The Medical Practice Impact of Functional Neuroimaging Studies in Patients with Disorders of Consciousness

Abstract

Functional neuroimaging studies of patients with disorders of consciousness have shown a small number of patients clinically diagnosed as in a vegetative state who, by fMRI or FDG-PET activation patterns, retain ideational capacity to follow commands showing they are aware. This finding impacts medical practice in several ways. The diagnostic criteria for disorders of consciousness must evolve from purely clinical to clinical plus functional neuroimaging. Prognosis is affected because the subgroup who retain this capacity comprise those with a higher likelihood for spontaneous clinical improvement. A few patients can be taught communication systems using fMRI responses, improving patient-centered care by allowing their participation in their own medical treatment decisions involving neurorehabilitation, stimulation, and palliation. A few medicolegal practice issues also are impacted by fMRI studies. But before functional neuroimaging studies can be fully incorporated into medical practice in these patients, they must be better understood, validated, and standardized.