Imaging Shows Vegetative State Patients Aware and Attentive

The new research could help physicians identify patients who are aware in spite of being unable to communicate.

Determining how consciousness arises in the brain is an intangible but enticing scientific question. However, for patients diagnosed as vegetative and minimally conscious, and their families, this is much more than just an academic question—it takes on a very real significance. There has been a lot of interest recently in how much patients in a vegetative state following severe brain injury are aware of their surroundings. Although unable to move and respond, some of these patients are able to perform tasks such as imagining playing a game of tennis. Using a functional magnetic resonance imaging (fMRI) scanner, which gauges brain activity, researchers have earlier been able to record activity in the pre-motor cortex, the brain area that controls movement, in apparently unconscious patients asked to imagine playing tennis.

A team of researchers led by scientists from the University of Cambridge (UK) and the Medical Research Council Cognition and Brain Sciences Unit (MRC CBSU; Cambridge, UK) now have used high-density electroencephalographs (EEG) and a branch of mathematics known as graph theory to examine networks of activity in the brains of 32 patients diagnosed as vegetative and minimally conscious and compare them to healthy adults. The findings of the research are published October 16, 2014, in the journal PLOS Computational Biology.

The researchers revealed that the abundant and diversely connected networks that support awareness in the healthy brain are typically—but importantly, not always—impaired in patients in a vegetative state. Some vegetative patients had well-preserved brain networks that look similar to those of healthy adults. These patients were those who had shown signs of hidden awareness by following commands such as imagining playing tennis.

Dr. Srivas Chennu from the department of clinical neurosciences at the University of Cambridge, said, “Understanding how consciousness arises from the interactions between networks of brain regions is an elusive but fascinating scientific question. But for patients diagnosed as vegetative and minimally conscious, and their families, this is a lot more than just an academic question--it takes on a very real significance. Our research could improve clinical assessment and help identify patients who might be covertly aware despite being uncommunicative.”

The findings could help researchers develop a comparatively easy way of identifying which patients might be aware while in a vegetative state. Unlike the “tennis test,” which can be a difficult task for patients and requires costly and frequently unavailable fMRI scanners, this new technique uses EEG and could therefore be administered at a patient’s bedside. However, the tennis test is stronger evidence that the patient is indeed conscious, to the degree that they can follow commands using their thoughts. The researchers believe that a combination of such tests could help improve accuracy in the prognosis for a patient.

Dr. Tristan Bekinschtein from the MRC Cognition and brain sciences unit and the department of psychology, University of Cambridge, added, “Although there are limitations to how predictive our test would be used in isolation, combined with other tests it could help in the clinical assessment of patients. If a patient’s awareness networks are intact, then we know that they are likely to be aware of what is going on around them. But unfortunately, they also suggest that vegetative patients with severely impaired networks at rest are unlikely to show any signs of consciousness.”

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