Acute Brain Injury: Detection of Brain Activation in Unresponsive Patients

MedicalResearch.com Interview with:

Jan Claassen, MD, PhD, FNCS Associate Professor of Neurology Division of Division of Critical Care and Hospitalist Neurology Columbia University Medical Center

Dr. Claassen

Jan Claassen, MD, PhD, FNCS
Associate Professor of Neurology
Division of Division of Critical Care and Hospitalist Neurology
Columbia University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Unconsciousness is common and predicting recovery is challenging – often inaccurate. Many patients do not show movements on commands and typically this is interpreted as unconsciousness. Some of these patients may be able to have brain response to these commands raising the possibility of some preservation of consciousness. This has previously been shown months or years after the injury mostly using MRI.

We were able to detect this activation at the bedside in the ICU shortly after brain injury. For this we applied machine learning to the EEG to distinguish the brain’s responses to commands. Patients that showed this activation were more likely to follow commands prior to discharge and had better outcomes one year later. 

MedicalResearch.com: What should readers take away from your report?

Response: These findings need to be confirmed and we do not know if those patients that showed the activation completely understand the instructions. However, the results suggest that early after brain injury patients that appear unresponsive may have brain activation to commands that distinguish between a “move” and “stop move” instruction. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: These results need to be replicated in a larger sample and obtained at multiple centers. We need to determine the mechanisms underlying this dissociation between cognition and behavior to hopefully in the future use this as a target for interventions.

Citation:

Detection of Brain Activation in Unresponsive Patients with Acute Brain Injury

Jan Claassen, M.D., Kevin Doyle, M.A., Adu Matory, B.A., Caroline Couch, B.A., Kelly M. Burger, B.A., R.E.E.G.T., Angela Velazquez, M.D., Joshua U. Okonkwo, M.D., Jean-Rémi King, Ph.D., Soojin Park, M.D., Sachin Agarwal, M.D., David Roh, M.D., Murad Megjhani, Ph.D., et al June 27, 2019

N Engl J Med 2019; 380:2497-2505
DOI: 10.1056/NEJMoa1812757 

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