awareness state, welcomed the new research but cautioned that it was still early days for the research: "It's very useful if you have a scan which can show some activity but you need a detailed sensory assessment as well.

"A lot of patients are slipping through the net and this adds another layer to ensure patients are assessed correctly."

She said the hospital did a study of 60 patients admitted with a diagnosis of vegetative state and 43% could communicate.

Late-night teens 'face greater depression risk'

Going to bed earlier protects teenagers against depression and suicidal thoughts, New York research suggests.

Of 15,500 12 to 18-year-olds studied, those who went to bed after midnight were 24% more likely to have depression than those who went before 2200.

And those who slept fewer than five hours a night had a 71% higher risk of depression than those who slept eight hours, the journal Sleep reports.

It is estimated 80,000 UK children and young people have depression.

The researchers from Columbia University Medical Center in New York looked at data from 15,500 teenagers collected in the 1990s.

One in 15 of those studied were found to have depression.

Enough sleep, good food and regular exercise and all essential to stay emotionally healthy Sarah Brennan, YoungMinds

As well as the higher risk of depression, those who were set a bedtime by their parents of after midnight were 20% more likely to think about suicide than those whose bedtime was 2200 or earlier.

Those who had less than five hours sleep a night were thought to have a 48% higher risk of suicidal thoughts compared with those who had eight hours of sleep.

Teenagers who reported they "usually get enough sleep" were 65% less likely to be depressed.

Depression and suicidal thoughts were also more likely in girls, older teenagers and in those who had a lower self-perception of how much parents care about them.

Most of the parents of the adolescents in the study set a bedtime of 2200 or earlier.

A quarter set a bedtime of midnight or later.

On average the teenagers were having seven hours and 53 minutes sleep a night - less than the nine hours recommended at that age.

Study leader Dr James Gangwisch said although it it was possible that youngsters with depression struggle to sleep, the fact that parental set bedtimes were linked with depression suggests that a lack of sleep is somehow underpinning the development of the condition.

He said a lack of sleep could affect emotional brain responses and lead to moodiness that hindered the ability to cope with daily stresses.

This moodiness could affect judgment, concentration and impulse control.

Regular exercise

"Adequate quality sleep could therefore be a preventative measure against depression and a treatment for depression," he added.

Sarah Brennan, chief executive at the mental health charity YoungMinds, said: "Enough sleep, good food and regular exercise are all essential to stay emotionally healthy.

"Nearly 80,000 children and young people suffer with depression, yet we are still failing to provide our young people with the help and support to cope with it and prevent it.

"Providing parents with information about how to look after your body, for example by getting enough sleep, and how to get help if they are worried about their teenager, will ensure problems are tackled early and prevent serious mental health conditions such as depression."