Post by Harvard Medical School

The discovery of hidden awareness, also known as covert consciousness, in seemingly unresponsive patients is raising difficult questions in brain injury care. First identified in a 2006 study, covert consciousness is detected with advanced neurotechnologies like task-based functional MRI or electroencephalography. In these tests, patients are asked to imagine performing a specific activity, like opening and closing their hand. “For 25% of patients who cannot physically do that at the bedside, we can see that they are purposefully modulating their brain activity trying to perform the task,” said Brian Edlow, a critical care neurologist and an HMS associate professor of neurology at Massachusetts General Hospital. Most deaths from traumatic brain injury in the ICU result from the withdrawal of life-sustaining therapy, often within the first few days. If signs of covert consciousness can be detected and help to predict a patient’s prognosis, it gives more insight to families and clinicians facing difficult decisions. Yet most patients worldwide lack access to these advanced tests. Edlow and colleagues are working to expand access and improve testing while also addressing the ethical and clinical challenges the phenomenon presents. Their efforts could ultimately reshape how patients with brain injury are understood, cared for, and treated.

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