Conscious Children: A Brief Look at Hydranencephaly

Conscious Children: A Brief Look at Hydranencephaly

Web Paper #2

“It is on the whole probably that we continually dream, but that consciousness makes such a noise that we do not hear it” Carl Jung once wrote.  But, what happens if a child is born with a rare neurological condition where they are missing 80% of their brain?  Are they conscious of what is going on?  Do these children live in a ‘vegetative state’ or are they aware of sensory inputs and outputs?  Do they smile when happy and become agitated when in pain if consciousness originates in a region of the brain they lack?  As we have explored consciousness throughout the semester in class discussions, we have tried to tease out the definition of consciousness and where consciousness originates.  These questions have been researched by many scientists for decades with countless theories evolving on many sides of the debate.

What Is Hydranencephaly?

Hydranencephaly, is a disorder where the cerebral hemispheres are completely or near absent at birth, including the cerebral cortex and basal ganglia and are replaced by cerebrospinal fluid (1).  Small amounts of tissue from the frontal, temporal and occipital lobes may be left intact and the thalami, pons, and cerebellum are generally present and functioning (2).  In most cases, evidence has shown the disorder is a non-inherited condition and usually develops after the second trimester of pregnancy.  It has been linked to injuries to the fetus, placental anomalies, and cytomegalovirus, herpes simplex, and Toxoplasma gondii infections affecting the mother (2).

After the infant is born, there may be no initial detection of hydranencephaly and it may go unnoticed for several months until the child misses developmental targets such as motor control (holding up head and neck), lack of eye contact or enlarged head (3).  The first year of life for the child with hydranencephaly and their families presents the most challenges and difficulties, both physically and emotionally.  It is at this time complications arise and medical emergencies can be a part of daily life.  Seizures, pneumonia due to aspiration, and problems with temperature regulation are a few of the complications that commonly occur (3).  Due to many hurdles, some children do not make it through their first year of life, but some have gone on to live into their late twenties with medical intervention and deeply caring family members.

Does the Cortex Reign Supreme?

Neuroscientists have paved the way for the development of further research into the controversial subject of consciousness and the view of the “supremacy of the cerebral cortex” (3) continue to be debated.  Until 1949, it was assumed that the regulation of the stages of sleep and wakefulness were ruled by cortical functioning (3).  Scientists Moruzzi and Magoun researched this regulating function through animal experimentation with astonishing results.  They found, “local stimulation of circumscribed cell groups in the pons and midbrain of experimental animals exerts a global activating influence on the cerebral cortex as well as on behavioral state, and that experimental lesions in these brainstem sites are capable of rendering animals somnolent and even comatose” (3).  This, in turn led neurosurgeons Penfield and Jasper to look further into the higher functioning debate of consciousness by studying patients with epilepsy (3). In surgical operations on patients who suffered with severe epileptic seizures, Penfield and Jasper removed cortical tissue while the patient was conscious.  They found that even with substantial removal of cortex, including hemispherectomy, the patients continued responding and maintaining consciousness (3 & 5). Through many years of study, Jasper and Penfield concluded that consciousness could not be an independent function of the cortex but a combination of brain connections, with the upper brainstem system serving as the conductor (3).

Exploring Levels of Consciousness

In understanding children with hydranencephaly, I feel it necessary to think about the possibility of the evolution of consciousness in the brain.  In the article, “Consciousness without a cerebral cortex: A challenge for neuroscience and medicine” by Bjorn Merker, he details his theory and research into consciousness and demonstrates evidence of his research with his experiences of children with hydranencephaly.  There are differences in the range of possibilities in consciousness as Bjorn Merker explains:

                “to see, to hear, to feel, or otherwise to experience something is to be conscious, irrespective of whether in addition one is aware that one is seeing, hearing, and so forth, as cogently argued by Dretske.  Such additional awareness, in reflective consciousness or self-consciousness, is one of many content of consciousness available to creatures with sophisticated cognitive capacities. However, as noted by Morin (2006), even in their case, it is present only intermittently, in a kind of time-sharing with more immediate, unreflective experience. To dwell in the latter is not to fall unconscious, but to be unselfconsciously conscious. Reflective awareness is thus more akin to a luxury of consciousness on the part of certain big-brained species, and not its defining property” (3). 

So, in reflective awareness (the “I”) would be what Merker defines as a “luxury”, essentially unnecessary for

 consciousness to occur in human beings, thus allowing for those without a cortex to experience conscious

states, including children with hydranencephaly.

                Children with hydranencephaly demonstrate evidence for Merker’s argument that the brain stem holds many answers for understanding consciousness. On the website, Rays of Sunshine, families of children with hydranencephaly support one another and exchange information. In three separate questionnaires, they gathered data about their experiences, asking numerous questions ranging from the age, sex, and time of diagnosis to medical conditions, allergies and medications their child was currently prescribed. The data proved to show an enormous amount of surprising and sometimes, contradictory information compared to what had been previously believed of the children (5). The most common health concerns with the children were respiratory, neurological issues involving problems with the shunt used for drainage of fluid from the brain (approx. 65% of children have shunts), seizures (approx. 77%), feeding problems and spasticity (5).

                As far personal contact with the child’s family and caregiver including motor functioning processes and sensory input, the following questions were asked:

1.       Can your child move his/her hands? Approx. 50% Yes

2.       Can your child give hugs or kisses? Approx. 20% Yes, Sometimes 11%

3.       Can your child cry? Approx. 91% Yes

4.       Can your child hear? Approx. 93% Yes

5.       Can your child make sounds? Approx. 96% Yes

6.       Is your child aware of his/her surroundings? Approx. 74% Yes

7.       Does your child understand what is said to him/her? Approx. 22% Yes

8.       Does your child use a communication device? Approx 14% Yes

The data collected shows evidence of consciousness and awareness of the primary caregiver and other family members and the ability in some children to even communicate needs and wants. This gives rise to understanding implications to many other important issues surrounding ethics including pain management in neonates, understanding fetal pain and pain for those who live in so-called “vegetative” states.

                Since hydranencephaly is a rare condition affecting just 1 in less than 10,000 births, and the mortality rate is extremely high for newborns, much extensive research still needs to be done regarding hydranencephaly. On July 25, 2006 in the Omaha World-Herald, there was an article posted, “Q & A: Meet the mother of a 27-year-old with hydranencephaly.”  This was the first article I read on hydranencephaly and knew I wanted to investigate the condition further when I read her response to one simple question, “How much brain tissue does she have?”  The mom’s response,

“I don’t really know. Back when Katie was diagnosed with this, I tried to do some research on it and it was so frustrating. Even going to a library, you might find a paragraph or two lines, and that was it. Even now you go to a doctor and say ‘hydranencephaly’ and half of them don’t understand. They’ll write ‘hydroecephalic.’ You have to say, ‘No, it is hydranencephaly (4).’” 

 

May the noise of consciousness get out of our way so we can some day find a cure for the Katie’s of the world.

  
  

WWW Works Cited

(1)    MedicineNet.com.  “Definition of Hydranencephaly.”   http://www.medterms.com/script/main/art.asp?articlekey=15547.

(2)    Wagner MD, Andrew L., and Dennis Rohrer, MD. “Hydranencephaly.”  eMedicine. Eds. Charles M. Glasier, MD., Bernard D. Coombs, MB, ChB, PhD, Marta Hernanz-Schulman, MD, FAAP, Robert M Krasny, MD, Lawrence M. Davis, MD.  18 Feb. 2008. WebMD.  http://emedicine.com/radio/TOPIC351.HTM

(3)    Merker, Bjorn. “Consciousness without a Cerebral cortex: A Challenge for neuroscience and medicine.”   Behavioral and Brain Science. (2007) 30. 63-134.  Tripod. BMC Library, Bryn Mawr, PA.   http://journals.cambridge.org.proxy.brynmawr.edu/download.php?file=%2FBBS%2FBBS30_01%2FS0140525X07000891a.pdf&code=81285b3b5f33a08f0244640216120c97

(4)    Aksamit, Nichole. “Q & A: Meet the mother of a 27-year old with hydranencephaly.” Omaha World Herald. 25 July, 2006. http://www.omaha.com

(5)     Rays of Sunshine.  http://hydranencephaly.com/about_hydranencephaly.htm>

Other helpful resources:

Paul, Annie Murphy. “The First Ache.” The New York Times. 10 Feb. 2008. 28 Mar. 2008. http://www.nytimes.com/2008/02/10/magazine/10Fetal-t.html?scp=1&sq=e+first+ache&st=nyt

Schwartz, Jeffrey M. and Sharon Begley. The Mind and The Brain: Neuroplasticity and the Power of Mental Force. New York:  HarperCollins 2002.

Bower, Bruce. “Consciousness in the Raw.” Science News Online. 15 Sept. 2007. Science News.  5 Apr. 2008.  http://sciencenews.org/articles/20070915/bob9.asp