Latest / Kvetch & Release / New technique to detect “preserved consciousness” in apparent comatose patients following severe brain injury

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New technique to detect “preserved consciousness” in apparent comatose patients following severe brain injury · Kvetch & Release

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  Speaker 1: This is a wild story that I came across earlier. Today,
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  Speaker 1: researchers at lass In Health Research Institute and Western University
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  Speaker 1: are using a new brain imaging technique to detect preserved
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  Speaker 1: consciousness in the Intensive care unit at London Health Sciences
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  Speaker 1: Center and patients that appear to be in a coma
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  Speaker 1: following a severe brain injury. This is being called a
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  Speaker 1: groundbreaking discovery. It was published in the Proceedings of the
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  Speaker 1: National Academy of Sciences and researchers used functional near infrared
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  Speaker 1: spect oscopy, which is a portable brain imaging technique. I'm
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  Speaker 1: not going to talk about what this is because I
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  Speaker 1: don't know what it is. I shouldn't be the one
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  Speaker 1: explaining something that I don't get. What we can do, though,
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  Speaker 1: is talk with a neurologist at London Health Sciences Center,
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  Speaker 1: Doctor DEBICKI joins me right now. How are you doing, doctor,
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  Speaker 1: I'm doing very well.
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  Speaker 2: Thanks you toal, doing very well.
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  Speaker 1: Thank you for joining me here. So what is this?
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  Speaker 1: Could you break this down? Like I don't have any
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  Speaker 1: background in science? What's whoever? WI should be pretty easy?
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  Speaker 2: Sure, I'd love to. In the Intensive carry unit, we
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  Speaker 2: take care of patients who are very critically ill, and
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  Speaker 2: some of those patients have severe brain injuries. And what
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  Speaker 2: we currently do is use our critical tools, so our
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  Speaker 2: bedside examinations, we use some other tests and investigations that we
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  Speaker 2: have available to us in a general sense, like CT
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  Speaker 2: scans and MRI scans and blood work to try to
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  Speaker 2: understand why patients have their severe brain injury and to
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  Speaker 2: try to get an appreciation of what we think their outcomes,
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  Speaker 2: their functional outcomes might be after if they can survive
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  Speaker 2: this injury or not. But sometimes there's patients where it's
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  Speaker 2: a bit unclear, and so we're trying to use more
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  Speaker 2: advanced techniques or advanced imaging methods to be able to
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  Speaker 2: take a look at those patients and to see if
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  Speaker 2: there is any evidence to suggest that they might have
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  Speaker 2: some what we call preserve of consciousness despite not being
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  Speaker 2: able to interact with us, and hopefully that can help
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  Speaker 2: us with giving patients and their families a better prognosis
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  Speaker 2: of what things might look like in the future.
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  Speaker 1: Okay, so you used this functional near infrared spectroscopy and
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  Speaker 1: Fner's is what it's being called, and what was that
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  Speaker 1: used to determine? It looks like it's a big helmet
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  Speaker 1: or a cap with wires coming all out of it.
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  Speaker 1: I'm looking at a photo here, that's right.
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  Speaker 2: So there's a cap with a little kind of dots
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  Speaker 2: on them that either emit light or detect light. So
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  Speaker 2: we kind of shine light or light waves that are
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  Speaker 2: able to penetrate the skull and bounce off the brain.
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  Speaker 2: And essentially we're using that light property to look at
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  Speaker 2: properties of blood flow in the brain, and by doing that,
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  Speaker 2: we can see which parts of the brain are active
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  Speaker 2: or not active during different tasks, and then we can
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  Speaker 2: compare that when we take a look. The hope is
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  Speaker 2: that when we take a look at patients and the
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  Speaker 2: intensive carrying in it, we can compare that to what
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  Speaker 2: we think the response should be based on the bigger
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  Speaker 2: set of healthy control subjects that we described in this paper.
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  Speaker 1: So you're using this to actually determine if people who
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  Speaker 1: are unresponsive, unconscious, potentially comatose, are actually aware of what's
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  Speaker 1: going on, like their brain responding to it. Just if
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  Speaker 1: I understand that's right.
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  Speaker 2: So when patients are really severely ill in the ICU,
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  Speaker 2: they may be in what we call a coma, and
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  Speaker 2: as patients try to emerge from a coma. If they're
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  Speaker 2: able to, then we start to see elements of more wakefulness,
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  Speaker 2: so they might start to open their eyes or they
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  Speaker 2: might start to make some movements of some sort. But
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  Speaker 2: what we really need to figure out is are they
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  Speaker 2: aware and are they understanding what's going on around them?
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  Speaker 2: There is a small percentage of patients in which they
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  Speaker 2: may be aware but not be able to interact with
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  Speaker 2: the environment, and so what this type of technique is
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  Speaker 2: trying to do is to see are these kind of
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  Speaker 2: patients Can we detect that in our patient population? And
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  Speaker 2: if we can, then is that going to help us
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  Speaker 2: be able to provide a better diagnosis for patients in
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  Speaker 2: their family and ultimately a better prognosis to discuss some
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  Speaker 2: care plans from there.
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  Speaker 1: So how could this potentially unlock new advancements in patient care?
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  Speaker 1: Like what is I mean, what is the dream scenario
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  Speaker 1: from this type of technology or are you still you know,
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  Speaker 1: way beyond being able to get to that point. I'm
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  Speaker 1: just curious about that.
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  Speaker 2: Yeah, we're still in kind of an early phase of things,
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  Speaker 2: particularly with this ef nears technology, but we're adding on
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  Speaker 2: to kind of other work that's being done by both
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  Speaker 2: our research group here at Western and other research groups
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  Speaker 2: around the world that are really trying to look at
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  Speaker 2: advanced techniques and of being able to measure things from
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  Speaker 2: the brain and being able to analyze that in a
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  Speaker 2: really kind of good way. And the ultimate goal here
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  Speaker 2: is to try to identify patients with more confidence, those
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  Speaker 2: that we think will have a good functional outcome and
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  Speaker 2: that may change care plans in the intensive care unit
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  Speaker 2: in terms of seeing if they're if we would continue
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  Speaker 2: aggressive care and supportive care for patients, or that might
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  Speaker 2: open up the door for us to then be able
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  Speaker 2: to continue on with trials of medications or other interventions,
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  Speaker 2: including surgical interventions that might help unlock patients if they
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  Speaker 2: truly are able to interact but not able to do
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  Speaker 2: so physically.
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  Speaker 1: It sounds like, and please correct me if I'm wrong,
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  Speaker 1: it sounds like when dealing with these patients in the
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  Speaker 1: intensive care unit who may be come to that it's
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  Speaker 1: really just sort of wait and see at this point,
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  Speaker 1: and that this technology is hoping to more quantify what
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  Speaker 1: outcomes could be achieved based on the gathering of data.
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  Speaker 1: Am I correct with that?
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  Speaker 2: That's a good way of thinking about it. I think
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  Speaker 2: what we really need to do is with this technology,
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  Speaker 2: and as we're developing it and trying to implement it
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  Speaker 2: with more patients and really try to get a sense
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  Speaker 2: of what the relationship between our signals are and future
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  Speaker 2: functional outcomes, I think what we have to do is
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  Speaker 2: try to identify the patients that will benefit most from
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  Speaker 2: this type of testing. We know that there are going
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  Speaker 2: to be some patients that are quite sick in the
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  Speaker 2: intensive carry unit but wake up and really show good
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  Speaker 2: functional outcomes quite quickly, so that patient group won't really
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  Speaker 2: benefit from this. And there are patients that we know
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  Speaker 2: right from the start have suffered such severe brain injuries
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  Speaker 2: that they're unlikely to recover and survive their hospital stay.
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  Speaker 2: So it's really identifying which of those patients that are
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  Speaker 2: kind of in the middle that we can then tailor
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  Speaker 2: and provide individualized medicine to over time.
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  Speaker 1: Fascinating and groundbreaking stuff here. Again, this is so outside
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  Speaker 1: of my wheel well, but I really like having people
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  Speaker 1: on like you experts to help break this down for us.
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  Speaker 2: Doctor to Becky, Oh, it's a pleasure.
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  Speaker 1: Thank you so much for your time. I hope you
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  Speaker 1: have a great afternoon, and hey, good luck with all
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  Speaker 1: of this.
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  Speaker 2: Still, Thank you so much.
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  Speaker 1: All the best doctor to. Becky is a neurologist at
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  Speaker 1: London Health Sciences Center. He's also a prof at Western University.