Vegetative state: Years of minimal consciousness

It sounds like a medical miracle: Emirati woman Munira Abdulla was in a vegetative state for 27 years — and now she's home with her family and able to communicate with loved ones again. Abdulla was treated in a clinic in Bavaria after being injured in a car accident in 1991. She woke up in May 2018, but her family only announced the information now because they wanted to wait until her condition had stabilized.

Abdulla's son Omar, who was four in 1991 and was also injured in the accident, told reporters: "We felt we needed to share the story to give people going through the same or similar experiences hope."

Her doctors say she is able to "consciously interact with her environment and participate in family life again," even though she remains severely handicapped and confined to a wheelchair.

What is special about Abdulla's case is how long she was in a vegetative state of minimal consciousness.

What is a coma?

The word coma is used to describe a wide range of conditions in which a patient is left with no or very limited consciousness. A person usually falls into a coma after experiencing a brain injury, for example in an accident, or going through an illness. People in a coma are completely unresponsive, meaning they don't move, react to outside stimuli or feel pain. Their eyes are closed. This is the brain's response to extreme trauma — it is effectively shutting down.

What is a vegetative state?

In most cases, comas last several weeks at most. Most patients who stay unresponsive for years or even decades are not in a coma, medically speaking. They are considered to be in a vegetative or minimally conscious state. Contrary to coma patients, they can move parts of their body, their eyes might open from time to time and they might pull away from sources of pain. Some people in a vegetative state even make sounds or say words.

Despite all of this, they are usually not aware of themselves or their surroundings. The movements and sounds are involuntary. This condition is also known as "apallic syndrome" or "unresponsive wakefulness syndrome". In the US, three months after a non-traumatic brain injury or one year after a traumatic brain injury, patients with this condition are classified as being in a permanent vegetative state.

Friedemann Müller, a neurological specialist who cared for Abdulla in the Bavarian hospital she was at, said that she was in a vegetative state, not a coma.

Varying opinions on awareness

Some doctors say that people in a vegetative state have zero awareness of what's happening around them, cannot answer questions and don't hear relatives coming to visit or read to them. But some studies suggest this isn't entirely true.

A team of researchers put vegetative state patients in British and Belgian treatment centers in an MRI machine and published their results in 2010. Five out of 54 patients were able to react mentally to tasks the scientists had for them, which was then visible on their MRI scans. One of the five could even answer yes-or-no questions — not out loud, but by thinking the right answer.

"These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition," the researchers wrote.  

Treating patients in a vegetative state

Abdulla, the woman in a vegetative state for 27 years, was treated with a combination of physical therapy, medicine, operations and sensory stimulation. Doctors took a holistic approach to her treatment, controlling her muscle contractions with an exoskeleton at times, adjusting her medication, and taking her outside to hear songbirds.

Aside from making sure patients are comfortable by moving them around to prevent sores or treat infections, it is crucial to continuously monitor their mental state to account for any changes in brain activity.

Chance of recovery

The likelihood of a patient waking from a vegetative state decreases the longer they are in it.

Adults roughly have a 50 percent chance and children a 60 percent chance of recovering consciousness within the first 6 months in the case of traumatic brain injury. For non-traumatic injuries, the recovery rate falls within the first year. After this period the chances that patients will regain consciousness are very low.

In general, younger patients fare better than older ones. The longer a patient was in a vegetative state, the more likely they are to have lasting disabilities like the ones Munira Abdulla has. Her son is still extremely grateful to have his mother back after such a long time.

"I dreamed of this moment for years," Omar said.