When Does Life Begin?

real wrote: But it's still an attempt to chose between two wrong answers, and more importantly, it's not a scenario that has any real relationship to the actual everyday issue that the abortion question presents.

Real can recognize "any real relationship to actual everyday issue," but refuses to acknowledge that it doesn't affect him personally in any way when a woman he doesn't even know has an abortion, but wants to impose his religious' belief anyway.

Real life, abortion becomes an irrational choice (except for medical or other compelling reasons) when the fetal brain develops to the point that awareness might be possible. There is no exact day or time (developmental rates vary slightly), but it certainly does not occur before 24 weeks gestation when synaptic connections between the neocortex and thalamus are established.

Real life, abortion becomes an irrational choice (except for medical or other compelling reasons) when the fetal brain develops to the point that awareness might be possible. There is no exact day or time (developmental rates vary slightly), but it certainly does not occur before 24 weeks gestation when synaptic connections between the neocortex and thalamus are established.

Can 'Lazarus pill' end a woman's living death?

By Caroline Davies
Last Updated: 1:55am GMT 22/11/2006

Your view: Who should decide on the treatment for coma patients?

A British woman in a persistent vegetative state for three years is to be given the sleeping pill zolpidem, said to have woken other patients in a similar condition, after a High Court judge overruled her relatives' wishes to let her "die with dignity".

Yesterday the mother of the first persistent vegetative state (PVS) patient to recover after being given the so-called "Lazarus pill" applauded the decision.

Sir Mark Potter, the president of the High Court Family Division, sided with the Official Solicitor representing the interests of the unnamed 53-year-old, ruling that doctors should try the drug as a last resort.

Her family had wanted artificial feeding and hydration withdrawn, arguing that she would not want to live if the drug worked and she became aware of her disabilities.

But Sienie Engelbrecht, 57, from Johannesburg, South Africa, whose son Louis was the first patient to respond to the drug, said: "They cannot let her die when there is still hope."

Mrs Engelbrecht, a sales representative, said yesterday: "I would say to this woman's family: 'I really think you must definitely try zolpidem. If it worked for my son, it could just work for her.'

"They cannot let her die without trying it. It might help. I am praying for her."

Her son, Louis Viljoen, 25, was a hospital switchboard operator looking forward to marrying his fiancee when he was hit by a truck in May, 1996. The crash happened while he was riding home on a bicycle in Springs, Johannesburg.

For three years he was in PVS and totally unresponsive to his hospital surroundings.

His GP, Dr Wally Nel, had initially prescribed zolpidem as a sleeping tablet for his mother's insomnia. Its effect on PVS patients was discovered by accident.

Dr Nel said yesterday: "I gave it to his mother to help her sleep. She was sitting with him every night, and she was worried because although he was in PVS, he was restless. He was pulling the foam out of his mattress with one hand in uncoordinated movements, and pulling at the sheets. His mother said: 'What can I do?' I said: 'Give him some zolpidem'. I thought it would settle him."

It had the opposite effect. Louis's remarkable response has triggered the debate over zolpidem and led to the start of the first proper clinical trials on 30 PVS patients by the British company ReGen, due to begin in South Africa on Monday.

Mrs Engelbrecht crushed a tablet into some water and gave it to Louis. "It was about 25 minutes later when I thought I heard him make a little sound," she recalled.

"I said: 'Louis, can you hear me?' He said: 'Yes'. For the first time in three years he said 'yes'. So I said: "Can you say hello to me?" and he said: "Hello mummy."

"I cried my heart out for at least a week."

Louis has been taking the drug in decreasing amounts for the past seven years, and according to his mother and Dr Nel, he continues to improve so that he can sit up, hold conversations, make jokes and move his arms.

He can even remember the World Cup and the names of his old teachers, though not details of his accident. The effects usually last for about six hours after each tablet. He is still being treated at a rehabilitation centre, but neither he nor his mother have given up hope that he will one day be allowed back home.

"He is getting better and better every day," she said. "To me, it is a miracle. It really is an eye-opener for people that have suffered brain damage.

"When people today ask me why I didn't switch off Louis's machine, I tell them there must have been a reason. Now I know what it was."

She said she thought the publicity surrounding the British legal case would draw attention to the fact that there were many other people like Louis, who had also benefited.

"There are so many of them," she said. "He was the first but it has worked for others. I really hope and pray that it works for this woman.

"I know how hard all this must be for her family, but I truly believe this was the right decision."

Dr Nel said: "If it happens to one person in the world, is the door not open for others?"

He said he had since tried the drug on some 250 patients, and 60 per cent of them had responded "beneficially". The fact that the British woman, who had collapsed while on holiday, had been in PVS for three years would increase her chances of responding positively, he said.

"The longer the brain rests, the better your chances of it working are," he said. "There is nothing I would like more than for it to work for her."

Man's brain rewired itself, doctors contend
Nerve connections severed in accident nearly 20 years ago

By Karen Kaplan, Los Angeles Times | July 4, 2006

LOS ANGELES -- Terry Wallis awoke from a coma-like state 19 years after tumbling over a guardrail in a pickup truck and falling 25 feet into a dry riverbed. Now doctors armed with some of the latest brain-imaging technology think they may know part of the reason why.

Wallis showed few outward signs of consciousness, but his brain was methodically rebuilding the white-matter infrastructure necessary for him to interact with the outside world, researchers reported yesterday in the Journal of Clinical Investigation.

``I believe it's a very, very slow self-healing process of the brain," said Henning Voss, lead author of the study and a physicist at Weill Cornell Medical College's Citigroup Biomedical Imaging Center.

Wallis emerged from a minimally conscious state in 2003 at the age of 39 and uttered his first word since Ronald W. Reagan was in the White House: ``Mom." Since then, the onetime mechanic from Big Flat, Ark., has regained the ability to form sentences and recovered some use of his limbs, though he still can't walk or feed himself.

Using both Positron Emission Tomography scans and an advanced imaging technique called diffusion tensor imaging, the researchers examined Wallis's brain after he regained full consciousness, and found that cells in the relatively undamaged areas had formed new axons, the long nerve fibers that transmit messages between neurons.

``In essence, Terry's brain may have been seeking out new pathways to reestablish functional connections to areas involved in speech and motor control -- to compensate for those lost due to damage," said the study's senior author, Dr. Nicholas Schiff, a neurologist at the Weill Cornell Medical College in New York.

Schiff cautioned that Wallis was a ``1 in 300 million" case. But Dr. Steven Laureys, a neurologist at the University of Liege in Belgium, said the findings will force doctors to reconsider the way they treat patients who are in minimally conscious and persistent vegetative states.

``It does show there are changes happening" in the brain, said Laureys, who coauthored a commentary that also appears in the journal. ``It obliges us to reconsider old dogmas."

In a minimally conscious state, a patient shows intermittent signs of awareness but generally is unable to interact with the outside world. It is a less severe condition than a persistent vegetative state, in which the patient is awake but has no awareness of herself or her surroundings.

Terri Schiavo, the Florida woman at the center of a right-to-die battle, had been in a persistent vegetative state for 15 years when her husband won a court order to have her feeding tube removed last year.

Neurologists believe that the longer a patient remains in a minimally conscious or persistent vegetative state, the lower the chances for recovery. As a result, such patients are often neglected by doctors and insurance companies, and it can be difficult for family members to find facilities that will accept them, Laureys said.

In his last few years at Stone County Nursing and Rehabilitation Center in Mountain View, Ark., Wallis's family began to notice that Terry, a Ford enthusiast, would grunt when a Chevrolet commercial came on the television. They said he answered questions by blinking his eyes.

About two years before he regained full consciousness, he began taking the antidepressant Paxil, which his doctors think may have contributed to his recovery.

Within a week of his first utterance, Wallis began speaking in simple sentences. Once paralyzed from the neck down, he can now point with his left hand and move both legs.

The researchers scanned Wallis's brain eight months after his awakening and found strong evidence that axons were making new connections in the cerebellum, the region that controls movement. The activity was stronger than in the brains of 20 healthy people scanned for the sake of comparison, and seemed to correlate with Wallis's physical improvement, Voss said.

When his brain was rescanned 18 months later, signs of growth in the cerebellum had leveled off, and other areas of the brain were using more energy.

Wallis's language skills improved during that time; he learned to count to 25 without interruption, and his speech became more intelligible.

But when the researchers looked for evidence of increased activity in the language centers of his brain, they found none.

``Maybe we just missed it, or maybe the language areas are unusable because important connections are missing," said Voss, who theorizes that another part of the brain may have picked up the slack.

Voss and his colleagues also scanned the brain of a car accident victim who is still minimally conscious, and they found significant axonal regrowth as well.

That patient, however, has not shown corresponding clinical improvement, according to the study.

Thats' probably because it's a whole other issue.

No one ever comes out of a PVS. If they do, then it wasn't a PVS...it was a TVS by definition.