Brain-damaged people may be aware

Thousands of brain-damaged people who are treated as if they are almost completely unaware may in fact hear and register what is going on around them but be unable to respond, a new brain imaging study suggests.

The findings, if repeated in follow-up experiments, could have sweeping implications for determining the best care for these patients. Some experts said the study, which appeared Monday in the journal Neurology, could also have consequences for legal cases, when parties dispute the mental state of a patient who is unresponsive.

The research showed that brain-imaging technology could be a powerful tool to help doctors and family members determine whether a person had lost all awareness or was still somewhat mentally engaged, experts said.

"This study gave me goose bumps, because it shows this possibility of this profound isolation, that these people are there, that they've been there all along, even though we've been treating them as if they're not," said Dr. Joseph Fins, chief of the medical ethics division of New York Presbyterian Hospital-Weill Cornell Center. Fins was not involved in the study but collaborates with its authors on other projects.

Other experts warned that the new research was more suggestive than conclusive, and that it did not mean that unresponsive people with brain damage were more likely to recover or that treatment was yet possible.

But they said the study did open a window on a world that has been neglected by medical inquiry. "This is an extremely important work, for that reason alone," said Dr. James Bernat, a professor of neurology at Dartmouth.

Bernat said findings from studies like these would be relevant to cases like that of Terri Schiavo, a Florida woman with brain damage who has been kept alive for years against her husband's wishes. In that case, relatives of Terri Schiavo disagree about her condition, and a brain-imaging test — once it has been standardized — could help determine whether brain damage has extinguished awareness.

The patients in question have significant brain damage. Three million to six million Americans live with the consequences of serious brain injuries, neurologists say. An estimated 100,000 to 300,000 of them are in what is called a minimally conscious state: They are bedridden, cannot communicate and are unable to feed or care for themselves, but they typically breathe on their own.

They may occasionally react to instructions to blink their eyes or even reach for a glass, although such responses are unpredictable. By observing behavior in a bedside examination, neurologists can determine whether a person is minimally conscious or in a "persistent vegetative state" — without awareness and almost certain not to recover.