Why Botulism Probably Didn't Cause Otto Warmbier's Coma

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The release of Otto Warmbier, still in an unresponsive state, from North Korean imprisonment has left his family struggling to understand the mysterious circumstances surrounding the 22-year-old's medical condition. He spent at least 17 months in prison for allegedly stealing a propaganda poster before North Korea returned him to the United States. According to North Korea, Warmbier went into a coma after contracting botulism and taking a sleeping pill. However, Warmbier's father, among others, don't believe that explanation could possibly be accurate.

Upon his arrival back into the states on June 13, he was immediately rushed to the University of Cincinnati Medical Center and diagnosed with severe neurological damage and loss of brain tissue. And this is where doctors have called North Korea's bluff. Medical personnel from North Korea provided several brain MRI images dating back to April 2016, the only information on Warmbier's medical treatment during detainment. But Warmbier's doctors dispute North Korea's claim and say they have found no sign of botulism. They also described his state as "unresponsive wakefulness."

Unlike in a coma, patients with unresponsive wakefulness syndrome are technically awake and can show small signs of eye movement, such as blinking, even if they don't display conscious awareness or reaction to their surroundings like in Warmbier's case.

Fred and Cindy Warmbier, Otto's parents, have also expressed disbelief at North Korea's story that their son caught extreme food poisoning. Instead, they believe their son was tortured.

But backing up — could botulism actually cause a coma? Botulism is a type of uncommon but potentially deadly neural poisoning that can paralyze the entire body. The bacteria that produce the toxin thrive in conditions that lack air, and cases of adult botulism can be traced to improperly canned foods or by injecting contaminated drugs into someone. Symptoms of botulism can appear within the same or following day after contamination. One of the symptoms, muscle paralysis, could impair breathing and fail to deliver sufficient oxygen to the brain, which would lead to neurological damage.

In 2015 there were 199 cases of botulism in the United States, about 70 percent of which were infants. If the antitoxin is given before complete body paralysis, recovery time can shorten and the patient can improve their condition with hospital treatment.

Although he could not comment on Warbier's case, Dr. Robert Glatter told USA Today that botulism is unlikely to cause a coma. Glatter, an emergency physician at NYC's Lennox Hill Hospital, said that excessive sleeping medication does have the potential, however, to induce a coma.

Warmbier's team of doctors said they believe his brain injury was not caused by head trauma, but possibly by cardiopulmonary arrest triggered by respiratory failure. This means their patient would have to have been in a situation where he stopped breathing. The brain can suffer permanent damage if it doesn't receive blood and oxygen for a prolonged period of time, although Warmbier's doctors did not disclose if his brain injury was irreversible.