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 Inside the injured brain, many kinds of awareness

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Date posted: 11/04/2005

Neuroscientists now understand at least some of the physiology behind a wide range of unconscious states, from deep sleep to coma, from partially conscious conditions to a persistent vegetative state, the condition diagnosed in Schiavo's case.

New research, by laboratories in New York and Europe, has allowed for much clearer distinctions to be made between the uncounted number of people who at some time become comatose. "Understanding what these processes are will give us a better sense of how to help the whole range of people living with brain injuries," said Dr. Nicholas Schiff, an assistant professor of neurology and neuroscience at NewYork-Presbyterian/Weill Cornell hospital. "That is where this field is ultimately headed: toward a better understanding of what consciousness is."

In a landmark study published in February, a team of neuroscientists in New York, New Jersey and Washington, led by Schiff, used imaging technology to compare the brain activity in two young men who were deemed to be minimally conscious with the brain activity of seven healthy men and women. The researchers recorded an audiotape for each of the nine subjects in which a relative or loved one reminisced, telling familiar stories or recalling shared experiences.

In each of the brain-damaged patients, the sound of the voice prompted a pattern of brain activity similar to that of the healthy participants. The team has since replicated the results in other minimally conscious patients.

Like an interlocking set of old Christmas lights, blinking on and then off, the neural connections in minimally conscious patients seem to be in place, the research suggests. In persistently vegetative brains, by contrast, the crucial connections are apparently shot: maybe one light blinks here, another over there, but the full network is dark.

One case, of a 26-year-old English woman named Kate who emerged from a subdued unconscious state after six months, suggests such patients may be at times acutely aware of what is happening around them. During rehabilitation, though unable to communicate, this woman had a visit from a college friend.

"I have just met an old friend from Uni and it really upset me," the woman recalled thinking, doctors reported. "I can now see how much I am missing. She has been married for five years and she has a house and a life. I just scream as I can't cry, which I would do if I could."

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