Scientists Identify Level of Consciousness in Some Coma Patients

Comas are a medical phenomenon often associated with profound tragedy, where individuals find themselves in an unconscious state, seemingly cut off from the world around them. The inability to communicate or respond to loved ones’ voices and the physical world is heart-wrenching for families and a profound challenge for medical professionals.

But there may be hope on the horizon. Scientists, per The Washington Post, have made progress in identifying cognitive motor dissociation (CMD) in patients with brain injuries using routine structural magnetic resonance imaging (MRI).

What is a coma?

According to the Mayo Clinic, a coma is “a state of prolonged loss of consciousness. It can have a variety of causes, including traumatic head injury, stroke, brain tumor, or drug or alcohol intoxication. A coma may even be caused by an underlying illness, such as diabetes or an infection.”

Coma is a medical emergency, and immediate action is required to save a person’s life and brain function. Healthcare providers conduct blood tests and brain scans to determine the cause of the coma for appropriate treatment. Comas are typically short-lived, lasting no more than a few weeks. Extended unconsciousness may lead to a persistent vegetative state or brain death.

How does a coma differ from other vegetative states?

A coma, a persistent vegetative state, and brain death, are distinct conditions, despite some similarities:

Coma	Persistent Vegetative State	Brain death
●      The individual is in a deep state of unconsciousness, unable to respond to stimuli or exhibit signs of awareness. ●      Typically short-term, lasting for a few weeks at most. ●      The brain’s activity is significantly depressed.	●      The individual displays periods of wakefulness but lacks awareness and the ability to respond to their surroundings. ●      Can last for an extended period, often months or years. ●      The brain activity may show periods of wakefulness, but it lacks higher cognitive function.	●      The individual is in a complete and irreversible loss of brain function, including brainstem function. ●      A state of total and permanent unconsciousness with no chance of recovery. ●      Legally and medically considered death.

What is cognitive motor dissociation?

CMD is a condition where patients may appear comatose but are conscious and processing information, yet they cannot physically respond. Traditional CMD diagnosis requires specialized equipment and expertise, often only available in a few labs worldwide. However, by using structural MRI to look for specific brain lesion patterns unique to CMD patients, this research offers a potential screening tool that could aid in the early identification of CMD. Identifying CMD is crucial for providing better care, as these patients may still have cognitive function and the potential for recovery. In the future, this knowledge could lead to tailored therapies and communication tools for CMD patients.

The CMD test performed on comatose patients primarily involves the use of advanced brain imaging techniques, such as structural magnetic resonance imaging (MRI), to diagnose patients who are in a coma or a similar unresponsive state but may have cognitive function. Here’s how it works:

• Initial assessment: The first step is an initial assessment of the patient’s condition. If a person is in a coma or unresponsive state, healthcare professionals may consider the possibility of CMD.
• Traditional diagnostic methods: Before employing the CMD test, traditional diagnostic methods are often used. These include computed tomography (CT) scans or structural MRI to check for physical brain damage, such as swelling, hemorrhaging, or fluid leaks.
• Electroencephalogram (EEG): An EEG, which involves attaching electrodes to the patient’s scalp, is frequently conducted. This test measures electrical activity in the brain and can provide insights into overall brain health.
• Functional EEG and functional MRI: To perform the CMD test, healthcare professionals need more advanced equipment, specifically a functional EEG and a functional MRI (fMRI). These tests are different from standard EEG and MRI scans.
• Questioning the patient: During the functional EEG and fMRI, the patient is repeatedly asked to respond to carefully chosen questions or commands. For example, they may be asked to imagine opening and closing their hand.
• Data analysis: Extensive training is required to analyze and interpret the patient’s brain activity data collected during questioning. Healthcare professionals look for signs that the patient is mentally processing the questions or commands, even if they cannot physically respond.
• Identification of CMD: The primary goal of the CMD test is to identify whether the patient is experiencing cognitive motor dissociation. In CMD, the person is aware and processing information but cannot physically respond.
• Structural MRI: In the recent study mentioned in the article, researchers used structural MRI to identify specific brain lesion patterns in patients with CMD. These patterns were in areas of the brain responsible for motor output but not command comprehension or arousal. This indicated that patients with CMD could understand but not physically respond.

It’s important to note that this approach requires specialized equipment, extensive training, and specific expertise. In the future, identifying CMD more easily through structural MRI scans may improve the chances of early diagnosis and appropriate care for patients who are aware but unresponsive.

Here’s why our Charlotte brain injury lawyers are excited about this discovery

The discovery of using structural MRI to identify specific brain lesion patterns in patients with cognitive motor dissociation is generating excitement for many reasons. Currently, diagnosing CMD is a complex and resource-intensive process, limiting its accessibility. This discovery potentially introduces a more accessible screening tool that can identify CMD in patients with brain injuries, making it easier to recognize those who are cognitively aware but appear unresponsive.

Furthermore, the identification of CMD has a significant impact on patient care, reducing the risk of prematurely withdrawing life-sustaining therapies. Some CMD patients have a higher chance of recovery than unresponsive patients without CMD. This knowledge empowers families to make more informed decisions about care, rehabilitation, and therapies, ultimately leading to better patient outcomes. Additionally, the identification of CMD may open the door to tailored therapies and communication tools, improving the quality of life for those affected. This discovery not only validates the experiences of patients and families who have suspected CMD but also ensures that they receive the care and advocacy they deserve, offering hope for a brighter future.

At Price, Petho & Associates, we care about our clients. Our Charlotte brain injury attorneys and legal team care about our community. That comatose patients might be able to have a higher quality of life in the near future is a reason to celebrate. Too often, car accidents, workplace accidents, and other types of injuries lead to a victim being in a comatose state, and our hearts hurt for those people. We celebrate with the families of those patients who are one step closer to communicating with their loved ones again. If you or a loved one have been injured, please call our office or complete our contact form today. We have offices in Charlotte, Rockingham, and Rutherfordton for your convenience.