Editor’s Message


At some point in the development of Western civilization, Philosophy and Science diverged. In recent decades, they have seemed to collide. In the coming years, evidence suggests, the two fields may yet be reconciled. And functional MRI (fMRI) could be the technology that facilitates the happy reunion.

Monti, et al., writing recently in the New England Journal of Medicine, report that in unresponsive or minimally responsive patients—those in so-called “vegetative” states— activity in the cerebrum was identified on fMRI in response to verbal instructions. For example, patients were asked to navigate a familiar place (such as their home or a wellknown city) or to imagine playing a sport. The team elicited activity in five of 54 scanned patients. Although the authors indicate that difficulty differentiating vegetative states from minimal consciousness could impact results, their findings engender questions about vegetative states, the plasticity of the brain, and the enigma of the mind.

In an editorial accompanying the study, Allan R. Hopper, MD elucidated some of the numerous possible philosophical implications of the findings. He also cautions about limitations of the imaging study; still, it is nearly guaranteed that the study will be cited and interpreted in many different ways by many different people. Surely those who ponder existential issues will take interest in the research.

The recent fMRI findings confirm one thing: despite remarkable advancements in research, the brain (and more so the mind) remain largely unchartered territories. There remains much to learn about the function (and dysfunction) of the brain, and imaging technologies are certainly providing new insights. As noted in this month’s cover story, increasingly sophisticated imaging could contribute to the understanding of what a “concussion” really is. Already, it is leading the way to new diagnostic modalities for Alzheimer’s disease and other neurodegenerative disorders.

The brain and its multiple functions has intrigued scientists for years. It’s only relatively recently that physicians have been able to meaningfully modulate neurologic functions. Given the pace of advancements over the last century, the future holds incredible potential.


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Wendy Terry

About Practical Neurology

Launched in 2002, Practical Neurology is a publication uniquely dedicated to presenting current approaches to patient management, synthesis of emerging research and data, and analysis of industry news with a goal to facilitate practical application and improved clinical practice for all neurologists. Our straightforward articles give neurologists tools they can immediately put into practice.