Terminal Lucidity in a Pediatric Oncology Clinic.

ABSTRACT: The sporadic occurrence of unusually enhanced mental clarity before death has been documented over time and cultures, and reported in patients with and without neurodegenerative diseases, psychiatric disorders, and other neurocognitive deficits, as well as those with nonterminal and terminal conditions. Using a purposive sampling method via existing professional networks, clinical presentations of terminal lucidity in pediatric populations, as witnessed by pediatric oncologists and medical personnel, were solicited. We document clinical presentations suggestive of terminal lucidity in children, which were compiled by their attending physician at two large tertiary pediatric hospitals. Unanticipated and unexplained changes in mental clarity, verbal communication, and/or physical capability in the days and hours before the death of the pediatric patients were observed. Each patient's medical condition should not have allowed for such changes. The phenomenon known as terminal lucidity provides a conceptual framework for these deviations, although more systematic documentation and clinical research is required before definitive conclusions can be drawn.

Paradoxical lucidity: A potential paradigm shift for the neurobiology and treatment of severe dementias.

Unexpected cognitive lucidity and communication in patients with severe dementias, especially around the time of death, have been observed and reported anecdotally. Here, we review what is known about this phenomenon, related phenomena that provide insight into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We conclude that paradoxical lucidity, if systematically confirmed, challenges current assumptions and highlights the possibility of network-level return of cognitive function in cases of severe dementias, which can provide insight into both underlying neurobiology and future therapeutic possibilities.

Discrepancy Between Cerebral Structure and Cognitive Functioning: A Review.

Neuroscientists typically assume that human mental functions are generated by the brain and that its structural elements, including the different cell layers and tissues that form the neocortex, play specific roles in this complex process. Different functional units are thought to complement one another to create an integrated self-awareness or episodic memory. Still, findings that pertain to brain dysplasia and brain lesions indicate that in some individuals there is a considerable discrepancy between the cerebral structures and cognitive functioning. This seems to question the seemingly well-defined role of these brain structures. This article provides a review of such remarkable cases. It contains overviews of noteworthy aspects of hydrocephalus, hemihydranencephaly, hemispherectomy, and certain abilities of "savants." We add considerations on memory processing, comment on the assumed role of neural plasticity in these contexts, and highlight the importance of taking such anomalies into account when formulating encompassing models of brain functioning.

Albert Heim (1849-1937): The Multifaceted Geologist Who Influenced Research Into Near-death Experiences and Suggestion Therapy.

Swiss geologist Albert Heim is well known for his pioneering contributions to several aspects of geology, and for his role in establishing the breeding of different kinds of Swiss mountain dogs. In the field of near-death research, it is also recognized that he performed a pioneering study into near-death states of falling mountaineers. It seems hardly known, however, that Heim also influenced suggestion therapy significantly-in particular, the treatment of warts by suggestion. This article provides an overview of Heim's contribution in the latter field of study.

Canities subita: a reappraisal of evidence based on 196 case reports published in the medical literature.

We have reviewed the medical literature on unusually rapid Canities of body hair to assess whether the reported clinical evidence can be explained with the current hypotheses of pathogenetic mechanisms. We screened the medical literature from 1800 onward, searching for as many case reports as possible. We assessed literature in Dutch, English, French, German, Italian and Spanish and included all cases, which contained an explicit mention or description of unusually rapid graying or whitening of hair. Case reports were classified into three categories: Cases are "authenticated" when the authors personally observed the rapid color change, "non-authenticated" when they saw the subject only after the alleged color change and "anecdotal" when authors were told about the case by a third party. In total, we found 196 cases of which 44 were authenticated. These studies reported the graying of human hair in the context of aging, somatic diseases, emotional trauma or stress and psychiatric disorders. Numerous cases involved not only scalp hair, but also beards, eyelashes and other body hair. Several authors stressed that there was no alopecia. Although plausible explanations exist to explain Canities subita occurring together with an effluvium, the observation of viable hair losing color along the axis within a timespan shorter than its growth rate remain as yet unexplained.

The death of Anna Katharina Ehmer: a case study in terminal lucidity.

Terminal lucidity, the unexpected return of mental clarity and memory shortly before the death of patients suffering from severe psychiatric and neurologic disorders, has raised the curiosity of numerous physicians and laypersons in the past. However, this peculiar phenomenon has received little attention in the recent decades. In previous publications, we have presented overviews of cases of terminal lucidity in various neurologic and psychiatric disorders. In this article, we highlight terminal lucidity in persons with mental disabilities, and focus on one of the most remarkable cases that have been reported. We provide biographical background information about the two principal witnesses who reported this case. It concerns the death of Anna Katharina Ehmer, a 26-year-old woman with severe mental disabilities who lived in an institution for people with mental disorders, and who had allegedly never spoken a single word during her life. Yet, she was reported to have sung dying songs for a half hour before she died. The case was reported by the head of this institution and by its chief physician. We consider it difficult to evaluate the authenticity of the case definitively in retrospect. Nevertheless, there are similar cases and a variety of other anomalous brain-related findings we consider worth investigating. Studies into such anomalous cases might improve our concepts of human brain functioning and of mental processing in persons with mental disabilities, and might be of special value for the dying, the bereaved, and caretakers.

Terminal lucidity: a review and a case collection.

The unexpected return of mental clarity and memory shortly before death in patients suffering from severe psychiatric and neurologic disorders, which we have called "terminal lucidity", has been reported in the medical literature over the past 250 years, but has received little attention. We review a range of terminal lucidity cases in order to encourage investigation of the mechanisms involved and possible insights into both the neuroscience of memory and cognition at the end of life and treatment of terminal illness. These examples include case reports of patients suffering from brain abscesses, tumors, strokes, meningitis, dementia or Alzheimer's disease, schizophrenia, and affective disorders. Several of these accounts suggest that during terminal lucidity, memory and cognitive abilities may function by neurologic processes different from those of the normal brain. We expect that significant contributions to better understanding the processes involved in memory and cognition processing might be gained through in-depth studies of terminal lucidity. Studying terminal lucidity might also facilitate the development of novel therapies. In addition, increased awareness of unusual end-of-life experiences could help physicians, caregivers, and bereaved family members be prepared for encountering such experiences, and help those individuals cope with them.

Terminal lucidity in patients with chronic schizophrenia and dementia: a survey of the literature.

In this article, we present the results of a literature survey on case reports of the unexpected return of mental clarity and memory shortly before death, which we have called "terminal lucidity." We focus specifically on terminal lucidity in mental disorders, of which we have found 81 case references. Of these, we were able to retrieve 49 case reports, most of which had been recorded before 1849. Thereafter, comparatively few reports of terminal lucidity have been published. Some more recent publications referred to terminal lucidity in patients suffering from schizophrenia and dementia. We draw parallels and distinctions between terminal lucidity and remissions attributable to febrile illness in neurosyphilis. We recommend in-depth studies on the psychopathology and neuropathology involved in terminal lucidity, since they might enable the development of both improved therapies and a better understanding of unresolved aspects of cognition and memory processing.