Patients in A Coma Helped Scientists Uncover the Fundamental Puzzle of the Brain
Scientists estimate that approximately forty percent of patients in a coma may actually be conscious. This is shown by the latest diagnostic methods, allowing to evaluate the activity of neurons in real time. How people with severe brain injuries come back to life .
Munira Abdula had a car accident in 1991. Due to serious brain damage, she was in a vegetative state, but the family continued to treat her.
In 2017, the patient was brought to a specialized clinic in Germany, and one day she suddenly made a strange sound, and a few days later called her son by name. After 27 years of coma, the patient regained consciousness. According to the BBC, she can communicate with relatives at an elementary level and even talk a little.
This is a rare case. However, a full life, as a rule, is no longer possible: brain damage is too severe.
Coma is a complete loss of consciousness. A person does not respond to external stimuli, cannot move, all brain activity is inhibited. However, life is still warming. Typically, this condition is the result of severe mechanical damage to the brain: due to an accident, a fall from a high altitude or a violation of cerebral circulation (stroke).
Back in the middle of the last century, scientists found that the whole thing is damage to the brain stem – the oblong part in the lower part of the cranial box, connected with the spinal cord. It was suggested that in different parts of the brain there are certain centers of wakefulness that exchange signals with the cortex and activate consciousness.
In 2016, scientists at Harvard Medical School discovered a tiny area of two cubic millimeters in the brain stem that interacts with cortical The authors examined 36 patients with severe damage to the brain stem, of which 12 were in a coma. With the seemingly identical scale of defeat, some had consciousness, while others did not. Mapping with fMRI indicated a portion of the brain stem in the left lid of the bridge: it is precisely its damage that leads to a coma.
This site interacts with two regions of the cerebral cortex: the anterior part of the insular lobe and the pregenital part of the anterior cingulate cortex. There are large neurons that penetrate the processes into all layers of the cortex. Only animals with large brains such as primates, elephants, dolphins have such.
If the “place of soul localization” in the trunk is destroyed, the connection between these areas in the cortex is broken, and the brain is disconnected. Wakingness and understanding of the environment disappear – two key states that determine consciousness.
Scientists from the clinic of the University of Iowa (USA) believe that consciousness also relies on one of the deepest parts of the brain, such as the hypothalamus or the basal forebrain. The state of wakefulness depends on their safety.
Thalamus was affected in 33 patients after a stroke. Four fell into a coma. It turned out that their brain is much more damaged than others: in addition to the thalamus, the hypothalamus and trunk are damaged. Russian biologist Vladimir Kovalzon called it “a place of soul localization.”
Scientists from Russia and Kazakhstan observed 87 patients who were in a coma. Over time, almost half regained consciousness, some partially restored cognitive functions.
In general, it looks as follows. After a coma, a vegetative state occurs, that is, the body is alive, but does not respond to anything. Then a small consciousness returns, when a person can, for example, fix his gaze or follow his eyes with an object.
And only then functions of a higher level are restored, say, the ability to move a hand on a command, answer elementary questions – at least with eyes. The authors of the work note that the patient may not show any motor activity and nevertheless be conscious. That is why it is important to assess the condition of patients in a coma using new diagnostic methods.
Scientists from the USA and Great Britain speak about the same thing. They examined 21 people with severe brain damage, including in a vegetative state. Compared with 13 healthy. Family members read stories from their lives before the illness to patients, and researchers mapped the brain and recorded an electroencephalogram. It turned out that in some patients, the delay in the electrical activity of the brain in response to speech is the same as in healthy ones. Moreover, fMRI showed the activity of neurons in response to voice commands, although apparently the patients were in a vegetative state.
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The authors of the article emphasize: it is necessary to re-examine coma patients in order to identify those who are conscious, but locked in their bodies and can not report it. Such patients need to be treated in a completely different way, to carry out rehabilitation, which will return to them any physical and cognitive abilities.
Previously, researchers from Harvard Medical School and the University Hospital of Liège (Belgium) using the same means showed that the coma and vegetative state of patients admitted to the intensive care unit after severe brain damage should not serve as the basis for a final diagnosis. The patient is able to recover, although outwardly this can not be determined.
Doctors from Liège described the case of a victim in an accident in 1992. In intensive care, he was connected to a ventilator. The nurse said that the patient moved his hand at her command, but this did not change the diagnosis – the patient was placed in a coma clinic, where he was without any treatment.
Twenty years later, the patient’s relatives, being in the same room with him, felt that he was conscious, although there were no external signs of this. The patient was transferred to a university clinic, underwent a course of treatment and several levels of tests.
First, the patient spontaneously opened his eyes, chewed his mouth, moved his left arm and leg, then he began to fix his gaze on the subject and follow it. After some time, he was already fulfilling the simplest commands: he closed his eyes and answered questions with facial expressions. So it was possible to find out that he remembered his name and the names of relatives.
The works of recent years have not only helped in general outline to establish how consciousness arises, but also gave hope that patients locked in a coma can be brought back to life.
Patients in A Coma Helped Scientists Uncover the Fundamental Puzzle of the Brain - /10
Scientists estimate that approximately forty percent of patients in a coma may actually be conscious.