A new study finds that signs of covert consciousness — subtle brainwaves detectable with EEG — are the strongest predictor of eventual recovery for brain-injured patients who otherwise appear completely unresponsive.
The findings suggest brainwave analysis has the potential to completely change how unresponsive patients with acute brain injury are managed.
The study was published online in The Lancet Neurology.
“One of the most difficult challenges in ICU care is determining whether an unresponsive patient with a brain injury is likely to recover and to identify those that may benefit most from rehabilitation,” says study leader Jan Claassen, MD, associate professor of neurology and chief of critical care and hospitalist neurology at Columbia University Vagelos College of Physicians and Surgeons.
Standard bedside assessments alone do not always predict clinical outcomes. In the intensive care unit, doctors routinely assess the prognosis of brain-injured patients by asking them to respond to a simple verbal command, such as “move your hand” or “stick out your tongue.” Those who do not respond to these commands are thought to be unconscious. In the absence of any other explanations for this unresponsiveness, injuries may be considered so severe that patients are unlikely to regain consciousness.
“But in some rare cases, unresponsive patients do eventually regain consciousness and may make meaningful progress toward recovering many day-to-day functions many months later,” says Claassen, who also is an associate attending neurologist at NewYork-Presbyterian/Columbia University Irving Medical Center. “We just don’t have a reliable way to predict who those patients are.”
In a previous study, Claassen and colleagues found that while many brain-injured patients cannot physically respond to verbal commands, a few of them generate brainwave activity in response to those commands, suggesting they have some level of consciousness.
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