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Consciousness in congenitally decorticate children: developmental vegetative state as self-fulfilling prophecy

Published online by Cambridge University Press:  01 June 1999

D Alan Shewmon
Affiliation:
Pediatric Neurology, UCLA Medical Center, Los Angeles, CA, USA.
Gregory L Holmes
Affiliation:
Department of Neurology, Harvard Medical School Children's Hospital, Boston, MA, USA.
Paul A Byrne
Affiliation:
Pediatrics (Neonatology) Medical College of Ohio, St Charles Hospital, Oregon, OH, USA.
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Abstract

According to traditional neurophysiological theory, consciousness requires neocortical functioning, and children born without cerebral hemispheres necessarily remain indefinitely in a developmental vegetative state. Four children between 5 and 17 years old are reported with congenital brain malformations involving total or near-total absence of cerebral cortex but who, nevertheless, possessed discriminative awareness: for example, distinguishing familiar from unfamiliar people and environments, social interaction, functional vision, orienting, musical preferences, appropriate affective responses, and associative learning. These abilities may reflect ‘vertical’ plasticity of brainstem and diencephalic structures. The relative rarity of manifest consciousness in congenitally decorticate children could be due largely to an inherent tendency of the label ‘developmental vegetative state’ to become a self-fulfilling prophecy.

Type
Original Articles
Copyright
© 1999 Mac Keith Press

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