Scientists have been able to reach into the mind of a brain-damaged man and communicate with his thoughts. The research, carried out in the UK and Belgium, involved a new brain scanning method. Awareness was detected in three other patients previously diagnosed as being in a vegetative state. The study in the New England Journal of Medicine shows that scans can detect signs of awareness in patients thought to be closed off from the world. Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage. The scientists used functional magnetic resonance imaging (fMRI) which shows brain activity in real time.
Brain imaging has allowed a man who was previously considered unconscious to answer a series of yes-or-no questions. The study, published this week in the New England Journal of Medicine1, challenges clinicians' definition of consciousness and provides an unprecedented opportunity to communicate with those who show no outward signs of awareness.
Background The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity to show behavioral signs of awareness is diminished. Conclusions These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.
Despite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.
What if those coma patients thought to be beyond help could actually hear what we are saying? Could feel when pushed and prodded? Could respond to doctors, if only they could see the signs? A new group of neuroscientists thinks it has proved we can communicate with these “locked-in” patients – though not everyone believes them