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After a car accident the guy is in a minimally-conscious state for two years, they give him a sedative for a procedure, he starts talking to several people, even uses the cellphone. Two hours later the sedative wears off and he's back in a minimally-conscious state.

Wouldn't you want to give him another dose? No mention of it!

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Two years after the injury caused by a motor vehicle accident, the patient was mildly sedated, in order to undergo a CT scan, using midazolam instead of the more commonly used propofol. As the authors described in the article, the patient began to interact with the anesthetist and soon after with his parents. He talked by cellphone with his aunt and congratulated his brother when he was informed of his graduation; he recognized the road leading to his home. When he was asked about his car accident, he did not remember anything and apparently he was not aware of his condition. This clinical status lasted about two hours after drug administration and disappeared quickly thereafter, taking the patient back to the previous condition.

Mikek

Reply to
amdx
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I guess it's to spooky to comment. :-)

Reply to
amdx

Take a sedative.

Reply to
bloggs.fredbloggs.fred

Yeah I'd want to. But if the drug hasn't been cleared for that use I'd be taking a risk to do so. (even assuming I'm allowed to prescribe that sort of medicine - which I'm not)

AIUI first you've got to convince USFDA

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umop apisdn
Reply to
Jasen Betts

Midazolam is GABA A full agonist. From what I've read, the positive effects of GABA modulating drugs in most of this type of patient tends to wear off with time; the sedative effect of benzodiazepines wears off in time in healthy patients also. Some people are prone to "paradoxical" reactions to this class of drug - activatio instead of sedation - that may account for its effect in minimally conscious states.

The article also states that there may be a crossover in some patients between the MCS and catatonia, which is has been theorized by some to be some kind of ancient mammalian psychological defense mechanism against overwhelming trauma (play dead.) In that case then it's not too surprising that benzos cause improvement as they've been the first line treatment for catatonia for many years

I wonder if they've considered trying electroconvulsive therapy, as studies have shown it can increase levels of GABA transmission at least temporarily, and is the usual treatment given for refractory catatonia.

It's believed that up to 40% of people diagnosed as being in a persistent vegitative state may actually be in a MCS, which is scary because I believe conventional medical theory holds that people in a PVS cannot feel pain, so it's OK to perform any required medical procedures on them without anesthesia. It's now thought that some patients in a MCS may very well be able to experience pain.

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Reply to
bitrex

You don't have to convince the FDA of anything. Drugs are prescribed by doctors for "off label" uses all the time, and it's not illegal, so long as the use isn't grossly unsafe or unethical. There have been other patients like the one mentioned who have received long term treatment with this type of drug; it's hard to get informed consent from the patient but with the family's consent I don't think there would be much ethical issue. It's a common medication and the patient is already pretty bad off to begin with.

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Reply to
bitrex

Take a laxative, you're still 100% mentally constipated.

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Reply to
Michael A. Terrell

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