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March 18, 2005

Misdiagnosing PVS

Topics: Medical Issues

I heard Shep Smith on Fox News say several times this afternoon that no one has ever emerged from a persistent vegetative state. There's a good reason for that. When someone shows signs of consciousness, it is not assumed that they have emerged from PVS, it is assumed they were originally misdiagnosed.

Consider this study. Forty PVS patients were studied. They were given therapy to promote communication. Seventeen of the patients (43%!) were found to be able to communicate. The conclusions? These patients were all originally misdiagnosed as PVS, and such a diagnosis cannot be easily made and requires a team of specialists.

Perhaps this is an argument of semantics. Were they misdiagnosed or did they emerge from a PVS? It doesn't really matter. What matters is that in this sample 43% of people thought to be in a PVS were able to improve and learn to communicate. Another thing this study revealed is that a disproportionate number of those "misdiagnosed" were those that were visually impaired. The fact that Terri reacts to her mother's face when she gets very close to Terri may indicate that Terri does not see her well at a distance due to her brain damage.

This study is not unusual, either. I have seen estimates that range from 33% to 60% of PVS patients are misdiagnosed. So is Terri one of these "misdiagnosed," patients who could learn to communicate? Unless she is given the benefit of the type of therapy these test patients received we will never know.

From the abstract of this study:

The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made, even by the most experienced clinician, from a bedside assessment. Accurate diagnosis is possible but requires the skills of a multidisciplinary team experienced in the management of people with complex disabilities. Recognition of awareness is essential if an optimal quality of life is to be achieved and to avoid inappropriate approaches to the courts for a declaration for withdrawal of tube feeding.

Credits: Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit, Keith Andrews, director of medical services; Lesley Murphy, senior clinical psychologist; Ros Munday, senior occupational therapist; Clare Littlewood, senior occupational therapist; Royal Hospital for Neurodisability, London

Cross-posted at Wittenberg Gate

Posted by dory at March 18, 2005 5:31 PM

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» PVS~or not? from A Mom And Her Blog
I've heard so many people say today that Terri is PVS...there is just so much misinformation about this, and it drives me crazy. My son came home today already knowing that Terri's feeding tube had been removed. I was a... [Read More]

Tracked on March 18, 2005 6:29 PM

» http://entropyhouse.com/blog/2005/03/thirty-pieces from Christianity and Middle-Earth
I am not pleased with what I heard on Fox News this afternoon. They are not paying attention. [Read More]

Tracked on March 18, 2005 8:19 PM


Article from BBC NEWS July 2003:

US man wakes from 19-year coma

Terry Wallis: Weekend trips away kept his brain working
A man from the US state of Arkansas has regained consciousness after spending 19 years in a coma.
Terry Wallis, 39, had been at the centre of an accident in July 1984 when a car he was travelling in plunged into a creek.

The driver of the vehicle, Mr Wallis' friend, died.

Mr Wallis was discovered by rescuers a day later, but was comatose.

He has many historic events to catch up with, including the election of his state governor, Bill Clinton, to the presidency of the United States, his time in office and his handover to George W Bush.

He startled his family by speaking suddenly almost a month ago.

"He started out with 'Mom' and surprised her and then it was 'Pepsi' and then it was 'milk,'" Alesha Badgley, Stone County Nursing and Rehabilitation Centre social director, said.

I couldn't tell you my first thought, I just fell over on the floor

Angilee Wallis
"And now it's anything he wants to say."

Mr Wallis' father, Jerry Wallis, said his son uttered his first word. "He has improved every day since," he said.

Terry Wallis' wife, Sandi, said the whole family had missed his company.

"It's been hard dealing with it. It's been hard realising the man I married can't be there," she said.

Mr Wallis also has a daughter, Amber, who was born shortly before the accident took place.

She is now 19 and Mr Wallis - who was left a quadriplegic as a result of the crash - has said he wants to walk again, for her.

Terry Wallis was at the centre of a car accident
His mother, Angilee Wallis, called her son's return to consciousness "a miracle".

"I couldn't tell you my first thought, I just fell over on the floor," she said.

Doctors at the rehabilitation centre said Mr Wallis' recovery might be due in part to his family taking him out at weekends and special occasions.

"The doctor said that's why he remembers things; we might have kept his mind going," Sandi Wallis said.

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Posted by: karen at March 18, 2005 5:51 PM

How can I email or call the medical examiner if Terri does dies?

Posted by: Katie at March 18, 2005 6:53 PM

Katie, the contact information for the medical examiner's office is in the post just below this one. Click on the "continue reading..." link.

Posted by: Dory at March 18, 2005 6:59 PM