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PVS diagnosis 'based on probabilities, not absolutes'

The American Academy of Neurology (AAN) defines a "persistent vegetative state" as a condition that appears within one month after a brain injury and in which the patient shows:

-- No evidence of awareness of self or environment and an inability to interact with others;

-- No evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli;

-- No evidence of language comprehension or expression;

-- Intermittent wakefulness manifested by the presence of sleep-wake cycles;

-- Sufficiently preserved hypothalamic and brainstem autonomic functions to permit survival with medical and nursing care;

-- Bowel and bladder incontinence; and

-- Variably preserved cranial nerve (pupillary, oculocephalic, corneal, vestibulo-ocular, gag) and spinal reflexes.

The academy also states that "recovery of consciousness from post-traumatic PVS after 12 months in adults and children is unlikely. Recovery from non-traumatic PVS after 3 months is exceedingly rare." AAN guidelines finally explain that the diagnosis of a "permanent vegetative state" is, "as with all clinical diagnoses in medicine, based on probabilities, not absolutes."

Stevens said that last criterion is the main problem with the types of absolute statements made by doctors like Cranford when giving a PVS diagnosis.

"With persistent vegetative state, that diagnosis is based upon an observation and an opinion," Stevens said. "The diagnosis itself carries with it a prognosis -- in other words, that people are not going to recover, that this is permanent and that, therefore, you can do things like were done with Terri Schiavo, where her feeding tube was removed.

"A number of cases have shown this not to be the case," Stevens said. "The one that [Cranford] was involved in is a good example of that, but there are other cases as well, where patients thought to be in a persistent vegetative state have then recovered, some of them quite significantly."

Cybercast News Service found more than two dozen cases where published news reports document patients diagnosed as being in a persistent or permanent vegetative state, or coma "waking up," including:

--Recovery after three years - Marcello Manunza suffered a brain injury during a car crash in November 1987. In July 1990, relatives noticed that he was following them around the room with his eyes and appeared to be trying to read encouraging signs that had been placed in his nursing home room. Within days he was able to eat, control the movement of his limbs and speak;

--Recovery after seven years - Hawaii resident Peter Sana lapsed into a coma after contracting meningitis, an inflammation of the membrane that encloses the brain and spinal cord. He was in a Honolulu nursing home in September 2001 when he began responding to commands from nurses. Sana's father visited him every day during the seven years. His caregivers credit visits by family members with giving Sana the will to wake up;

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