http://www.nationalpost.com/todays-paper/Reawakening/5685224/story.html

Reawakening
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Thandi Fletcher, Postmedia News . Nov. 10, 2011 | Last Updated: Nov. 10,
2011 3:08 AM ET



Imagine being a prisoner of your own body and mind, aware of your
surroundings but unable to communicate with the outside world. The condition
is called locked-in syndrome and it could be more widespread than doctors
realized in the past.

But the understanding of the condition could change with a recent discovery
by a team of neuroscientists at the University of Western Ontario in London,
Ont., who have found that an inexpensive and portable medical device called
an electroencephalography device, or EEG, is as effective as magnetic
resonance imaging, or MRI, in detecting brain activity of some patients once
thought to be in a permanent vegetative state.

The groundbreaking findings, published online Wednesday in the peerreviewed
medical journal Lancet, could help doctors find the answer to a question
they've been unable to ask until now: Are there other misdiagnosed
vegetative patients out there, locked inside their own bodies and unable to
communicate?

"This is something that we really don't know," said Adrian Owen, coauthor of
the study and neuroscientist from the University of Western Ontario's Centre
for Brain and Mind.

"Patients are in care homes, they're in residential homes, they're in
hospitals," he explained. "Until now it has not been possible to get out and
offer this to patients who are unable to get to a high-field MRI scanner."

Functional MRI, a specialized type of brain imaging, is the current "gold
standard" for detecting brain activity in vegetative patients, said Owen.

However, the machine is not available in all hospitals and is incredibly
expensive, at a cost of about $3-million, he said, and the logistics of
transporting vegetative patients from their homes or care facilities makes
it difficult for them to get to the MRI machines. Some of these patients,
after suffering a traumatic injury, also have metal implants such as plates
or pins in their bodies and cannot be exposed to strong magnetic fields
created inside an MRI machine, said Dr. Owen.

He said the researchers wanted to figure out a way to take brain-imaging
equipment to a patient's bedside.

"That's really what we were trying to achieve here," he said. "And if so,
can we do it as well as we could do it with fMRI and what would the results
be?"

In the study, the researchers looked at 16 vegetative patients from
Addenbrooke's Hospital in the United Kingdom and the University Hospital of
Liege in Belgium. The patients were of varying ages, were vegetative for
varying lengths of time, and suffered a variety of different injuries that
resulted in them being in a vegetative state.

Attaching an EEG, the researchers gave the patients basic commands to use in
response to a series of questions. They were told to imagine squeezing their
right hand to answer yes, and to imagine moving their toes to answer no. An
EEG involves placing a series of electrodes against the scalp, which pick up
small electrical signals created by the brain. Neuroscientists understand
the two regions of the brain that control hand movement and toe movement.

Compared with healthy patients used as controls in the study, the results of
the seemingly vegetative pa-tients were surprising, said Damian Cruse, lead
author of the study and post-doctoral fellow at the University of Western
Ontario.

Nearly 20% understood and responded to the questions, he said.

"They were able to follow the commands that we were giving them despite the
fact that to all external appearances, they appeared to not be aware at
all," said Dr. Cruse. "In fact, all of the standard clinical assessments for
these patients have diagnosed them as being entirely unconscious."

As an EEG, at about $80,000, is much less expensive than an MRI and is
portable, Dr. Owen said he hopes their findings can be used to find more
patients who appear to be vegetative but are actually conscious.

The new research also opens up the door to developing a "brain computer
interface," portable technology that can help patients with locked-in
syndrome to communicate with the outside world. "It's not really realistic
to imagine somebody spending the rest of their life lying in a fMRI scanner
to communicate with the outside world," said Dr. Owen. "We have to come up
with something that is more portable and at least in some point in the
future could perceivably be used in the home to communicate."

Dr. Owen emphasized that not all seemingly vegetative patients can
communicate through brain activity.

"This is 20%," he said. "It's a minority, but it's a significant minority."

However, he added that some patients in the trial could have not fully
understood the questions, or could have been asleep when tested, he said.

Although often confused, vegetative patients are different from those
believed to be brain-dead with no obvious brain activity.

In 2006, the same researchers determined for the first time using MRI
screening that a patient previously diagnosed as being in a vegetative state
was in fact consciously aware of her surroundings.

The study was carried out as a joint collaboration with researchers at the
University of Cambridge, Addenbrooke's Hospital and the University of Liege.

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