Columbia Scientists Discover Source of Hidden Consciousness in “Comatose” Patients

MRI scans reveal mind accidents underlying hidden consciousness. Credit: Claassen lab, Columbia University Irving Medical Center

Researchers from Columbia have found mind accidents that could possibly be the basis of hidden consciousness. This mysterious situation happens when people with mind injury appear unresponsive to primary instructions, showing unconscious though they keep some extent of consciousness.

“Our study suggests that patients with hidden consciousness can hear and comprehend verbal commands, but they cannot carry out those commands because of injuries in brain circuits that relay instructions from the brain to the muscles,” says research chief Jan Claassen, MD, affiliate professor of neurology at Columbia University Vagelos College of Physicians and Surgeons and chief of crucial care and hospitalist neurology at NewYork-Presbyterian/Columbia University Irving Medical Center.

The findings may assist physicians extra rapidly determine brain-injured sufferers who may need hidden consciousness and higher predict which sufferers are more likely to get well with rehabilitation.

Brain circuits disrupted in sufferers with hidden consciousness

Hidden consciousness, also referred to as cognitive motor dissociation (CMD), happens in about 15% to 25% of sufferers with mind accidents stemming from head trauma, mind hemorrhage, or cardiac arrest.

In earlier analysis, Claassen and colleagues discovered that refined brainwaves detectable with EEG are the strongest predictor of hidden consciousness and eventual restoration for unresponsive brain-injured sufferers.

But the exact pathways in the mind that change into disrupted in this situation have been unknown.

In the brand new research, the researchers used EEG to look at 107 mind damage sufferers. The approach can decide when sufferers try, although unable, to answer a command equivalent to “keep opening and closing your right hand.”

The evaluation detected CMD in 21 of the sufferers.

The researchers then analyzed structural MRI scans from all of the sufferers.

“Using a technique we developed called bi-clustering analysis, we were able to identify patterns of brain injury that are shared among patients with CMD and contrast to those without CMD,” says co-lead creator Qi Shen, PhD, affiliate analysis scientist in the Claassen lab and an knowledgeable in sign processing, machine studying, and biostatistics.

The researchers discovered that each one of the CMD sufferers had intact mind constructions associated to arousal and command comprehension, supporting the notion that these sufferers have been listening to and understanding the instructions however have been unable to hold them out.

“We saw that all of the CMD patients had deficits in brain regions responsible for integrating comprehended motor commands with motor output, preventing CMD patients from acting on verbal commands,” says Claassen.

The findings could permit researchers to raised perceive which mind damage sufferers have CMD, which will probably be helpful for scientific trials that help restoration of consciousness.

More analysis is required earlier than these approaches might be utilized to scientific follow. “However, our study shows that it may be possible to screen for hidden consciousness using widely available structural brain imaging, moving the detection of CMD one step closer to general clinical use,” Claassen says.

“Not every critical care unit may have resources and staff that is trained in using EEG to detect hidden consciousness, so MRI may offer a simple way to identify patients who require further screening and diagnosis.”

Reference: “Injury patterns associated with cognitive motor dissociation” by Eva Franzova, Qi Shen, Kevin Doyle, Justine M Chen, Jennifer Egbebike, Athina Vrosgou, Jerina C Carmona, Lauren Grobois, Gregory A Heinonen, Angela Velazquez, Ian Jerome Gonzales, Satoshi Egawa, Sachin Agarwal, David Roh, Soojin Park, E Sander Connolly and Jan Claassen, 14 August 2023, Brain.
DOI: 10.1093/brain/awad197

The research was supported by grants from the National Institutes of Health (R01NS106014 and R03NS112760) and the Dana Foundation.

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