Vegetative State Recovery

A vegetative state may at times be confused with a coma and vice versa but this is not true. A vegetative state is a condition which occurs when there is significant damage to the areas of the human brain (nervous system) that are associated with voluntary movement and actions, but the brainstem, which is associated with bodily vegetative functions (including the cardiovascular, respiratory and digestive systems), is intact and functions normally.

A coma, on the other hand, is a state of total unconsciousness, where the patient is unable to feel any sensation and does not wake up, even when stimulated to do so. Thus, the basic difference between a coma and a vegetative state is that, in the latter, the patient is awake or conscious, but is unaware of himself or anybody around him. Also, the patient is unable to perform any voluntary action. A coma can thus, regress or progress to brain death or a vegetative state, respectively. There are chances of recovery but the odds could be low, especially, if the patient has been exhibiting the symptoms of vegetative state for a period longer than a year.

Stages of Vegetative State
The cases are usually classified into two distinct stages. The first is known as the persistent vegetative state, in which case, the patient has been in a vegetative condition for up to 4 weeks. The second stage is known as the permanent vegetative state. A patient is pronounced as being in a permanent vegetative state, when he has been persistent in this state for about a year. In the UK, the term persistent vegetative state has been replaced by the term continuous vegetative state and they both mean the same thing.

Causes and Symptoms
There can be a number of causes of a vegetative state such as brain tumors, uremia or kidney failure, alcohol ingestion, electrolyte imbalance, encephalopathy, irregular heart function, poisoning or overdose of drugs, insulin overdose, shock and trauma to the brain.

Vegetative state symptoms include the inability of the patient to respond to external stimuli but the patient still has some level of consciousness. This includes the ability to open and close eyes as part of the sleep cycle. They open their eyes on being fed and are capable of swallowing. The patient might even exhibit some other behavior which might make an observer think that the patient is regaining consciousness, like smiling, grinding their teeth, shedding tears, making sounds such as grunting, moaning or in some cases even screaming.

Recovery
Vegetative state recovery can range from a matter of a few weeks or months to no recovery at all for many years. The rate of recovery can vary according to the age of the affected individual and the extent of the brain injury. There are generally two stages of recovery. First is the retrieval of consciousness where the person becomes aware of his body as well as the surrounding environmental stimuli. Second is the retrieval of functions like communication, mobility and participation in activities. Retrieval of function is not possible without the restoration of consciousness but the reverse is not true.

The recovery period is shorter and there are better chances of recovery of the younger individuals as compared to the older ones. The odds of recovery go down considerably, once a person has been in a vegetative state for a period of more than 6 months. Even if the patient recovers after a period of more than six months, they are usually disabled and are unable to perform some of the normal functions. They need to be taken care of.

There has been enormous debates on the implications of the vegetative state and whether patients who have been in such a state for long periods of time should be allowed to die (known as mercy killing). There have been cases of patients being in such a state for years without showing any signs of recovery. They survive as long as they are connected to a feeding tube. There have been a number of legal issues too, related to mercy killings over the last few years and there are a number of people both for and against this.

Vegetative state recovery can happen. There have been certain cases of recovery after a long period of time, and have often been termed miraculous. All one needs is faith!