How Can We Tell If a Comatose Patient Is Conscious?

So the difference between unresponsiveness, minimal consciousness and locked-in would seem to be hard to determine.

That’s right. If there is no response to commands, sounds or pain stimuli, this does not necessarily mean that the patient is unconscious. It may be that the patient does not want to respond to a command or that the regions of the brain that process language are so damaged that the person simply doesn’t understand me. Then there are cases in which the brain says, “Move!” but the motor neural pathways have been severed. Family members are often quicker than physicians to recognize whether a patient exhibits consciousness. They may perceive subtle changes in facial expression or notice slight movements that escape the physician’s attention.

With different brain scanners, I can find out where brain damage is located and which connections are still intact. This information tells family members what the chances of recovery are. If the results show that there is no hope whatsoever, we then discuss difficult topics with the family, such as end-of-life options. Occasionally we see much more brain activity than anticipated, and then we can initiate treatment aimed at rehabilitation.

One well-known case was that of Rom Houben.

That’s right . He was a very important patient for us: as far as anyone could tell, he had been left completely unresponsive for 23 years after a car accident. But in the mid-2000s we placed him in a brain scanner and saw clear signs of consciousness. It is possible that he experienced emotions over all those years. He was the first of our patients who was given a different diagnosis after such a long time. We subsequently conducted a study in several Belgian rehab centers and found that 30 to 40 percent of unresponsive patients may exhibit signs of consciousness.

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