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7: Documentation

7: Substantial evidence indicates that children born missing the bulk of the cerebral cortex, those with hydranencephaly, nevertheless experience pain.

 DOCUMENTATION:

1. Brusseau, 2008, p.17, para.2-3, “Clinical evidence for conscious perception mediated by such a subcortical system comes from infants and children with hydranencephaly…31-33.  Despite the total or near-total absence of cerebral cortex, these children clearly demonstrate elements of consciousness.34… It is important to note that these are not hydrocephalic children who possess a thin rim of intact, functional cortex, but rather children with little or no cortex at all…what little cortex may remain is generally nonfunctional and without normal white matter connectivity.35

“As such, it would seem these children demonstrate that anatomic development or functional activity of the cortex may not be required for conscious sensory perception.  They may, and do in fact, respond to painful or pleasurable stimuli in what may easily be argued to be a conscious, coordinated manner, similar to intact children.36

Brusseau R. Developmental Perpectives: is the Fetus Conscious? International Anesthesiology Clinics.  46:3 (2008) 11-23.

31Counter SA. Preservation of brainstem neurophysiological function in hydranencephaly. Journal of Neuroscience.  263 (2007) 198-207.

32Marin-Padilla M. Developmental neuropathology and impact of perinatal brain damage. Journal of Neuropathology & Experimental Neurology. 56 (1997) 219-235.

33Takada K, Shiota M, Ando M, et al. Porencephaly and hydranencephaly: a neuropathological study of four autopsy cases. Brain Development. 11 (1989) 51-56.

34Shewmon DA, Holmes GL, Byrne PA. Consciousness in congenitally decorticate children: Developmental vegetative state as self-fulfilling prophecy. Developmental Medicine & Child Neurology.  41 (1999) 364-374.

35Merker B. Life expectancy in hydranencephaly. Clinical Neurology & Neurosurgery.  110 (2008) 213-214.

36McAbee GN, Chan A, Erde EL. Prolonged survival with hydranencephaly: report of two patients and literature review. Pediatric Neurology. 23 (2000) 80-84.

2. Merker, 2007, p.79, col.1, para.4, “My impression from this first-hand exposure to children with hydranencephaly confirms the account given by Shewmon and colleagues.  These children are not only awake and often alert, but show responsiveness to their surroundings in the form of emotions or orienting reactions to environmental events… They express pleasure by smiling and laughter, and aversion by “fussing,” arching of the back and crying (in many gradations), their faces being animated by these emotional states.”

Merker B. Consciousness without a cerebral cortex: A challenge for neuroscience and medicine. Behavioral and Brain Sciences.  30 (2007) 63-81.

Shewmon DA, Holmes GL, Byrne PA. Consciousness in congenitally decorticate children: Developmental vegetative state as self-fulfilling prophecy.  Developmental Medicine & Child Neurology. 41 (1999) 364-374.

3. Brusseau, 2006, p.191, col.1, para.1, “Indeed, there is evidence that hydranencephanic children responds to painful and pleasurable stimuli in a coordinated manner similar to other children.11

Brusseau R, Myers L.  Developing consciousness: fetal anesthesia and analgesia. Seminars in Anesthesia, Perioperative Medicine and Pain.  25 (2006) 189-195.

11Anand KJS.  U.S. Congress.  House of Representatives.  Committee on the Judiciary.  Pain of the Unborn: Hearing Before the Subcommittee on the Constitution. 109th Cong., 1st Sess., 2005. 

4. Beshkar, 2008, p.554, col.1, para.1, “Shewmon et al. (1999) reported the cases of four children aged 5-17, with hydranencephaly involving complete or nearly complete absence of cerebral cortex.  The authors observed that these children possessed a variety of cognitive capacities that were indicative of ordinary consciousness, including…appropriate affective responses.”

p.555, col.2, para.3, “Whether or not children born with hydranencephaly have consciousness is still controversial.  However, the body of evidence in favor of the presence of consciousness in these patients seems to be more convincing than evidence and arguments against consciousness in such children.”

Beshker M.  The Presence of Consciousness in the Absence of the Cerebral Cortex.  Synapse. 62 (2008) 553-556.

Shewmon DA, Holmes GL, Byrne PA. Consciousness in congenitally decorticate children: Developmental vegetative state as self-fulfilling prophecy. Developmental Medicine & Child Neurology.  41 (1999) 364-374.

5.Bellieni, 2012, page 1-6, “If the presence of a mature cortex is the prerequisite of the experience of pain, fetal pain is improbable, as several authors argue; on the other hand, several studies50-59 highlight the possibility of perception due to subcortical centers. Infants and children with hydranencephaly, despite total or near-total absence of the cortex, clearly possess discriminative awareness58,59: they discriminate familiar from unfamiliar people and environments and are capable of social interaction, visual orienting, musical preferences, appropriate affective responses, and associative learning56. Several stimuli are processed without the need of the cortex 51,52,57 and give useful visual information 58,59 or trigger complex experiences such as fear 53,60. Some authors hypothesize a similar scenario for subcortical fetal processing of pain 61,62.”

Carlo V. Bellieni & Giuseppe Buonocore, “Is fetal pain a real evidence?,” The Journal of Maternal-Fetal and Neonatal Medicine (2012), 1–6.

50Denton DA, McKinley MJ, Farrell M, Egan GF. The role of primordial emotions in the evolutionary origin of consciousness. Conscious Cogn 2009;18:500–514.

51Merker B. Consciousness without a cerebral cortex: a challenge for neuroscience and medicine. Behav Brain Sci 2007;30:63–81; discussion 81.

52Johnson MH. Subcortical face processing. Nat Rev Neurosci 2005;6:766–774.

53Ohman A, Carlsson K, Lundqvist D, Ingvar M. On the unconscious subcortical origin of human fear. Physiol Behav 2007;92:180–185.

54Marín-Padilla M. Developmental neuropathology and impact of perinatal brain damage. II: white matter lesions of the neocortex. J Neuropathol Exp Neurol 1997;56:219–235.

55Takada K, Shiota M, Ando M, Kimura M, Inoue K. Porencephaly and hydranencephaly: a neuropathological study of four autopsy cases. Brain Dev 1989;11:51–56.

56Shewmon DA, Holmes GL, Byrne PA. Consciousness in congenitally decorticate children: developmental vegetative state as self-fulfilling prophecy. Dev Med Child Neurol 1999;41:364–374.

57Mulckhuyse M, Theeuwes J. Unconscious attentional orienting to exogenous cues: A review of the literature. Acta Psychol (Amst) 2010;134:299–309.

58Sewards TV, Sewards MA. Visual awareness due to neuronal activities in subcortical structures: a proposal. Conscious Cogn 2000;9:86–116.

59Pasley BN, Mayes LC, Schultz RT. Subcortical discrimination of unperceived objects during binocular rivalry. Neuron 2004;42:163–172.

60Morris JS, Ohman A, Dolan RJ. A subcortical pathway to the right amygdala mediating “unseen” fear. Proc Natl Acad Sci USA 1999;96:1680–1685.

61Mahieu-Caputo D, Dommergues M, Muller F, Dumez Y. [Fetal pain]. Presse Med 2000;29:663–669.

62Anand KJ. Fetal pain? Pain Clinical Updates. 2006;14:1–8.

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