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A Fate Worse Than Death: The Persistent Vegetative State in Childhood

A Fate Worse Than Death: The Persistent Vegetative State in Childhood Abstract As resuscitation techniques and intensive care technology have improved, an increasing number of comatose children now survive for prolonged periods, entering a "twilight zone" of apparent wakefulness without awareness. Common causes of this condition include head trauma, hypoxic insults, near-drowning, and metabolic or infectious encephalopathies. Up to 12% of patients who survive a coma will remain in this "persistent vegetative state" (PVS).1-4 The Karen Quinlan case, in 1975, drew national attention to the difficult ethical aspects of treating such patients; Karen Quinlan remains "alive" in a nursing home to this date. Her status highlights the poignant tragedy, financial cost, and family burden of such prolonged comatose states. TERMINOLOGY States of consciousness between stupor and profound coma have been labeled with a variety of confusing and sometimes ill-defined terms, including akinetic mutism,5,6apallic syndrome,7neocortical death,8coma vigil,9 and PVS.10 Unfortunately, the terms have been applied References 1. Bruce DA, Schut L, Bruno LA, et al: Outcome following head injuries in children . J Neurosurg 1978;48:679-688.Crossref 2. Margolis LH, Shaywitz BA: The outcome of prolonged coma in childhood . Pediatrics 1980;65: 477-482. 3. Seshia SS, Seshia MM, Sachdeva RK: Coma in childhood . Dev Med Child Neurol 1977;19: 614-628.Crossref 4. Bates D, Caronna JJ, Cartlidge NE, et al: A prospective study of non-traumatic coma: Methods and results in 310 patients . Ann Neurol 1977;2:211-220.Crossref 5. Cairns H, Oldfield RC, Pennybacker JB, et al: Akinetic mutism with an epidermoid cyst of the third ventricle . Brain 1941;64:273-290.Crossref 6. Skultety FM: Clinical and experimental aspects of akinetic mutism . Arch Neurol 1968;19: 1-14.Crossref 7. Kretschmer E: Das appallisches Syndrome . Zentralbl Gesamte Neurol Psychiatry 1940;169: 576-579.Crossref 8. Brierley JB, Adams JH, Graham DI, et al: Neocortical death after cardiac arrest . Lancet 1971;2:560-565. 9. Plum F, Posner JB: The Diagnosis of Stupor and Coma , ed 3. Philadelphia, FA Davis Co, 1980, pp 7-8, 24-26. 10. Jennett B, Plum F: Persistent vegetative state after brain damage: A syndrome in search of a name . Lancet 1972;1:734-737.Crossref 11. Young RSK, Phelan KW, Lehman RA, et al: Computed tomographic findings in akinetic mutism . AJDC 1984;138:166-167. 12. Golden GS, Leeds N, Kremenitzer MW, et al: The 'locked-in' syndrome in children . J Pediatr 1976;89:596-598.Crossref 13. Higashi K, Sakata Y, Hatand M: Epidemiological studies on patients with a persistent vegetative state . J Neurol Neurosurg Psychiatry 1977;40:876-885.Crossref 14. Dougherty JH, Rawlinson DG, Levy DE, et al: Hypoxic-ischemic brain injury and the vegetative state: Clinical and neuropathologic correlation . Neurology 1981;31:991-997.Crossref 15. Jennett B, Teasdale G: Management of Head Injuries . Philadelphia, FA Davis Co, 1981, pp 311-312. 16. Posner JB: Coma and other states of consciousness: The differential diagnosis of brain death . Ann NY Acad Sci 1978;315:215-227.Crossref 17. Higashi K, Hatano M, Abiko S, et al: Five-year follow-up study of patients with persistent vegetative state . J Neurol Neurosurg Psychiatry 1981;44:552-554.Crossref 18. Levy DE, Knill-Jones RP, Plum F: The vegetative state and its prognosis following non-traumatic coma . Ann NY Acad Sci 1978;315: 293-306.Crossref 19. Shuttleworth E: Recovery to social and economic independence from prolonged post-anoxic vegetative state . Neurology 1983;33:372-374.Crossref 20. Rosenberg GA, Johnson SF, Brenner RP: Recovery of cognition after prolonged vegetative state . Ann Neurol 1977;2:167-168.Crossref 21. Gillies JD, Seshia SS: Vegetative state following coma in childhood: Evolution and outcome . Dev Med Child Neurol 1980;22:642-648.Crossref 22. Paris JJ: The six-million-dollar woman . Conn Med 1981;45:720-721. 23. Cranford RE, Smith HL: Some critical distinctions between brain death and the persistent vegetative state . Ethics Sci Med 1979;6:199-209. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

A Fate Worse Than Death: The Persistent Vegetative State in Childhood

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1984.02140400014003
Publisher site
See Article on Publisher Site

Abstract

Abstract As resuscitation techniques and intensive care technology have improved, an increasing number of comatose children now survive for prolonged periods, entering a "twilight zone" of apparent wakefulness without awareness. Common causes of this condition include head trauma, hypoxic insults, near-drowning, and metabolic or infectious encephalopathies. Up to 12% of patients who survive a coma will remain in this "persistent vegetative state" (PVS).1-4 The Karen Quinlan case, in 1975, drew national attention to the difficult ethical aspects of treating such patients; Karen Quinlan remains "alive" in a nursing home to this date. Her status highlights the poignant tragedy, financial cost, and family burden of such prolonged comatose states. TERMINOLOGY States of consciousness between stupor and profound coma have been labeled with a variety of confusing and sometimes ill-defined terms, including akinetic mutism,5,6apallic syndrome,7neocortical death,8coma vigil,9 and PVS.10 Unfortunately, the terms have been applied References 1. Bruce DA, Schut L, Bruno LA, et al: Outcome following head injuries in children . J Neurosurg 1978;48:679-688.Crossref 2. Margolis LH, Shaywitz BA: The outcome of prolonged coma in childhood . Pediatrics 1980;65: 477-482. 3. Seshia SS, Seshia MM, Sachdeva RK: Coma in childhood . Dev Med Child Neurol 1977;19: 614-628.Crossref 4. Bates D, Caronna JJ, Cartlidge NE, et al: A prospective study of non-traumatic coma: Methods and results in 310 patients . Ann Neurol 1977;2:211-220.Crossref 5. Cairns H, Oldfield RC, Pennybacker JB, et al: Akinetic mutism with an epidermoid cyst of the third ventricle . Brain 1941;64:273-290.Crossref 6. Skultety FM: Clinical and experimental aspects of akinetic mutism . Arch Neurol 1968;19: 1-14.Crossref 7. Kretschmer E: Das appallisches Syndrome . Zentralbl Gesamte Neurol Psychiatry 1940;169: 576-579.Crossref 8. Brierley JB, Adams JH, Graham DI, et al: Neocortical death after cardiac arrest . Lancet 1971;2:560-565. 9. Plum F, Posner JB: The Diagnosis of Stupor and Coma , ed 3. Philadelphia, FA Davis Co, 1980, pp 7-8, 24-26. 10. Jennett B, Plum F: Persistent vegetative state after brain damage: A syndrome in search of a name . Lancet 1972;1:734-737.Crossref 11. Young RSK, Phelan KW, Lehman RA, et al: Computed tomographic findings in akinetic mutism . AJDC 1984;138:166-167. 12. Golden GS, Leeds N, Kremenitzer MW, et al: The 'locked-in' syndrome in children . J Pediatr 1976;89:596-598.Crossref 13. Higashi K, Sakata Y, Hatand M: Epidemiological studies on patients with a persistent vegetative state . J Neurol Neurosurg Psychiatry 1977;40:876-885.Crossref 14. Dougherty JH, Rawlinson DG, Levy DE, et al: Hypoxic-ischemic brain injury and the vegetative state: Clinical and neuropathologic correlation . Neurology 1981;31:991-997.Crossref 15. Jennett B, Teasdale G: Management of Head Injuries . Philadelphia, FA Davis Co, 1981, pp 311-312. 16. Posner JB: Coma and other states of consciousness: The differential diagnosis of brain death . Ann NY Acad Sci 1978;315:215-227.Crossref 17. Higashi K, Hatano M, Abiko S, et al: Five-year follow-up study of patients with persistent vegetative state . J Neurol Neurosurg Psychiatry 1981;44:552-554.Crossref 18. Levy DE, Knill-Jones RP, Plum F: The vegetative state and its prognosis following non-traumatic coma . Ann NY Acad Sci 1978;315: 293-306.Crossref 19. Shuttleworth E: Recovery to social and economic independence from prolonged post-anoxic vegetative state . Neurology 1983;33:372-374.Crossref 20. Rosenberg GA, Johnson SF, Brenner RP: Recovery of cognition after prolonged vegetative state . Ann Neurol 1977;2:167-168.Crossref 21. Gillies JD, Seshia SS: Vegetative state following coma in childhood: Evolution and outcome . Dev Med Child Neurol 1980;22:642-648.Crossref 22. Paris JJ: The six-million-dollar woman . Conn Med 1981;45:720-721. 23. Cranford RE, Smith HL: Some critical distinctions between brain death and the persistent vegetative state . Ethics Sci Med 1979;6:199-209.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Feb 1, 1984

References