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

• Published in: Developmental medicine and child neurology 1999-06, Vol.41 (6), p.364-374, Article S0012162299000821
• Main Authors: Shewmon, D Alan, Holmes, Gregory L, Byrne, Paul A
• Format: Article
• Language: English
• Subjects: Brain - abnormalities; Brain - diagnostic imaging; Brain Diseases - congenital; Brain Diseases - diagnostic imaging; Child; Consciousness - physiology; Female; Humans; Male; Original Articles; Persistent Vegetative State - physiopathology; Tomography, X-Ray Computed
• ISSN: 0012-1622; 1469-8749
• DOI: 10.1017/S0012162299000821

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.