Doctors say the American student imprisoned in North Korea is experiencing ‘unresponsive wakefulness’ — here’s what that means

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Doctors caring for Otto Warmbier, the American student imprisoned in North Korea for 17 months, said on June 15 that the 22-year-old is in a state of “unresponsive wakefulness.”

Warmbier was detained as he was leaving Pyongyang in January 2016, and was subsequently sentenced to 15 years of hard labour on the grounds that he attempted to steal a banner containing political slogans.

On June 13, Warmbier was medically evacuated from North Korea, reportedly in a coma, and flown to Cincinnati. The Warmbier family told the Washington Post that the North Koreans suggested Otto’s condition was due to a case of botulism that he contracted after his trial, combined with the effects of a sleeping pill. Fred Warmbier, Otto’s father, has refuted that account. He told Fox News that his son went into a coma the day after his sentencing, and had remained that way for more than a year before his evacuation (though his family only found out a week ago).

Warmbier’s doctors say they did not find any current signs of botulism in his system. Instead, they’re suggesting he suffered extensive brain damage — Warmbier has neither spoken nor demonstrated any purposeful movements since returning to the US.

“This pattern of brain injury is usually seen as result of cardiopulmonary arrest where the blood supply to brain is inadequate for a period of time resulting in the death of brain tissue,” Dr. Daniel Kanter, director of the Neurocritical Care Program at the University of Cincinnati Medical Center, said in a press conference, according to CNN.

Warmbier’s state of “unresponsive wakefulness” most likely means that he can open his eyes and has functioning reflexes, but is unresponsive to commands and other tests of consciousness. This is different than a coma, in which a patient is technically asleep and keeps their eyes closed.

Until 2010, Warmbier’s condition was generally referred to as a vegetative state, but many doctors saw the term as pejorative, since it suggested that a patient was somehow similar to a vegetable. The term actually dates back to the 1800s, when anatomist and pathologist Marie Francois Xavier divided the human nervous system into animalic and vegetative functions. Vegetative, according to this early definition, included many involuntary, automatic functions, like the cardiovascular and respiratory systems. The animalic processes were the ones that helped a person perceive and understand their environment — intellect, locution, senses, etc.

The modern conception of a vegetative state was first put forth in a 1972 paper as a way to describe medical patients whose sleep cycles and automatic functions continued somewhat normally, but who didn’t exhibit any awareness of their own self or external environment. But in the last five to 10 years, the term “unresponsive wakefulness syndrome” has increasingly been used instead of “vegetative state” to avoid negative associations.

A 2013 review of cases of unresponsive wakefulness syndrome suggests that patients in this state have neuronal function levels that remain below the threshold required for them to experience consciousness. Their chances of recovery therefore depend on how far their neuronal activity is from this necessary level.

Doctors have thus far declined to speculate on Warmbier’s prognosis.

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