Sir,

Wijdicks and Wijdicks [1] have published an original article regarding portrayal of PVS in movies. These authors concluded that distortion of coma and awakening was frequent ^{in films, and most surveyed viewers recognized inexactness of illustration of coma, awakenings, and dialogues on the understanding of being in a coma.1}

Even among physicians there are misunderstandings about terms such as coma, prolonged coma, coma vigil, apallic syndrome, etc.[2] I explored how the media handled some news about movies related to portrayal of PVS.

The New York Times published a plot description of the movie “In the Matter of Karen Ann Quinlan.” It can be read: “After a serious accident, New Jersey woman Karen Ann Quinlan lapses into an irreversible coma. Only a complicated and expensive life-support system forestalls Karen's inevitable death; otherwise, she is brain dead and her prognosis is hopeless.” ^{[3] Hence, in this portrayal terms like “irreversible coma”, “brain dead”, “prognosis is hopeless”, are misunderstood.}

Regarding the Almodovar's film “Talk to Her”, Los Angeles Times published the following: “Benign... is her devoted nurse, his actions characterized by a virtuous willingness to work long hours at her side and an unshakable belief that Alicia hears all his talk even if she appears to be dead to the world.” According to this newspaper, Alicia, the PVS patient, “appears to be dead to the world”[4]

Wijdicks and Wijdicks [1] analyze a scene from this film in which a physician comments about a patient “awakening after 14 years”. The term “awakening” also introduces confusion even among physicians concerning the patho-physiology of PVS patients. PVS cases reveal the only condition in which a ^{dissociation of both components of consciousness is found: arousal is preserved and awareness is apparently lacking. Consequently, a functional improvement of PVS patients progressing to MCS, should not be described as “awakening”, but as a “recovery or awareness,” or a “resurgence of cognition,” “recuperation of the content of consciousness,” etc.[2] Moreover, most actors represent PVS patients with eyes closed.[1] This might explain why screenwriters usually characterize recuperation in these patients as “awakening.”}

We agree with these authors that screenwriters or directors are free to present fictional representations in their films. However, a disease confounding portrayal might construct an erroneous opinion in the public opinion, which could even affect health care programs, raising ethical dilemmas. Yes, neurological counsel would be extremely useful for a not confusing portrayal of patients suffering severe brain injury.¹