title: A Cuban perspective on management of persistent vegetative state.
abstract: The Cuban Group for Study of Disorders of Consciousness is developing several research protocols to search for possible preservation of residual brain and autonomic functions in cases of persistent vegetative and minimally conscious states. We present examples showing the importance of 3D anatomic reconstruction of brain structures and MRI tractography for assessing white matter connectivity. We also present results of use of proton magnetic resonance spectroscopy technique to follow up cognitive recovery in persistent vegetative state patients transitioning to minimally conscious state. We have demonstrated recognition of a mother's voice with emotional content after zolpidem administration, indicating high-level residual linguistic processing and brain activation despite the patient's apparent inability to communicate. Hence we differ with current thinking that, by definition, subjects in persistent vegetative state are isolated from the outside world and cannot experience pain and suffering. We also consider "vegetative state" a pejorative term that should be replaced. KEYWORDS Persistent vegetative state, minimally conscious state, consciousness disorders, magnetic resonance imaging, electroencephalography, heart rate variability.
authors.affiliation: Institute of Neurology and Neurosurgery (INN), Havana, Cuba. braind@infomed.sld.cu
authors.forename: Calixto
authors.initials: C
authors.lastname: Machado
authors.forename: Mario
authors.initials: M
authors.lastname: Estévez
authors.forename: Rafael
authors.initials: R
authors.lastname: Rodríguez
authors.forename: Jesús
authors.initials: J
authors.lastname: Pérez-Nellar
authors.forename: Joel
authors.initials: J
authors.lastname: Gutiérrez
authors.forename: Maylén
authors.initials: M
authors.lastname: Carballo
authors.forename: Ana
authors.initials: A
authors.lastname: Olivares
authors.forename: Marcia
authors.initials: M
authors.lastname: Fleitas
authors.forename: Alejandro
authors.initials: A
authors.lastname: Pando
authors.forename: Carlos
authors.initials: C
authors.lastname: Beltrán
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology; D001933:Brain Stem / Q000473:pathology / Q000503:physiopathology; D003462:Cuba; D004569:Electroencephalography; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging; D018458:Persistent Vegetative State / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D011725:Pyridines / Q000627:therapeutic use; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem