It is perhaps among the conditions of greatest suffering for one’s family members Patient with severe brain damage – not responding to any stimulus – not knowing whether she will recover sooner or later and therefore whether there is still reason for even the slightest hope. A new study recently published in Lancet Neurologymay help alleviate pain in these situations by providing a better diagnostic tool.
Research authors found that specific “Sign of the Hidden Conscience” – thin brain waves detectable with the electroencephalogram (Ei) – are the strongest predictor of a possible cure of patients with severe brain injuriesto appear completely insensitive. “One of the most difficult challenges in ICU care is determining whether an unresponsive patient is likely to recover and identifying those who could benefit most from rehabilitation,” the study leader said. Jan Claasen, Associate Professor of Neurology at Columbia University, USA.
Standard assessments alone cannot always provide answers. In intensive care units, doctors routinely assess the prognosis of patients with brain injuries by asking them to respond to a simple verbal command, such as “move your hand” or “stick out your tongue.” Those who do not respond to these commands are considered unconscious. In the absence of other explanations for this lack of response, the injuries are considered so severe that patients are unlikely to regain consciousness. “But on a few rare occasions Patients who do not respond eventually regain consciousness and they can make significant strides in restoring many everyday functions,” Claassen said. “We just don’t have a reliable way to predict who these patients are.”
In an earlier study, Claassen and his colleagues found that while many patients with brain injuries are physically unable to respond to verbal commands, some of them generate brainwaves in response to these commands, suggesting that they have some level of consciousness. “We have found that this hidden awareness is a more significant indicator of healing than any other factor we have examined, including the patient’s age Glasgow Coma Scale (a standard measure of the extent of neurological damage) or the cause of the brain injury,” Claassen clarified.
Hidden consciousness was found in 27 (14 percent) of 193 patients in the newly published study. Those with hidden consciousness consistently had higher and faster recovery rates than those without hidden consciousness. Within a year, 41 percent of patients with occult consciousness made a full recovery, compared to 10 percent of patients with no occult consciousness. Most patients with occult consciousness began to improve after three months, while patients without occult consciousness who recovered took much longer to show signs of improvement.. Currently, only a few select centers use the EEG to study hidden consciousness and a significant amount of biomedical experience is required to identify them. Claassen’s team is working on perfecting the artificial intelligence software so that the EEG can be used anywhere in the ICU to diagnose hidden consciousness.
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Gianmarco Pondrano Altavilla