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{{Talk header}}
''The case of the American woman Terri Schiavo is often cited as an example of PVS''
{{WikiProject banner shell|class=B|vital=yes|1=
It seems clunky to call her "the American woman Terri Schiavo", maybe it's just me though. ] 05:08, 27 Mar 2005 (UTC)
{{WikiProject Psychology|importance=Low}}
:I agree and have therefore removed it. "The American woman" was unnecessary. ] 18:17, 2005 Mar 31 (UTC)
{{WikiProject Medicine|importance=High|neurology=yes|neurology-imp=Mid}}
{{WikiProject Death|importance=Mid}}
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{{Reliable sources for medical articles}}


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== proposed content in Case Studies of Experimental Treatments ==
''This is also suspect "Eye tracking is often the earliest symptom of recovery."''


Moved here for discussion; content was added then re-added by ]:
Agreed, from what I have read on other sites, limited eye tracking is a normal reflex reaction, which often gives the impression that the patient is somehow aware. I propose removing it, but I'd like to find a good medical source stating one way or the other before axing another users contribution.


;Case Studies of Experimental Treatments
----xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
;Levodopa
In addition, there have been several case studies analyzed that emphasize another ] possibility of treatment for patients in a persistent vegetative state. Three patients whose brains had been damaged by severe head injury recovered from a persistent vegetative state after the administration of a drug called ], which boosts the body's ] levels. In all three cases, the patients were deeply ]tose on arrival to the hospital, remained unresponsive to simple verbal commands, and their condition was unchanged for a lengthy period of time even after intensive treatment including surgery. All three patients were diagnosed as being in a persistent vegetative state for three, seven, and twelve months respectively.<ref>{{cite journal|last1=Matsuda|first1=W|title=Awakenings from persistent vegetative state: report of three cases with parkinsonism and brain stem lesions on MRI.|journal=J Neurol Neurosurg Psychiatry|date=2003|volume=74|issue=11|page=1571-3|pmid=14617720}}</ref>
Case 1 describes a 14 year old boy who, three months after his trauma, could not follow moving objects with his eyes and experienced tremor-like involuntary movements as well as ] (increased tension of the muscles, meaning the muscle tone is abnormally rigid, hampering proper movement). Levodopa was recommended to relieve the patient’s ] features. Surprisingly, after nine days of treatment the patient’s involuntary movements were reduced and he began to respond toward voices. Three months after treatment, he was able to walk and obtained the intelligence of an elementary school child. One year after his trauma, he was able to walk to high school by himself. Case 2 involves a young adult who underwent ] one year after the trauma and showed no improvement. Levodopa was administered and one year later, once his tubes were removed, he said, "I want to eat sushi and drink beer!" Case 3 describes a middle-aged man who experienced ] of his extremities, was administered levodopa, and was able to say his name and address correctly after only two months.


After neurological evaluation, all three cases revealed asymmetrical rigidity or tremor and presynaptic damage in the ] (uses dopamine as neurotransmitter) systems. In conclusion, levodopa should be considered for patients in a persistent vegetative state with atypical features in their limbs and who have MRI evidence of ] in the dopaminergic pathway, particularly presynaptic lesions in areas such as the ] or ]. Data shows that only 6% of adult patients recover after being in a vegetative state for six to twelve months. This poor recovery rate demonstrates the significance in the rapid recovery of patients that begin levodopa treatment, particularly in those who were in a vegetative state for almost a year.
This line is should not exist: "in many cases family members who visit the patient will detect evidence of awareness when doctors with limited patient contact will deny it."


;Baclofen
This is also suspect "Eye tracking is often the earliest symptom of recovery."
This unexpected and late recovery of consciousness raises an interesting hypothesis of possible effects of partially regained spinal cord outputs on reactivation of cognition. Other case studies have shown that recovery of consciousness with persistent severe disability 19 months after a non-traumatic brain injury was at least in part triggered and maintained by intrathecal ] administration<ref>{{cite journal|last1=Sarà|first1=M|title=An unexpected recovery from permanent vegetative state.|journal=Brain Injury|date=2007|volume=21|issue=1|doi=10.1080/02699050601151761|pmid=17364525|accessdate=11/30/2016}}</ref>


;Removal of cold intubated oxygen
Seems a bit one-sided toward recovery and may warrant a NPOV designator. After all, many PVS patients never recover.
Another documented case reports recovery of a small number of patients following the removal of assisted respiration with cold oxygen. The researchers found that in many nursing homes and hospitals unheated oxygen is given to non-responsive patients via ]. This bypasses the warming of the upper respiratory tract and causes a chilling of aortic blood and chilling of the brain. The researchers describe a small number of cases in which removal of the chilled oxygen was followed by recovery from the PVS and recommend either warming of oxygen with a heated ] or removal of the assisted oxygen if it is no longer needed. The authors further recommend additional research to determine if this chilling effect may either delay recovery or even may contribute to brain damage.<ref>{{cite journal | author=Ford GP and Reardon DC | title=Prolonged unintended brain cooling may inhibit recovery from brain injuries: case study and literature review | journal=Med Sci Monit. | volume=12 | issue=8 |date=August 2006 | pages=CS74–79 | url=http://www.medscimonit.com/fulltxt.php?ICID=452867}}</ref>
;Bifocal extradural cortical stimulation
In December 2008, Dr Sergio Canavero, Director of the Advanced Neuromodulation Group based in ], ] and one of the leading experts in the field of cortical stimulation, announced that a girl (Greta) in the permanent vegetative state (i.e. vegetative state lasting more than 12 months), recovered consciousness and was regraded as minimally conscious following several months of ''bifocal extradural cortical stimulation'', a minimally invasive neurosurgical technique he and others developed for the treatment of central pain, ], ] rehabilitation, ], and other neurologic and psychiatric disorders.<ref>{{cite journal|last1=Canavero|first1=S|title=Bifocal extradural cortical stimulation-induced recovery of consciousness in the permanent post-traumatic vegetative state.|journal=J Neurol|date=2009|volume=256|issue=5|page=834-6|pmid=19252808}}</ref> Simultaneous stimulation of the fronto-parietal "consciousness" network achieved a marked improvement of the default network of the brain. A measure of voluntary responsiveness has been obtained. Previous attempts at deep brain stimulation - ] being one of the patients - failed to restore consciousness. This kind of stimulation can also be guided by results of Transcranial Magnetic Stimulation (TMS) as this was able to transitorily improve a patient in PVS. <ref></ref><ref>{{cite journal|last1=Naro|first1=A|title=A Single Session of Repetitive Transcranial Magnetic Stimulation Over the Dorsolateral Prefrontal Cortex in Patients With Unresponsive Wakefulness Syndrome: Preliminary Results.|journal=Neurorehabil Neural Repair|date=2015|volume=29|issue=7|page=603.-13|doi=10.1177/1545968314562114|pmid=25539781}}</ref>


{{reflist-talk}}
Many PVS patients certainly never recover, and the text doesn't contest this, or even suggest (as I might) that some part of this may be due to termination of nutrition and hydration. However, the percentage of people diagnosed as being in PVS who eventually demonstrate consciousness varies in different studies between 6% and 76%, and in either case the point needs to be made that absolute certainty is impossible. Frankly, I think that anyone proposing NPOV should be obliged to cite some evidence for their belief.


* Responses:
----
: IP, first section headers are sentence case, not title case - see ]
: second, we don't have sections called "Case Studies of Experimental Treatments"; you changed the name from "Treatments". Please see ]; per that guideline, what goes in the Treatment section, is actual treatments. Not research. This is all research.
: third, about the references, please see ], particularly ] where "primary" and "secondary" sources are defined, and ] which talks about the age of sources. The sources used here are almost all primary sources, and all are old. This is not how we build content.
: fourth, this content about " Dr Sergio Canavero, Director of the Advanced Neuromodulation Group based in ], ] and one of the leading experts in the field of cortical stimulation," is ] which violates a core policy here.
:if you want to revise this based on good secondary sources and remove the promotional content, please feel free to repost. ] (]) 16:51, 30 November 2016 (UTC)


From the page on Coma: One can be in a coma but still exhibit spontaneous respiration; one who is brain-dead by definition cannot do so. Just mentioning it because this page on vegitative states says that patients in a coma are unable to breathe on their own.


::First, ] is a guideline, not policy.
:Depends on the definition. If the cortex and much of the brainstem are dead but the ] is still being perfused, it is possible to be simultaneously braindead and breathing spontaneously. User_talk:Jfdwolff|<small>T@lk</small>]] 21:08, 25 Jan 2005 (UTC)
::Second, ] does not appear to prohibit case studies, though it indicates "excessive examples should be avoided."
::Third, in ] the "suggested headings" do not exclude alternative headings, such as I have suggested here. Moreover, even under the suggested heading "Treatment or Management" the ''suggestion'' to "avoid experimental/speculative treatments" should be read to chiefly apply to avoiding content that encourages "do it yourself" medical care--especially when there are widely accepted treatments. But in this case, there are no widely accepted treatments. Moreover, the fear of encouraging "do it yourself" treatments does not apply to this subject matter as these patients are all under physician's care and at "worst" we are providing people with information they may wish to bring to the attention of the attending physician of their loved one.
::Fourth, there is no prohibition to using peer reviewed studies . . . most of which include reviews of the literature and in that respect are secondary sources. Indeed, most of the sources cited are similar to those that were used in the section I restored. Please read the articles cited before arguing that they should be excluded.
::Fifth, I disagree on your assessment that the material is too dated. One source I added is from 2015...or did you not bother to look at it. Also, ] discusses replacing old reviews with newer reviews which if they are more updated. The fact that a source is over 5 years alone does not justify deleting that source if there is not a newer study to replace and update the information being provided.
::I have no problem with you removing what you consider to be promotional content or changing the title case. But I also think you--and the editor who originally cut this material without discussion--should study the ] guideline and look for ways to include and improve this content rather than for reasons to exclude it. For example, you can tag it with a request for newer studies, if you like, but it is not necessary to delete the material. For the general audience of readers interested in this subject, information on successes with experimental treatments in an area where there is no proven treatment may be interesting and wanted.] (]) 20:18, 30 November 2016 (UTC)
:::One ref is from 2015 but it is primary; not OK per MEDRS.
::: Guidelines and policies have wide consensus and you cannot just blow them off without justification (and saying "it is just a guideline" is not a justification). If you want to provide actual justifications I am interested in hearing. ] (]) 21:43, 30 November 2016 (UTC)


::::The justification is that many readers may be interested in well documented reports of experimental treatments which have produced positive results for a condition for which there is not a single universally accepted treatment.] (]) 15:42, 1 December 2016 (UTC)
== corrections / clarifications ==
::::::Thanks for replying. The mission of WP is not to interest readers but to provide them with accepted knowledge, per ], which is policy. The policies and guidelines are what allow us to serve the mission. Please use sources per ]. Thanks. ] (]) 15:50, 1 December 2016 (UTC)


:::::::Peer reviewed medical studies are not "definitive knowledge" but they are certainly "accepted knowledge" because they are literally accepted by experts in the field (peer reviewers) for publication because they make a significant contribution to knowledge in that field of specialty.
1) Terri Schiavo is ''not'' in PVS.


:::::::I realize there is always ways for self-appointed guardians of WP to wikilawyer policies in a manner to justify deleting material from verifiable sources and driving away new editors. But I need to ask, if we decide to go with your interpretation of all WP policies and your guidance for policing this article, shall I go ahead and remove all material from this article that cites medical journal articles that contain any original content (i.e.--are not strictly, 100% reviews of studies and therefore purely a "secondary source") or stray from the recommended list of sections covered by ]? And if we do that, how does such a slavish adherence to ] that really help readers? ] (]) 16:19, 1 December 2016 (UTC)
Not even close. Her father described her condition like this:
::::::::I see you opened a discussion at MEDMOS, ]. We'll see how that goes. Thanks for addressing MEDRS. It is an essential guideline; there is an essay (that I drafted originally) called ] that may help you understand its importance in WP. With regard to improving the article by improving refs and copyediting based on the better refs, that is always welcome, but it isn't helpful if it is done in ] way. ] (]) 16:31, 1 December 2016 (UTC)
:''Terri laughs, Terri cries, she moves, and she makes child-like attempts at speech with her mother and me.
:''Sometimes she will say "Mom" or "Dad" or "yeah" when we ask her a question. When I kiss her hello or goodbye,
:''she looks at me and "puckers up" her lips.''


:::::::::As per the MEDMOS outline for "Diseases or disorders or syndromes," I added the section "Research direction." I then edited the material to eliminate references to any particular researchers and, where possible, noted literature reviews.] (]) 18:41, 8 December 2016 (UTC)
2) Some definitions of PVS say that the patient does NOT experience sleep-wake cycles:
{{od}} yes it will need to go into the research section, but the content basically the same, with the same old, primary sources and all too much ]. Look i will try to find some time to find reviews and write appropriate encyclopedic content about this over the weekend. 19:21, 8 December 2016 (UTC)
:
So I changed the article to reflect that lack of concensus:


:I would point out that at least one of the papers, Ford, includes a literature review.] (]) 19:06, 9 December 2016 (UTC)
:"They may experience sleep-wake cycles, or be in a state of chronic wakefulness."
::I'll second what Jytdog has been saying. There is nothing about this situation that justifies deviating from ]. ] (]) 14:00, 10 December 2016 (UTC)


== A Biblico-Ethical Response to the Question of Withdrawing Fluid and Nutrition from Individuals in the Persistent Vegetative State (Master's thesis) ==
3) Many definitions of PVS mention that the patient is unresponsive to external stimuli:
:''
So I added that fact:


Is that indended to be a serious reference? WTF? --] (]) 17:19, 15 January 2022 (UTC)
:"They are unresponsive to external stimuli, except, possibly, pain stimuli."


== Requested move 5 June 2023 ==
] 20:15, 24 Feb 2005 (UTC)


<div class="boilerplate mw-archivedtalk" style="background-color: #efe; margin: 0; padding: 0 10px 0 10px; border: 1px dotted #aaa;"><!-- Template:RM top -->
Various court-appointed doctors have ruled that Terri Schiavo is in PVS. Q.v. . This element needs a "dispute" note or, better yet, it should simply state the facts, which are that court-appointd doctors have held her to be in PVS, while her parents seem to dispute this. The above poster clearly has not read the definition of PVS, since he/she claims that the fact that Schiavo laughs, cries, etc., is evidence that she is not in PVS, when in fact these are part of the definition of PVS. Someone from wiki please help this page become NPOV. ] 03:52, 26 Feb 2005 (UTC)
:''The following is a closed discussion of a ]. <span style="color:red">'''Please do not modify it.'''</span> Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a ] after discussing it on the closer's talk page. No further edits should be made to this discussion.''


The result of the move request was: '''Moved''' <small>(])</small> <span style="font-family:Monospace;color:black">>>>&nbsp;].]</span> 14:39, 12 June 2023 (UTC)
---- ----


] → {{no redirect|Vegetative state}} – Vegetative states are a stage in emergence from coma, and can last for short or long periods both; ''persistent'' vegetative states are a subset of long-lasting VS. This article covers both (there's no separate article for VS, and IMO it would be inappropriately splitty to write it). More concerningly, the concept of PVS in this article isn't necessarily concordant with current neurological understanding, with strongly recommending the use of 'chronic vegetative state' over the persistent/permanent terms tended towards in this article.
I don't have time to give much info right now, but as a graduating law student who has recently done a semester of Bioethics, I will agree that the current wiki PVS definition seems to be overly slanted towards exactly what folks like Schiavo's parents would have readers learn.

I would also note that I don't think the page even mentioned that some physicians refer to PVS as "permanent" rather than "persistent."

The definition also needs to note that many or most "recoveries" from PVS are probably just the result of misdiagnosis (patient not in PVS to start with) and usually occur within a shorter rather than longer period of time.

----

I will reasearch this more, but as one of many medical students who have been watching this case... she is not in PVS. She may have a much lower IQ than someone who was not the subject of questionable abuse, but not PVS. Her responces on the television (when you aren't listening to the reporter) are actually to what is going on around her. When someone called her pretty she laughed like a child. The reports of her saying " I want" with a really bad slur *when she was asked what she wanted*. Her responces are not random. If she were a veggie I think this debate would be different. Why her doctor called her this and isn't changing his mind.. why there wasn't more testing to differentiate this more.. why there was no reablilitation.. really weird case. It will be over soon though. By her urine out put.. she dies in the next few days from the lack of water. She may not improve from what damage has been done, but she is still functioning. It is not just wikipedia, but also the medical textbooks that have been refered to that support that the first doctor was incorrect. <Shrugs> can't examine, but can only say what it looks like from TV. She seems to be a misdiagnosis.

hmm
::I'm sorry, but most of what you have claimed has been debunked by reputable medical practitioners. If you can provide good citations for any of your claims that would be greatly appreciated. --] | ] 02:11, 1 Apr 2005 (UTC)

== Content removed ==

''Individuals in persistent vegetative states are often referred to as vegetables, though the term may be considered derogatory.''
:]. Further, the claim that individuals who are diagnosed as being in a PVS are "often referred to as vegetables" is false. This is a serious ] article about a topic in neurology, not a childish guide to pejorative slang. ] has failed to provide an authoritative reference for this claim. A search of ] does not turn up any relevant sources. Merriam-Webster's Medline Plus medical dictionary does not support this definition. A search of the article by The Multi-Society Task Force on PVS (1994). "Medical Aspects of the Persistent Vegetative State". '']'' 330: 1572-1579, also turns up nothing. --] | ] 03:09, 3 Apr 2005 (UTC)
::Give me a break! ''Of course'' you're not going to find terms like "]s" used in medical journals. That doesn't change the fact that it is a very common term used by the man/woman on the street to refer to individuals in PVSes. Restored content. ] 03:33, 3 Apr 2005 (UTC)
:::Give '''us''' a break. By your logic ] article must contain several dozen of its slang synonyms. ] 05:31, 3 Apr 2005 (UTC)
:::Well, if that's inappropriate for Misplaced Pages, the end of ] should be edited too.-](]) 06:57, Apr 3, 2005 (UTC)
::::It's not quite the same. An equivalent for ] would be to have a comment like "Kids often refer to them as ]" - it shows another name for a vegetable, and not another meaning for the same word.] 07:07, 3 Apr 2005 (UTC)

I'm not sure if the anon is wrong. The word is used very often in the public discourse (although it seems it ususally does refer to coma), and it would be a shame to remove the reference altogether.

Incidentally, many Misplaced Pages articles contain interminable lists of slang terms. A brief glance at ], ] and ] for good examples. I've often wondered if that is not over the top. ]&nbsp;|&nbsp;] 22:56, 5 Apr 2005 (UTC)
:I disagree. The word is not exactly used in the medical literature, and as far as public discourse is concerned, in the states at least, it is discouraged. For example, ] on the radio program, ] was discussing the Schiavo case a few days ago and almost used the word, but changed it at the last minute to another term. Can you give me examples of the term being used "very often" in serious public discorse? Tangentially, I want to point out that according to his edit history, the editor (63.173.114.***) who keeps adding this claim has engaged in edit wars on almost every page he has contributed to on Misplaced Pages. --] | ] 00:12, 6 Apr 2005 (UTC)
::Use in public discourse is discouraged? Sure. I don't disagree with that. That's why I've never removed the language (originally added by a different editor) that the term is generally considered derogatory. Edit wars? Anyone who edits politically contentious pages will wind up disagreeing with someone on how something should be worded. Seeking consensus is fine, but sometimes we must ]. ] 00:42, 6 Apr 2005 (UTC)
:::Practically every contribution you've made to Misplaced Pages has been reverted, so that tells me something. Also, you have failed to substantiate your claim in any way. Where's the evidence? --] | ] 00:52, 6 Apr 2005 (UTC)
I didn't know that; I wasn't judging the book by its cover. Every sensationalist newspaper uses the V-word occasionally in both PVS and coma. ]&nbsp;|&nbsp;] 00:23, 6 Apr 2005 (UTC)
:Formal sources seem to avoid the term , compared to . Still, in informal settings, the term "vegetable" is used quite often. I think this could go either way.-](]) 01:33, Apr 6, 2005 (UTC)
::The references you posted do not use the term "vegetable". --] | ] 05:02, 6 Apr 2005 (UTC)


'''I think I'll place my comment on the top to make spotting it easier.'''
:moved to Content Removed section, as it seems more appropriate.
'''''Hondje,''''' In correcting your big eraser, I '''did not''' revert, but, instead, reworded the passage to make it shorter and to the point. In the end, however, your claim that it was a POV (Point of View) is wrong. The edit does not say that Terri was --or was not --in PVS. It simply said that there was a shift in public opinion, and listed documentation to support that. These are the cold, hard facts, not opinions or points of views. Besides, the arguments that Terri WAS in PVS are listed as well, are they not? Lots of documentation is listed, so a little more clarification is not out of order, especially since there was no mention of an actual example, one you could see with your own two-eyes. --] 02:50, 14 May 2005 (UTC)
:The videos themselves are POV, not pointing out they exist. Sorry for not being clear. The whole reason they're on the internet was to sway people into thinking that Schiavo wasn't in PVS, which makes them rather POV in my opinion. If you're going to link to them, link to the videos of where she sits there drooling and obviously oblivious to the world as well, so that you're not just using bits that were taken out of context. Additionally, this isn't the ] article, and isn't the appropriate place for these videos. Taking a gander at your website, I get the hopefully incorrect impression that you aren't going to see why they're POV, being a big 'don't pull the tube' guy. As an aside, IMHO, .wmv is an inappropriate file type for a encyclopedia, since it isn't an open format. Of course you sometimes can't help it, but it really sucks for those of us who don't use Windows.] 06:00, 14 May 2005 (UTC)

::I think you're trying to strive for balance in the evidence, ], which is good. Now, your suggestion that such things like videos of Terri belong on the '''page''' about Terri makes sense, but you can not completely divorce the issue of PVS from the issue of "Terri," so the reading public needs to know of the full real deal on PVS, and mention of Terri (brief mention) is appropriate. --] 08:53, 15 May 2005 (UTC)

::That being said, you argue that the videos are "pro-Terri." Yes, I'll agree that they (by themselves) would be "POV," and think your novel suggestion that the drooling hours (if I could get hold of such videos) would be a good balance. However, those vids are not public (as far as I know?). Nonetheless, the fact that the court ruled Terri to be PVS would offer an opposing view, and I would agree that it should be mentioned if the videos are mentioned. --] 08:53, 15 May 2005 (UTC)

:: You don't like .wmv files? I understand some folk have trouble openeing them, so, I might search the Internet Universe for other types of files if I post them --and I should mention to the reader which types of files are which. Argh! Tedious research and typing, lol... --] 08:53, 15 May 2005 (UTC)

----

From Jennett, of Jennett and Plum who coined the term "Persistent Vegetative State"

:Bryan Jennett "The Vegetative State", Cambridge University Press (2002) --

:"(In the Oxford English Dictionary) 'vegetative' is used to describe 'an organic body capable of growth and development but devoid of sensation and thought." ... "Some commentators, including the Pro-Life Committee of Catholic Bishops in the US, have expressed concern that the word vegetative can suggest that the patient is a vegetable and therefore subhuman, and they have urged the medical profession to seek a less discriminatory and demeaning alternative."

The term obviously is offensive to some people, and understandably so, even though Jennett thought the root source was logical when he coined the term. There has been controversy over the word "niggardly". People have taken great offense at times, but the word is benign. Still, anyone can understand what the problem is. Maybe a solution here is to quote from Jennett's book to show even he recognizes there is a controversy. After all, PVS was his idea. ] 05:08, 2005 Apr 17 (UTC)

:That seems fairly reasonable, though compromising with blantent trolls runs contrary to instinct. Thanks for your contribution to the page, but make sure to use the 'show preview' button before commiting changes - it makes edits easier to follow. :) ] 06:24, 17 Apr 2005 (UTC)
----

"Some authorities hold that PVS is, in fact, irreversible, and that the reportedly recovered patients were not suffering from true PVS.

Some authorities hold that PVS is irreversible and that the case reports of recoveries were misdiagnosed and not true cases of PVS.


The article needs a fair bit of work, but both in its current state and in any viable future state it handles VS as a whole, and should have a title reflecting that. The current title implies a different and far narrower focus than both our present and ideal article on this have, and not a particularly viable focus anyway (because it's incoherent to talk about chronic VS without talking about VS in general). ]] 09:11, 5 June 2023 (UTC)
Organization in brevity - looks cleaner to me, but it is trivial.


*'''Support as proposed''' per nom and concise ] ] 22:42, 9 June 2023 (UTC)
Regarding use of vegetable, I applaud the decision to block its use. Please guard against using emotionally laden terms, for they may form the foundation for ad populum and ad misericordiam fallacies."
*'''Support''' per nom, splitting does not make sense to me either. ] (]) 19:49, 10 June 2023 (UTC)
:I moved this here from the actual article. This seems like talkpage material, anyway. MSDOJD, you can move it back if you would please adapt it to be appropriate for the article, somehow. Thanks, ] 17:06, 14 Apr 2005 (UTC)
<div style="padding-left: 1.6em; font-style: italic; border-top: 1px solid #a2a9b1; margin: 0.5em 0; padding-top: 0.5em">The discussion above is closed. <b style="color: #FF0000;">Please do not modify it.</b> Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.</div><!-- from ] -->
</div><div style="clear:both;"></div>


== Section added == == Page move on 12 June 2023 ==


Hello, I just completed the page move that was decided above, via the request at ]. This required adjusting the "also known as..." language in the article's opening paragraph. I went with what I figured was best, but please correct my prose if it's wrong. ---<span style="font-family: Calibri">]<small> (]&#124;]) </small></span> 14:51, 12 June 2023 (UTC)
I moved a paragraph from the ] page to the PVS article, as it was not about Schiavo at all, just about PVS. Please review if you can. ] 13:34, 3 May 2005 (UTC)

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proposed content in Case Studies of Experimental Treatments

Moved here for discussion; content was added here then re-added here by User: 97.91.202.83:

Case Studies of Experimental Treatments
Levodopa

In addition, there have been several case studies analyzed that emphasize another pharmacological possibility of treatment for patients in a persistent vegetative state. Three patients whose brains had been damaged by severe head injury recovered from a persistent vegetative state after the administration of a drug called levodopa, which boosts the body's dopamine levels. In all three cases, the patients were deeply comatose on arrival to the hospital, remained unresponsive to simple verbal commands, and their condition was unchanged for a lengthy period of time even after intensive treatment including surgery. All three patients were diagnosed as being in a persistent vegetative state for three, seven, and twelve months respectively.

Case 1 describes a 14 year old boy who, three months after his trauma, could not follow moving objects with his eyes and experienced tremor-like involuntary movements as well as hypertonicity (increased tension of the muscles, meaning the muscle tone is abnormally rigid, hampering proper movement). Levodopa was recommended to relieve the patient’s parkinsonian features. Surprisingly, after nine days of treatment the patient’s involuntary movements were reduced and he began to respond toward voices. Three months after treatment, he was able to walk and obtained the intelligence of an elementary school child. One year after his trauma, he was able to walk to high school by himself. Case 2 involves a young adult who underwent deep brain stimulation one year after the trauma and showed no improvement. Levodopa was administered and one year later, once his tubes were removed, he said, "I want to eat sushi and drink beer!" Case 3 describes a middle-aged man who experienced spasticity of his extremities, was administered levodopa, and was able to say his name and address correctly after only two months.

After neurological evaluation, all three cases revealed asymmetrical rigidity or tremor and presynaptic damage in the dopaminergic (uses dopamine as neurotransmitter) systems. In conclusion, levodopa should be considered for patients in a persistent vegetative state with atypical features in their limbs and who have MRI evidence of lesions in the dopaminergic pathway, particularly presynaptic lesions in areas such as the substantia nigra or ventral tegmentum. Data shows that only 6% of adult patients recover after being in a vegetative state for six to twelve months. This poor recovery rate demonstrates the significance in the rapid recovery of patients that begin levodopa treatment, particularly in those who were in a vegetative state for almost a year.

Baclofen

This unexpected and late recovery of consciousness raises an interesting hypothesis of possible effects of partially regained spinal cord outputs on reactivation of cognition. Other case studies have shown that recovery of consciousness with persistent severe disability 19 months after a non-traumatic brain injury was at least in part triggered and maintained by intrathecal baclofen administration

Removal of cold intubated oxygen

Another documented case reports recovery of a small number of patients following the removal of assisted respiration with cold oxygen. The researchers found that in many nursing homes and hospitals unheated oxygen is given to non-responsive patients via tracheal intubation. This bypasses the warming of the upper respiratory tract and causes a chilling of aortic blood and chilling of the brain. The researchers describe a small number of cases in which removal of the chilled oxygen was followed by recovery from the PVS and recommend either warming of oxygen with a heated nebulizer or removal of the assisted oxygen if it is no longer needed. The authors further recommend additional research to determine if this chilling effect may either delay recovery or even may contribute to brain damage.

Bifocal extradural cortical stimulation

In December 2008, Dr Sergio Canavero, Director of the Advanced Neuromodulation Group based in Turin, Italy and one of the leading experts in the field of cortical stimulation, announced that a girl (Greta) in the permanent vegetative state (i.e. vegetative state lasting more than 12 months), recovered consciousness and was regraded as minimally conscious following several months of bifocal extradural cortical stimulation, a minimally invasive neurosurgical technique he and others developed for the treatment of central pain, Parkinson's disease, stroke rehabilitation, depression, and other neurologic and psychiatric disorders. Simultaneous stimulation of the fronto-parietal "consciousness" network achieved a marked improvement of the default network of the brain. A measure of voluntary responsiveness has been obtained. Previous attempts at deep brain stimulation - Terri Schiavo being one of the patients - failed to restore consciousness. This kind of stimulation can also be guided by results of Transcranial Magnetic Stimulation (TMS) as this was able to transitorily improve a patient in PVS.

References

  1. Matsuda, W (2003). "Awakenings from persistent vegetative state: report of three cases with parkinsonism and brain stem lesions on MRI". J Neurol Neurosurg Psychiatry. 74 (11): 1571-3. PMID 14617720.
  2. Sarà, M (2007). "An unexpected recovery from permanent vegetative state". Brain Injury. 21 (1). doi:10.1080/02699050601151761. PMID 17364525. {{cite journal}}: |access-date= requires |url= (help); Check date values in: |accessdate= (help)
  3. Ford GP and Reardon DC (August 2006). "Prolonged unintended brain cooling may inhibit recovery from brain injuries: case study and literature review". Med Sci Monit. 12 (8): CS74–79.
  4. Canavero, S (2009). "Bifocal extradural cortical stimulation-induced recovery of consciousness in the permanent post-traumatic vegetative state". J Neurol. 256 (5): 834-6. PMID 19252808.
  5. Pape T, Rosenow J, Lewis G, Ahmed G, Walker M, Guernon A, Roth H, Patil V. (2009). Repetitive transcranial magnetic stimulation-associated neurobehavioral gains during coma recovery, Brain Stimul, 2(1):22-35. Epub 2008 Oct 23.
  6. Naro, A (2015). "A Single Session of Repetitive Transcranial Magnetic Stimulation Over the Dorsolateral Prefrontal Cortex in Patients With Unresponsive Wakefulness Syndrome: Preliminary Results". Neurorehabil Neural Repair. 29 (7): 603.-13. doi:10.1177/1545968314562114. PMID 25539781.
  • Responses:
IP, first section headers are sentence case, not title case - see WP:MOS
second, we don't have sections called "Case Studies of Experimental Treatments"; you changed the name from "Treatments". Please see WP:MEDMOS; per that guideline, what goes in the Treatment section, is actual treatments. Not research. This is all research.
third, about the references, please see WP:MEDRS, particularly WP:MEDDEF where "primary" and "secondary" sources are defined, and WP:MEDDATE which talks about the age of sources. The sources used here are almost all primary sources, and all are old. This is not how we build content.
fourth, this content about " Dr Sergio Canavero, Director of the Advanced Neuromodulation Group based in Turin, Italy and one of the leading experts in the field of cortical stimulation," is promotional which violates a core policy here.
if you want to revise this based on good secondary sources and remove the promotional content, please feel free to repost. Jytdog (talk) 16:51, 30 November 2016 (UTC)


First, WP:MEDMOS is a guideline, not policy.
Second, WP:MEDMOS does not appear to prohibit case studies, though it indicates "excessive examples should be avoided."
Third, in WP:MEDMOS the "suggested headings" do not exclude alternative headings, such as I have suggested here. Moreover, even under the suggested heading "Treatment or Management" the suggestion to "avoid experimental/speculative treatments" should be read to chiefly apply to avoiding content that encourages "do it yourself" medical care--especially when there are widely accepted treatments. But in this case, there are no widely accepted treatments. Moreover, the fear of encouraging "do it yourself" treatments does not apply to this subject matter as these patients are all under physician's care and at "worst" we are providing people with information they may wish to bring to the attention of the attending physician of their loved one.
Fourth, there is no prohibition to using peer reviewed studies . . . most of which include reviews of the literature and in that respect are secondary sources. Indeed, most of the sources cited are similar to those that were used in the section I restored. Please read the articles cited before arguing that they should be excluded.
Fifth, I disagree on your assessment that the material is too dated. One source I added is from 2015...or did you not bother to look at it. Also, WP:MEDDATE discusses replacing old reviews with newer reviews which if they are more updated. The fact that a source is over 5 years alone does not justify deleting that source if there is not a newer study to replace and update the information being provided.
I have no problem with you removing what you consider to be promotional content or changing the title case. But I also think you--and the editor who originally cut this material without discussion--should study the WP:Preserve guideline and look for ways to include and improve this content rather than for reasons to exclude it. For example, you can tag it with a request for newer studies, if you like, but it is not necessary to delete the material. For the general audience of readers interested in this subject, information on successes with experimental treatments in an area where there is no proven treatment may be interesting and wanted.97.91.202.83 (talk) 20:18, 30 November 2016 (UTC)
One ref is from 2015 but it is primary; not OK per MEDRS.
Guidelines and policies have wide consensus and you cannot just blow them off without justification (and saying "it is just a guideline" is not a justification). If you want to provide actual justifications I am interested in hearing. Jytdog (talk) 21:43, 30 November 2016 (UTC)
The justification is that many readers may be interested in well documented reports of experimental treatments which have produced positive results for a condition for which there is not a single universally accepted treatment.97.91.202.83 (talk) 15:42, 1 December 2016 (UTC)
Thanks for replying. The mission of WP is not to interest readers but to provide them with accepted knowledge, per WP:NOTEVERYTHING, which is policy. The policies and guidelines are what allow us to serve the mission. Please use sources per WP:MEDRS. Thanks. Jytdog (talk) 15:50, 1 December 2016 (UTC)
Peer reviewed medical studies are not "definitive knowledge" but they are certainly "accepted knowledge" because they are literally accepted by experts in the field (peer reviewers) for publication because they make a significant contribution to knowledge in that field of specialty.
I realize there is always ways for self-appointed guardians of WP to wikilawyer policies in a manner to justify deleting material from verifiable sources and driving away new editors. But I need to ask, if we decide to go with your interpretation of all WP policies and your guidance for policing this article, shall I go ahead and remove all material from this article that cites medical journal articles that contain any original content (i.e.--are not strictly, 100% reviews of studies and therefore purely a "secondary source") or stray from the recommended list of sections covered by WP:MEDRS? And if we do that, how does such a slavish adherence to WP:MEDRS that really help readers? 97.91.202.83 (talk) 16:19, 1 December 2016 (UTC)
I see you opened a discussion at MEDMOS, here. We'll see how that goes. Thanks for addressing MEDRS. It is an essential guideline; there is an essay (that I drafted originally) called WP:Why MEDRS? that may help you understand its importance in WP. With regard to improving the article by improving refs and copyediting based on the better refs, that is always welcome, but it isn't helpful if it is done in WP:POINTY way. Jytdog (talk) 16:31, 1 December 2016 (UTC)
As per the MEDMOS outline for "Diseases or disorders or syndromes," I added the section "Research direction." I then edited the material to eliminate references to any particular researchers and, where possible, noted literature reviews.97.91.202.83 (talk) 18:41, 8 December 2016 (UTC)

yes it will need to go into the research section, but the content basically the same, with the same old, primary sources and all too much WP:WEIGHT. Look i will try to find some time to find reviews and write appropriate encyclopedic content about this over the weekend. 19:21, 8 December 2016 (UTC)

I would point out that at least one of the papers, Ford, includes a literature review.97.91.202.83 (talk) 19:06, 9 December 2016 (UTC)
I'll second what Jytdog has been saying. There is nothing about this situation that justifies deviating from WP:MEDRS. Looie496 (talk) 14:00, 10 December 2016 (UTC)

A Biblico-Ethical Response to the Question of Withdrawing Fluid and Nutrition from Individuals in the Persistent Vegetative State (Master's thesis)

Is that indended to be a serious reference? WTF? --jae (talk) 17:19, 15 January 2022 (UTC)

Requested move 5 June 2023

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: Moved (non-admin closure) >>> Extorc.talk 14:39, 12 June 2023 (UTC)

Persistent vegetative state → Vegetative state – Vegetative states are a stage in emergence from coma, and can last for short or long periods both; persistent vegetative states are a subset of long-lasting VS. This article covers both (there's no separate article for VS, and IMO it would be inappropriately splitty to write it). More concerningly, the concept of PVS in this article isn't necessarily concordant with current neurological understanding, with current practice guidelines strongly recommending the use of 'chronic vegetative state' over the persistent/permanent terms tended towards in this article.

The article needs a fair bit of work, but both in its current state and in any viable future state it handles VS as a whole, and should have a title reflecting that. The current title implies a different and far narrower focus than both our present and ideal article on this have, and not a particularly viable focus anyway (because it's incoherent to talk about chronic VS without talking about VS in general). Vaticidalprophet 09:11, 5 June 2023 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Page move on 12 June 2023

Hello, I just completed the page move that was decided above, via the request at Misplaced Pages:Requested moves/Technical requests. This required adjusting the "also known as..." language in the article's opening paragraph. I went with what I figured was best, but please correct my prose if it's wrong. ---DOOMSDAYER520 (TALK|CONTRIBS) 14:51, 12 June 2023 (UTC)

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