Scientists estimate that approximately forty percent of comatose patients may actually be awake. This is shown by the latest diagnostic methods that allow assessing the activity of neurons in real time. How people with severe brain damage come back to life.
The persistence of loved ones brought the mother out of the coma
Munira Abdula was in a car accident in 1991. Due to severe brain damage, she was in a vegetative state, but the family continued to treat her.
In 2017, the patient was brought to a specialized clinic in Germany, and one day she suddenly made a strange sound, and a few days later she called her son by name. After 27 years of coma, the patient regained consciousness. According to the BBC, she can communicate with relatives at an elementary level and even speak a little.
This is the rarest case. However, a full life, as a rule, is no longer possible: the brain damage is too severe.
The triangle of consciousness
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Coma is a complete loss of consciousness. A person does not respond to external stimuli, cannot move, all brain activity is inhibited. At the same time, life is still glowing. Usually this condition is the result of severe mechanical damage to the brain: due to an accident, a fall from a great height, or a violation of cerebral circulation (stroke).
Back in the middle of the last century, scientists found out that the whole thing is in damage to the brain stem - an oblong section in the lower part of the cranium connected to the spinal cord. It was suggested that in different parts of the brain there are some centers of wakefulness that exchange signals with the cortex and activate consciousness.
In 2016, scientists at Harvard Medical School discovered a tiny area of two cubic millimeters in the brainstem that interacts with neurons in the cortex. Russian biologist Vladimir Kovalzon called it "the place of localization of the soul."
Patients who have a damaged center in the left tire of the bridge fall into a coma. This site is associated with two regions of the cerebral cortex - anterior part of the islet and anterior cingulate cortex / Illustration by RIA Novosti. Depositphotos / edesignua.
The authors of the work examined 36 patients with severe brain stem damage, of which 12 were in a coma. With a seemingly equal scale of defeat, some had consciousness, while others did not. The fMRI mapping indicated a region of the brainstem in the left lining of the bridge: it is this damage that leads to coma.
This site interacts with two regions of the cerebral cortex: the anterior part of the insular lobe and the pregenual region of the anterior cingulate cortex. There are large neurons that penetrate by processes into all layers of the cortex. These are found only in animals with large brains - great apes, elephants, dolphins.
If the “place of localization of the soul” in the trunk is destroyed, the connection between these areas in the cortex is broken, and the brain turns off. Wakefulness and understanding of the environment - two key states that determine consciousness - disappear.
Scientists from the Iowa State University Hospital (USA) believe that consciousness also relies on one of the deep parts of the brain, such as the hypothalamus or basal forebrain. The state of wakefulness depends on their safety.
In 33 patients, the thalamus was affected after stroke. Four fell into a coma. It turned out that their brains were damaged much more than others: in addition to the thalamus, the hypothalamus and trunk were damaged.
Reacting to Past Life Memories
Scientists from Russia and Kazakhstan observed 87 patients in a coma. Over time, almost half regained consciousness, some partially regained their cognitive functions.
In general, it looks like this. After a coma, a vegetative state sets in, that is, the body is alive, but does not react to anything. Then small consciousness returns, when a person can, for example, fix his gaze or follow an object with his eyes.
And only then are functions of a higher level restored, for example, the ability to move the hand on command, to answer elementary questions - at least with the eyes. The authors of the work note that the patient may not display any motor activity and nevertheless be conscious. This is why it is important to assess the condition of patients in coma using new diagnostic methods.
Scientists from the USA and Great Britain speak about the same. They studied 21 people with severe brain damage, including those in a vegetative state. Compared with 13 healthy subjects. Family members read to patients stories from their lives before the illness, and researchers mapped the brain and filmed an electroencephalogram. It turned out that in some patients the delay in the electrical activity of the brain in response to speech is the same as in healthy people. Moreover, fMRI showed the activity of neurons in response to voice commands, although outwardly the patients were in a vegetative state.
The authors of the article emphasize that it is necessary to re-examine comatose patients in order to identify those who are conscious, but locked in their bodies and cannot report it. Such patients need to be treated in a completely different way, to carry out rehabilitation, which will return them to any physical and cognitive abilities.
Earlier, researchers from Harvard Medical School and the University Hospital of Liege (Belgium), using the same means, showed that coma and vegetative state of patients admitted to the intensive care unit after severe brain damage should not serve as the basis for a definitive diagnosis. The patient is able to recover, although outwardly it cannot be determined in any way.
Doctors from Liège described the case of an injured person in an accident in 1992. In intensive care, he was connected to a ventilator. The nurse said that the patient moved his hand at her command, but this did not change the diagnosis - the patient was admitted to a comatose clinic, where he remained without receiving any therapy.
Twenty years later, the patient's relatives, being in the same room with him, felt that he was conscious, although there were no external signs of this. The patient was transported to a university clinic, underwent treatment and several levels of tests.
First, the patient spontaneously opened his eyes, chewed with his mouth, moved his left arm and leg, then began to fix his gaze on an object and follow it. After some time, he was already executing the simplest commands: he closed his eyes, answered questions with facial expressions. So we managed to find out that he remembered his name and the names of his relatives.
The work of recent years not only helped to establish in general terms how consciousness arises, but also gave hope that patients who were locked in a coma could be brought back to life.
Tatiana Pichugina