Assessing consciousness may seem like the ultimate exercise in subjectivity, but some researchers are moving closer to what they call an objective measure.
The goal is to provide clearer information for families with loved ones living in vegetative or minimally conscious states — conditions that are often caused by brain trauma or cardiac arrest.
“We really need to find a way to be able to measure consciousness reliably,” says Melanie Boly, a postdoctoral fellow at the Belgian National Fund for Research in Liege, Belgium. “For the family, this changes everything,” says Boly, who presented her team’s research on 14 October at the Society for Neuroscience meeting in New Orleans, Louisiana.
Vegetative patients make only reflexive movements and appear insensitive to their surroundings, while minimally conscious patients can make some purposeful movements and even feel pain. Clinically, the differences between these patients can be difficult even for experienced physicians to discern. But legally, the differences are clear.
In 2011, the UK court system denied a family’s request to end life support for their daughter after additional tests revised her initial diagnosis from ‘vegetative’ to ‘minimally conscious’.
To derive a numerical measure of consciousness, Boly and her colleagues pulsed subjects’ heads with a brief electromagnetic wave, then measured neural responses using electrodes stuck to the scalp.
In 32 healthy, awake people, the electromagnetic impulse sent complex patterns of electrical activity reverberating throughout the brain. In healthy sleeping people, or people under general anaesthesia, the brain displayed shorter, simpler responses that stayed closer to the site of the initial stimulation. The researchers quantified these differences in a measure of response complexity.
In six patients diagnosed as vegetative, the electromagnetic pulse elicited responses with complexity indices similar to those in sleeping or anaesthetized healthy subjects. Twelve minimally conscious patients showed slightly more complex responses. And two ‘locked-in’ patients — people who are fully conscious but unable to move or communicate — showed complexity indices similar to healthy, awake subjects.
Boly and her colleagues have previously noted some of these differences across patient groups but with poor reliability for individual patients. With the complexity index, which combines several aspects of the brain’s response, she says, “this is the first time we really have a measure that works at a single-subject level.”
“It’s not going to supplant a clinical assessment,” says Nicholas Schiff, a neurologist at the Weill Cornell Medical College in New York. But he says the complexity index could become a valuable tool for adding some certainty to the subjective process of evaluating patient consciousness.
“I personally would welcome a test that could provide us with objective measurements,” says David Okonkwo, clinical director of the Brain Trauma Research Center at the University of Pittsburgh in Pennsylvania. However, he said much more testing is needed to tell whether the complexity index meets that standard.
“We need more patients,” agrees Boly, “but it’s extremely promising.”