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Awake or not?

Brain damaging tests on a severely brain-damaged woman in an unresponsive, vegetative state showed clear signs of conscious awareness, according to report by researchers,// a revolutionary finding that could change how unconscious patients are cared for and diagnosed.

The researchers found that in response to commands, the patient’s brain flared with activity, lighting the same language and planning regions that are active when healthy people hear the commands. Although previous studies had found similar activity in partly conscious patients, who occasionally respond to commands, it has never been found in someone who was totally unresponsive.

Neurologists did caution that the new report characterized only a single case, and one should not infer that unresponsive brain-damaged people were more likely to recover or treatment was possible. In the study the woman could not communicate with the researchers, and therefore it was not possible to know whether her subjective experience was similar to the consciousness of healthy people. The woman was injured in a traffic accident last year.

However there was such dramatic contradictions in the woman’s diagnosed condition that the limitations of standard methods of bedside diagnosis. These findings are bound to raise hopes for tens of thousands of families caring for unresponsive, brain-damaged patients around the world — whether those hopes are justified or not, experts said.

Dr. James Bernat, a professor of neurology at the Dartmouth Medical School, who was not involved in the study said, “One always hesitates to make a lot out of a single case, but what this study shows me is that there may be more going on in terms of patients’ self-awareness than we can learn at the bedside. Even though we might assume some patients are not aware, I think we should always talk to them, always explain what’s going on, always make them comfortable, because maybe they are there, inside, aware o
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