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One-quarter of unresponsive people with brain injuries are conscious
https://www.nature.com/articles/d41586-024-02614-zNEWS
14 August 2024
One-quarter of unresponsive people with brain injuries are conscious
More people than we thought who are in comas or similar states can hear what is happening around them, a study shows.
By Julian Nowogrodzki
At least one-quarter of people who have severe brain injuries and cannot respond physically to commands are actually conscious, according to the first international study of its kind1.
Although these people could not, say, give a thumbs-up when prompted, they nevertheless repeatedly showed brain activity when asked to imagine themselves moving or exercising.
“This is one of the very big landmark studies” in the field of coma and other consciousness disorders, says Daniel Kondziella, a neurologist at Rigshospitalet, the teaching hospital for Copenhagen University.
The results mean that a substantial number of people with brain injuries who seem unresponsive can hear things going on around them and might even be able to use brain–computer interfaces (BCIs) to communicate, says study leader Nicholas Schiff, a neurologist at Weill Cornell Medicine in New York City. BCIs are devices implanted into a person’s head that capture brain activity, decode it and translate it into commands that can, for instance, move a computer cursor. “We should be allocating resources to go out and find these people and help them,” Schiff says. The work was published today in The New England Journal of Medicine1.
[...]
14 August 2024
One-quarter of unresponsive people with brain injuries are conscious
More people than we thought who are in comas or similar states can hear what is happening around them, a study shows.
By Julian Nowogrodzki
At least one-quarter of people who have severe brain injuries and cannot respond physically to commands are actually conscious, according to the first international study of its kind1.
Although these people could not, say, give a thumbs-up when prompted, they nevertheless repeatedly showed brain activity when asked to imagine themselves moving or exercising.
“This is one of the very big landmark studies” in the field of coma and other consciousness disorders, says Daniel Kondziella, a neurologist at Rigshospitalet, the teaching hospital for Copenhagen University.
The results mean that a substantial number of people with brain injuries who seem unresponsive can hear things going on around them and might even be able to use brain–computer interfaces (BCIs) to communicate, says study leader Nicholas Schiff, a neurologist at Weill Cornell Medicine in New York City. BCIs are devices implanted into a person’s head that capture brain activity, decode it and translate it into commands that can, for instance, move a computer cursor. “We should be allocating resources to go out and find these people and help them,” Schiff says. The work was published today in The New England Journal of Medicine1.
[...]
==============
https://www.nejm.org/doi/10.1056/NEJMoa2400645
Cognitive Motor Dissociation in Disorders of Consciousness
Authors: Yelena G. Bodien, Ph.D. https://orcid.org/0000-0003-4858-2903, Judith Allanson, F.R.C.P., Ph.D., Paolo Cardone, M.S. https://orcid.org/0000-0002-8537-2123, Arthur Bonhomme, M.D., Jerina Carmona, M.P.H., Camille Chatelle, Ph.D., Srivas Chennu, Ph.D., +31, and Nicholas D. Schiff, M.D.Author Info & Affiliations
Published August 14, 2024
N Engl J Med 2024;391:598-608
DOI: 10.1056/NEJMoa2400645
VOL. 391 NO. 7
Abstract
BACKGROUND
Patients with brain injury who are unresponsive to commands may perform cognitive tasks that are detected on functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). This phenomenon, known as cognitive motor dissociation, has not been systematically studied in a large cohort of persons with disorders of consciousness.
METHODS
In this prospective cohort study conducted at six international centers, we collected clinical, behavioral, and task-based fMRI and EEG data from a convenience sample of 353 adults with disorders of consciousness. We assessed the response to commands on task-based fMRI or EEG in participants without an observable response to verbal commands (i.e., those with a behavioral diagnosis of coma, vegetative state, or minimally conscious state–minus) and in participants with an observable response to verbal commands. The presence or absence of an observable response to commands was assessed with the use of the Coma Recovery Scale–Revised (CRS-R).
RESULTS
Data from fMRI only or EEG only were available for 65% of the participants, and data from both fMRI and EEG were available for 35%. The median age of the participants was 37.9 years, the median time between brain injury and assessment with the CRS-R was 7.9 months (25% of the participants were assessed with the CRS-R within 28 days after injury), and brain trauma was an etiologic factor in 50%. We detected cognitive motor dissociation in 60 of the 241 participants (25%) without an observable response to commands, of whom 11 had been assessed with the use of fMRI only, 13 with the use of EEG only, and 36 with the use of both techniques. Cognitive motor dissociation was associated with younger age, longer time since injury, and brain trauma as an etiologic factor. In contrast, responses on task-based fMRI or EEG occurred in 43 of 112 participants (38%) with an observable response to verbal commands.
CONCLUSIONS
Approximately one in four participants without an observable response to commands performed a cognitive task on fMRI or EEG as compared with one in three participants with an observable response to commands. (Funded by the James S. McDonnell Foundation and others.)
[...]
Authors: Yelena G. Bodien, Ph.D. https://orcid.org/0000-0003-4858-2903, Judith Allanson, F.R.C.P., Ph.D., Paolo Cardone, M.S. https://orcid.org/0000-0002-8537-2123, Arthur Bonhomme, M.D., Jerina Carmona, M.P.H., Camille Chatelle, Ph.D., Srivas Chennu, Ph.D., +31, and Nicholas D. Schiff, M.D.Author Info & Affiliations
Published August 14, 2024
N Engl J Med 2024;391:598-608
DOI: 10.1056/NEJMoa2400645
VOL. 391 NO. 7
Abstract
BACKGROUND
Patients with brain injury who are unresponsive to commands may perform cognitive tasks that are detected on functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). This phenomenon, known as cognitive motor dissociation, has not been systematically studied in a large cohort of persons with disorders of consciousness.
METHODS
In this prospective cohort study conducted at six international centers, we collected clinical, behavioral, and task-based fMRI and EEG data from a convenience sample of 353 adults with disorders of consciousness. We assessed the response to commands on task-based fMRI or EEG in participants without an observable response to verbal commands (i.e., those with a behavioral diagnosis of coma, vegetative state, or minimally conscious state–minus) and in participants with an observable response to verbal commands. The presence or absence of an observable response to commands was assessed with the use of the Coma Recovery Scale–Revised (CRS-R).
RESULTS
Data from fMRI only or EEG only were available for 65% of the participants, and data from both fMRI and EEG were available for 35%. The median age of the participants was 37.9 years, the median time between brain injury and assessment with the CRS-R was 7.9 months (25% of the participants were assessed with the CRS-R within 28 days after injury), and brain trauma was an etiologic factor in 50%. We detected cognitive motor dissociation in 60 of the 241 participants (25%) without an observable response to commands, of whom 11 had been assessed with the use of fMRI only, 13 with the use of EEG only, and 36 with the use of both techniques. Cognitive motor dissociation was associated with younger age, longer time since injury, and brain trauma as an etiologic factor. In contrast, responses on task-based fMRI or EEG occurred in 43 of 112 participants (38%) with an observable response to verbal commands.
CONCLUSIONS
Approximately one in four participants without an observable response to commands performed a cognitive task on fMRI or EEG as compared with one in three participants with an observable response to commands. (Funded by the James S. McDonnell Foundation and others.)
[...]