Several studies conducted in the last decade have found that a quarter of recent brain injuries may have a level of consciousness to unanswered patients that are usually hidden from their families and physicians.
New research of Columbia University and New York-PressBiterian may soon help doctors identify patients with universal brain-chops with hidden consciousness, which are likely to obtain long-term recovery in search of brain waves that are signs of common sleep patterns.
Consciousness hidden in comatose patients
“We are at an exciting intersection in neurocritical care, where we know that many patients appear unconscious, but some are recovering without our knowledge. We are starting to lift the lid slightly and find some signs of recovery, as it is,” Columbia University Wagelos College of Physicians and Songs in the Sergain, ” Are.
“The families of my patients ask me all the time, does my mother wake up? My mother is going to see in three, six, or 12 months? Very often we can’t guide them very accurately, and it is important that we improve our predictions to guide our decisions.”
Klassen, who is also the head of Critical Care and Hospitalist Neurology at the New York-PressBiterian/Columbia University Irwing Medical Center, has developed refined techniques to identify patients with hidden consciousness by analyzing EEG recording of a patient earlier as they are presented with a command in the neurocritical caler units. The technique detects EEG brain wave activity, indicating that the patient can hear and understand the instructions of their physicians (for example, to open and close their hand) and understand, even if the patient does not react physically.
Sleep Spindle: Key of Recovery
But the techniques can be difficult to apply and get false-negative results. Classen decided to focus on sleep, as the brain circuits that are fundamental to consciousness, including cognitive motor separation, are also important to control sleep.
“I always wonder how my work can be best implemented and used in the real world, and is practical and scientifically understandable by looking at sleep,” says Classen. “Sleep is easy to record brain waves and does not require intervention from the care team.”
In the new study, researchers watched through EEG recording of brain activity overnight in 226 comatose patients, which underwent more complex tests for cognitive motor separation.
“Electric activity looks relatively chaotic during sleep, and sometimes in some patients, these very organized, sharp frequencies appear,” says Classen. These burst-coaled sleep spindle-often more complex method, with return of consciousness and cognitive motor seizure with long-term recovery.
“The spindle normally occurs during sleep and they are showing some levels of organization in the brain, suggests a circuit between the thelasm and cortex required for consciousness.” About one-third of patients had well-defined sleep spindles, including about half of patients with cognitive motor separation.
Promising results and forward path forward
Patients with sleep spindle and cognitive motor separation were more likely to cure consciousness and functional freedom. Among people with sleep spindle and cognitive motor separation, 76% of patients showed evidence of consciousness until they were discharged from the hospital. A year later, 41% of these patients recovered neurological functions, either with minor deficit or medium disabilities, and were able to take care of themselves during the day. Neither sleep spindle nor cognitive motor separation with only 29% of patients showed signs of consciousness, until they were discharged and reconstructed just 7% neurological function after a year.
Even though these conclusions do not prove that motivating the sleeping spindle will translate for better consequences, they increase the possibility that a patient’s sleep improves sleep-promoting their recovery by changing their environment. “If you think about the ICU environment, it is disruptive for a good night sleep. There is noise everywhere, the alarm is closing, the doctors touch them, 24/7. It is all for a good reason, but it is difficult to sleep in that atmosphere,” Classen says.
Classen has warned that findings apply only to patients with recent injuries, not with long -term disorders of consciousness. For most patients in the current study, normal sleep spindle appeared within days of initial injury. And prophets were not correct: 19 of the 139 patients who did not show signs of sleep spindle or cognitive motor separation, cured consciousness. Other data will be required to make more accurate predictions.
“I see these spindles as a way to direct patients to direct more sophisticated testing, which is the most likely to benefit,” says Classen. “Techniques are not yet ready for use in clinical practice, but this is something we are working actively.”
