A Cuban perspective on management of persistent vegetative state

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.