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Tuesday, September 16, 2014

The Brain: Locked In

"If you know a patient is aware, then you’re going to behave differently."
"As soon as the patient themselves can be included in decision-making, we can have a really big impact on their quality of life. That may be a big thing like 'What do you want your future to be?' … or a small thing like 'What kind of television do you like to watch?'"
Adrian Owen, neuroscientist, Western University, London, Ontario 

"For the first time, we show that a patient with unknown levels of consciousness can monitor and analyze information from their environment, in the same way as healthy individuals.
"We already know that up to one in five of these patients are misdiagnosed as being unconscious and this new technique may reveal that that number is even higher."
Lorina Naci, lead researcher, A common neural code for similar conscious experiences in different individuals study

Dr. Owen recalls the time the father of a 34-year-old vegetative patient -- a man who had sustained a brain injury and as a result has been unresponsive for 16 years -- related to him that he had taken his brain-injured son to the movies over that sixteen-year period, hoping he would be stimulated by the exposure, that it might be possible that he would understand something of what he was witnessing on the screen.

And that inspired Dr. Owen and his colleagues at Western University to conduct some experiments with a brain scanning technique meant to monitor the response of seemingly non-responsive patients where a film by Alfred Hitchock, Bang! You're Dead, a high-viewing-impact suspense thriller was used by the research team as a tool to engage the still-functioning brain they hypothesized might yet be active within a handful of research subjects.

The result of that study was the release of a paper Monday, published in the Proceedings of the National Academy of Sciences. Post-doctoral fellows worked alongside lead author Dr. Owen, all with Western University's Brain and Mind Institute who gathered both healthy and brain-damaged participants to an MRI scan while screening the Hitchcock film.

The team found that the participants who viewed the film exhibited common patterns of brain activity reflecting resemblance to those of healthy participants. Similarities in reactions from the frontal lobes and the posterior parietal portions of the brain representing areas where reasoning and more complex processes occur were clearly evident, the findings suggesting that at least one of the vegetative participants was aware of and understood the film

The same level of response wasn't detected in another non-responsive research participant. What appeared clear to the researchers was that the 34-year-old patient was capable of understanding language, of following events unfolding in time, was able to lay down memories and demonstrably, through detectable brain signals experienced emotions while following plot changes.

The 34-year-old just happened to be the very same man whose father regularly took him over the years, to view movies. And perhaps this regular exposure helped to stimulate his son's brain, creating patterns of normal reaction and recognition. Which in turn made it possible for the research scientists to view the results of that exposure. Without doubt, this possibility may lead to a move to enrich the environment of such patients rather than consign them to their vegetative state with no relief.

This may provide insight within the medical community that a method exists whereby patients considered to be in full vegetative non-awareness state, might be exposed to tests that could help determine whether patients are really conscious, and whether or not they are capable of thinking about what they view, and what they experience. That achieved, ways in which doctors could conceivably communicate with such patients to determine their wishes may become possible.

The research paper was titled 'A common neural code for similar conscious experiences in different individuals' and is certain to give a boost of hope to families whose loved one may be locked into such a state with no hope for recovery. From detecting that the brain remains operatively functional to possibly discovering at some future date how to effectively communicate and moving from there to techniques to restore brain function may be the wave of the future.

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