Unresponsive Brain-Damaged Patients May Have Some Awareness

When people suffer severe brain damage — as a result of car crashes, for example, or falls or aneurysms — they may slip into a coma for weeks, their eyes closed, their bodies unresponsive.

Some recover, but others enter a mysterious state: eyes open, yet without clear signs of consciousness. Hundreds of thousands of such patients in the United States alone are diagnosed in a vegetative state or as minimally conscious. They may survive for decades without regaining a connection to the outside world.

These patients pose an agonizing mystery both for their families and for the medical professionals who care for them. Even if they can’t communicate, might they still be aware?

A large study published on Wednesday suggests that a quarter of them are.

Teams of neurologists at six research centers asked 241 unresponsive patients to spend several minutes at a time doing complex cognitive tasks, such as imagining themselves playing tennis. Twenty-five percent of them responded with the same patterns of brain activity seen in healthy people, suggesting that they were able to think and were at least somewhat aware.

Dr. Nicholas Schiff, a neurologist at Weill Cornell Medicine and an author of the study, said the study shows that up to 100,000 patients in the United States alone might have some level of consciousness despite their devastating injuries.

The results should lead to more sophisticated exams of people with so-called disorders of consciousness, and to more research into how these patients might communicate with the outside world, he said: “It’s not OK to know this and to do nothing.”