Talk:Vegetative state

proposed content in Case Studies of Experimental Treatments

Moved here for discussion; content was added here then re-added here by User: 97.91.202.83:

Case Studies of Experimental Treatments

Levodopa

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.

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.

Baclofen

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

Removal of cold intubated oxygen

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.

Bifocal extradural cortical stimulation

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. 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.

References

• Responses:

IP, first section headers are sentence case, not title case - see WP:MOS

second, we don't have sections called "Case Studies of Experimental Treatments"; you changed the name from "Treatments". Please see WP:MEDMOS; per that guideline, what goes in the Treatment section, is actual treatments. Not research. This is all research.

third, about the references, please see WP:MEDRS, particularly WP:MEDDEF where "primary" and "secondary" sources are defined, and WP:MEDDATE which talks about the age of sources. The sources used here are almost all primary sources, and all are old. This is not how we build content.

fourth, this content about " 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," is promotional which violates a core policy here.

if you want to revise this based on good secondary sources and remove the promotional content, please feel free to repost. Jytdog (talk) 16:51, 30 November 2016 (UTC)

First, WP:MEDMOS is a guideline, not policy.

Second, WP:MEDMOS does not appear to prohibit case studies, though it indicates "excessive examples should be avoided."

Third, in WP:MEDMOS the "suggested headings" do not exclude alternative headings, such as I have suggested here. Moreover, even under the suggested heading "Treatment or Management" the suggestion to "avoid experimental/speculative treatments" should be read to chiefly apply to avoiding content that encourages "do it yourself" medical care--especially when there are widely accepted treatments. But in this case, there are no widely accepted treatments. Moreover, the fear of encouraging "do it yourself" treatments does not apply to this subject matter as these patients are all under physician's care and at "worst" we are providing people with information they may wish to bring to the attention of the attending physician of their loved one.

Fourth, there is no prohibition to using peer reviewed studies . . . most of which include reviews of the literature and in that respect are secondary sources. Indeed, most of the sources cited are similar to those that were used in the section I restored. Please read the articles cited before arguing that they should be excluded.

Fifth, I disagree on your assessment that the material is too dated. One source I added is from 2015...or did you not bother to look at it. Also, WP:MEDDATE discusses replacing old reviews with newer reviews which if they are more updated. The fact that a source is over 5 years alone does not justify deleting that source if there is not a newer study to replace and update the information being provided.

I have no problem with you removing what you consider to be promotional content or changing the title case. But I also think you--and the editor who originally cut this material without discussion--should study the WP:Preserve guideline and look for ways to include and improve this content rather than for reasons to exclude it. For example, you can tag it with a request for newer studies, if you like, but it is not necessary to delete the material. For the general audience of readers interested in this subject, information on successes with experimental treatments in an area where there is no proven treatment may be interesting and wanted.97.91.202.83 (talk) 20:18, 30 November 2016 (UTC)

One ref is from 2015 but it is primary; not OK per MEDRS.

Guidelines and policies have wide consensus and you cannot just blow them off without justification (and saying "it is just a guideline" is not a justification). If you want to provide actual justifications I am interested in hearing. Jytdog (talk) 21:43, 30 November 2016 (UTC)

The justification is that many readers may be interested in well documented reports of experimental treatments which have produced positive results for a condition for which there is not a single universally accepted treatment.97.91.202.83 (talk) 15:42, 1 December 2016 (UTC)

Thanks for replying. The mission of WP is not to interest readers but to provide them with accepted knowledge, per WP:NOTEVERYTHING, which is policy. The policies and guidelines are what allow us to serve the mission. Please use sources per WP:MEDRS. Thanks. Jytdog (talk) 15:50, 1 December 2016 (UTC)

Peer reviewed medical studies are not "definitive knowledge" but they are certainly "accepted knowledge" because they are literally accepted by experts in the field (peer reviewers) for publication because they make a significant contribution to knowledge in that field of specialty.

I realize there is always ways for self-appointed guardians of WP to wikilawyer policies in a manner to justify deleting material from verifiable sources and driving away new editors. But I need to ask, if we decide to go with your interpretation of all WP policies and your guidance for policing this article, shall I go ahead and remove all material from this article that cites medical journal articles that contain any original content (i.e.--are not strictly, 100% reviews of studies and therefore purely a "secondary source") or stray from the recommended list of sections covered by WP:MEDRS? And if we do that, how does such a slavish adherence to WP:MEDRS that really help readers? 97.91.202.83 (talk) 16:19, 1 December 2016 (UTC)

I see you opened a discussion at MEDMOS, here. We'll see how that goes. Thanks for addressing MEDRS. It is an essential guideline; there is an essay (that I drafted originally) called WP:Why MEDRS? that may help you understand its importance in WP. With regard to improving the article by improving refs and copyediting based on the better refs, that is always welcome, but it isn't helpful if it is done in WP:POINTY way. Jytdog (talk) 16:31, 1 December 2016 (UTC)

As per the MEDMOS outline for "Diseases or disorders or syndromes," I added the section "Research direction." I then edited the material to eliminate references to any particular researchers and, where possible, noted literature reviews.97.91.202.83 (talk) 18:41, 8 December 2016 (UTC)

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)

I would point out that at least one of the papers, Ford, includes a literature review.97.91.202.83 (talk) 19:06, 9 December 2016 (UTC)

I'll second what Jytdog has been saying. There is nothing about this situation that justifies deviating from WP:MEDRS. Looie496 (talk) 14:00, 10 December 2016 (UTC)

A Biblico-Ethical Response to the Question of Withdrawing Fluid and Nutrition from Individuals in the Persistent Vegetative State (Master's thesis)

Is that indended to be a serious reference? WTF? --jae (talk) 17:19, 15 January 2022 (UTC)

Requested move 5 June 2023

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

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). Vaticidalprophet 09:11, 5 June 2023 (UTC)

• Support as proposed per nom and concise Red Slash 22:42, 9 June 2023 (UTC)
• Support per nom, splitting does not make sense to me either. Draken Bowser (talk) 19:49, 10 June 2023 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Page move on 12 June 2023

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)