{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:37:09Z","timestamp":1790066229618,"version":"4.0.1"},"reference-count":15,"publisher":"The Royal Society","issue":"1377","license":[{"start":{"date-parts":[[1998,11,29]],"date-time":"1998-11-29T00:00:00Z","timestamp":912297600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/royalsociety.org\/journals\/ethics-policies\/data-sharing-mining\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Phil. Trans. R. Soc. Lond. B"],"published-print":{"date-parts":[[1998,11,29]]},"abstract":"<jats:p>The clinically described \u2018persistent vegetative state\u2019 (PVS), consists of wakefulness unaccompanied by any evidence of the subject's awareness of self or environment. Past studies from our own and other laboratories have used positron emission tomography (PET) to study brain metabolism in approximately 20 such patients during wakeful periods. All those efforts identified global cerebral glucose metabolism at or below levels encountered during deep barbiturate anaesthesia. Nevertheless, the clinical literature includes rare reports of relatively isolated cognitive functions expressed by PVS patients late in their course. The observation raises the question of whether such activity reflects awareness or unconscious automatic behaviour. We employed magnetometry (MEG), PET scanning, MR imaging and 24\u2013hour EEG recordings to evaluate three patients clinically vegetative between six months and 20 years after onset.<\/jats:p>\n                  <jats:p>Neither meticulous clinical examinations nor 24\u2013hour EEG and video monitoring provided any hint of cognitive interaction in any subject. Nevertheless, patient 1 uttered single words once every 48 hours or more; patient 2 frequently expressed coordinated, non\u2013purposeful, non\u2013dystonic movements in arms and\/or legs; and, patient 3 expressed strong emotional negativity without motor responses to noxious stimuli with occasional quieting in response to prosodic stimuli.<\/jats:p>\n                  <jats:p>All patients had whole\u2013brain averaged global metabolism levels below 50% of normal. Patient 1, however, demonstrated preserved islands of increased metabolism in the posterior frontal and posterior temporal lobes, as well as MEG activations of Heschl's gyrus all located in the left hemisphere. In patient 2, selected increased metabolism was confined to the frontal poles and related subcortical structures. MRI in patient 3 demonstrated severe, bilateral post\u2013traumatic cerebral atrophy. PET metabolism was diffusely reduced to 40% of normal but MEG evoked potentials indicated early and late sensory processing with abnormal later evoked components.<\/jats:p>\n                  <jats:p>The correlation of fragmentary behaviour with preserved metabolic and physiologic activity in cortical and subcortical regions known to support specific modular functions is novel. The finding demonstrates the capacity of severely damaged brains to partially express surviving modular functions without evidence of integrative processes that would be necessary to produce consciousness. These data represent a baseline against which less severely damaged brains may be assessed and ultimately tested the recovery of conscious expression.<\/jats:p>\n                  <jats:p>We conclude that the mere expression of isolated neuropsychologic activity by isolated modules is insufficient to generate consciousness in overwhelmingly damaged brains.<\/jats:p>","DOI":"10.1098\/rstb.1998.0345","type":"journal-article","created":{"date-parts":[[2002,7,26]],"date-time":"2002-07-26T19:55:43Z","timestamp":1027713343000},"page":"1929-1933","source":"Crossref","is-referenced-by-count":44,"title":["Coordinated expression in chronically unconscious persons"],"prefix":"10.1098","volume":"353","author":[{"name":"The American Association for Research into Nervous and Mental Diseases","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Plum","sequence":"additional","affiliation":[{"name":"Cornell University Medical College, NewYork Presbyterian Hospital, 1300 York Avenue, NY 10021,  USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Schiff","sequence":"additional","affiliation":[{"name":"Cornell University Medical College, NewYork Presbyterian Hospital, 1300 York Avenue, NY 10021,  USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Ribary","sequence":"additional","affiliation":[{"name":"Center for Neuromagnetism, New York University School of Medicine, 550 First Avenue, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Llin\u00e1s","sequence":"additional","affiliation":[{"name":"Center for Neuromagnetism, New York University School of Medicine, 550 First Avenue, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"175","published-online":{"date-parts":[[1998,11,29]]},"reference":[{"key":"p_1","unstructured":"Bichat M.-F.-X. 1800 Recherches physiologiques sur la vie et la mort pp. 1^189. Paris: Brosson Gabon."},{"key":"p_2","doi-asserted-by":"crossref","first-page":"75","DOI":"10.3171\/jns.1987.67.1.0071","article-title":"E\u00a1ect of barbiturate coma on glucose utilization in normal brain versus gliomas. Positron emission tomography studies","volume":"67","author":"Blacklock J. B.","year":"1987","journal-title":"J. Neurosurg."},{"key":"p_3","unstructured":"Cannon W. B. 1927 Bodily changes in pain hunger fear and rage (2nd edn). New York and London: D. Appleton & Co."},{"key":"p_4","doi-asserted-by":"crossref","DOI":"10.1152\/ajplegacy.1925.72.2.283","article-title":"Studies on the conditions of activity in endocrine glands, XV pseudoa\u00a1ective medulladrenal secretion","volume":"72","author":"Cannon W. B.","year":"1925","journal-title":"Am. J. Physiol."},{"key":"p_5","doi-asserted-by":"crossref","unstructured":"DeVolder A. G. Go\u00a4net A. M. Bol A. Michel C. de Barsy T. & Laterre C. 1990 Brain glucose metabolism in postanoxic stroke. Arch. Neurol. 47 197^204.","DOI":"10.1001\/archneur.1990.00530020103022"},{"key":"p_6","doi-asserted-by":"crossref","unstructured":"Giacino J. & Kalmar K. 1997 The vegetative and minimally conscious states: a comparison of clinical features and functional outcome. 12 36^51.","DOI":"10.1097\/00001199-199708000-00005"},{"key":"p_7","unstructured":"Hagen C. Malkmus D. & Durham P. 1972 Levels of cognitive functioning. Downey CA: Rancho Los Amigos Hospital."},{"key":"p_8","doi-asserted-by":"crossref","unstructured":"Jennett B. & Plum F. 1972 Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1 734^737.","DOI":"10.1016\/S0140-6736(72)90242-5"},{"key":"p_9","doi-asserted-by":"crossref","unstructured":"Levy D. E. Sidtis J. J. & Rottenberg D. A. 1987 Di\u00a1erences in cerebral blood \u00a3ow and glucose utilization in vegetative versus locked-in patients. Ann. Neurol. 22 673^682.","DOI":"10.1002\/ana.410220602"},{"key":"p_10","article-title":"Medical aspects of the persistent vegetative state. Part 1","volume":"330","author":"Multisociety Task Force on PVS","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"p_11","doi-asserted-by":"crossref","unstructured":"Phelps M. E. Huang S. C. Ho\u00a1man E. J. Selin C. Sokolo\u00a1 L. & Kuhl D. E. 1979 Tomographic measurement of local cerebral glucose metabolic rate in humans with (F-18) 2- \u00a3uoro-2-deoxy-D-glucose: validation of method. Ann. Neurol. 6 371^388.","DOI":"10.1002\/ana.410060502"},{"key":"p_12","unstructured":"Ross E. D. 1997 The aprosodias. In Behavioural neurology and neuropsychology (ed. T. E. Feinberg & M. J. Farah) pp. 699^710. New York: McGraw-Hill."},{"key":"p_13","unstructured":"Schi\u00a1 N. Ribary U. Plum F. & Llinas R. 1998 Words without Mind. J. Cog. Neurosci. (Submitted.)"},{"key":"p_14","unstructured":"Timme W. Davis T. K. & Riley H. A. (eds) 1928 1930 The vegetative nervous system; an investigation of the most recent answers. In Proc. Assoc. Res. Nerv. Mental Dis. vol. IX. Baltimore MD: Williams & Wilkins."},{"key":"p_15","article-title":"Regional metabolism of comatose and vegetative state patients","volume":"7","author":"Tomassino C.","year":"1995","journal-title":"J. Neurosurg. Anesth."}],"container-title":["Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/royalsocietypublishing.org\/doi\/pdf\/10.1098\/rstb.1998.0345","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/royalsocietypublishing.org\/doi\/pdf\/10.1098\/rstb.1998.0345","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T21:27:06Z","timestamp":1778621226000},"score":1,"resource":{"primary":{"URL":"http:\/\/royalsocietypublishing.org\/rstb\/article\/353\/1377\/1929-1933\/19351"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1998,11,29]]},"references-count":15,"journal-issue":{"issue":"1377","published-print":{"date-parts":[[1998,11,29]]}},"alternative-id":["10.1098\/rstb.1998.0345"],"URL":"https:\/\/doi.org\/10.1098\/rstb.1998.0345","relation":{},"ISSN":["0962-8436","1471-2970"],"issn-type":[{"value":"0962-8436","type":"print"},{"value":"1471-2970","type":"electronic"}],"subject":[],"published":{"date-parts":[[1998,11,29]]}}}