New test for wake coma patients

Brain researchers are developing tests with illogical questions for wake coma patients

08/02/2013

Some coma patients show abnormal brain activity when illogical sentences are read to them. The Bielefeld neuropsychologists found out. Their investigation showed that most of these patients awoke from the coma after three to five years. The researchers could have come up with an important indicator for the subsequent awakening. 14 of the 15 waxcoma patients whose brains respond to sentences like „Paul drinks his coffee with sugar and socks“ showed a reaction, woke up later.

Trial with illogical phrases triggers brain reaction in some vegetative patients
„The patient with this measurement curve woke up later“, explains Inga Steppacher to the news agency „dpa-infocom“, while she shows a graph. „We call that 'the mental ha'.“ The diagram shows a clear rash that shows the patient's brain response to an illogical sentence. The altered brainwaves are characterized by nonsense phrases „Klaus eats pasta with tomatoes and pants today“ triggered. The neuropsychologist analyzed more than 100 such diagrams in order to make statements on the chances of recovery of patients with the so-called apallic syndrome. The brain activity is based on a mechanism in the human brain, after which it gets into great excitement when sentences are illogically terminated. Because the brain always searches for a logical meaning. If it does not find it, it reacts with measurable rashes. As the results of Steppacher show, the works „search for meaning“ even with some wax coma patients. Although they seem to notice nothing of their environment, their brains respond to illogical sentences.

For ten years doctors in the rehabilitation clinics Schmieder in Allensbach at the Lake Constance patient had played different sounds, texts and also nonsense sentences and at the same time recorded the brain activity of the women and men. „A huge amount of data that has not yet been evaluated in terms of whether certain brainwave responses can be linked to the likelihood of re-awakening“, reported the neuropsychologist. In the next step, Steppacher examined which patients regained consciousness after being released from the clinic. Then she analyzed how they had responded to sounds like clapping hands or knocking, to the lyrics and finally to the illogical sentences. Only from the data of the nonsense sentences could be derived indications of possible chances of recovery. More than 80 percent of the awake coma patients, whose brains responded to the illogical sentences, regained consciousness later.

Brain response to illogical phrases enhances the chances of healing of budding coma patients?
Steppacher evaluated the disease history of 87 patients, 30 of whom recovered at least a minimum of communication skills. Fifteen of the eighty-seven coma patients had responded to the illogical sentences. 14 of them woke up later. Although some of the other 72 patients also regained consciousness that had not responded to the nonsense phrases, but with only 16 cases significantly less than in the group with a brain reaction.

„We have found a good indicator of the likelihood of waking up here. This is a milestone in wake coma research.“ explained Professor Johanna Kißler, who supervised the study, to the news agency. However, the brain reaction does not mean that the patients understood the content of the sentences. However, their brains are very likely, despite the awake humor, to be able to process the language the other patients did not have, said Steppacher. „Several brain structures must work together for this reaction. We suspect that this is the key to awakening again: that while the brain is currently severely damaged by a traffic accident or stroke, certain areas continue to operate correctly.“

Longer rehab phase for wake coma patients
Armin Nentwig, Chairman of the German Wachkoma Society „Skull brain patients in need“ has been helping sufferers and improving their situation for more than 20 years. „We've always said that before: look closely at how patients respond. But it just has to be measurable and scientifically verifiable before it gets attention“, Nentwig commented the result of the study to the news agency. She is one „a step in the right direction“.

„But there is much more to be done. We know too little about this disease, which is becoming increasingly important“, explained Nentwig. His son fell in 1988 after a skiing accident in the wake coma. He died after six months. In his opinion it was „important that such results lead to the active rehab phase being extended“. Often, patients would be laid off too quickly and in care „deported“ become.

But as the study of the Bielefeld brain researchers shows, even after a few years the chance to return to life exists. „We have seen that of the patients who recovered, almost half did not wake up until after three to five years“, said Steppacher. Further investigations are planned. The aim is to test how sentient coma patients react when the illogical sentences are spoken by their own mother, for example, and feelings are added.

Why do people fall into the vegetative state??
Each year, about 3,000 people fall into vegetative state. Triggers are brain injuries caused by car accidents, cerebral hemorrhage due to a burst vessel or cardiac arrest with prolonged oxygen deficiency of the brain.

The injury can affect different areas. While in some cases the outer cerebral cortex, the so-called cerebrum, is injured, which is responsible for the processing of stimuli and perception, in other patients the midbrain may be the damaged area. The midbrain is located below the cerebrum and has important areas for stimulus transmission. Damage to the brainstem, the oldest area of ​​the brain, can also cause patients to fall into the budding coma. Using special behavioral tests, doctors and brain researchers can find out if the person is still aware of something or if there is any reaction to the environment. Wake-coma patients who regain consciousness often need help throughout their lives. (Ag)

Image: Michael Bührke