you’re looking at me right now but
strangely different and when we were
examining him with the coma recovery
scale which is a scale we use in people
who had a coma and what we’re trying to
find out whether there is any recovery
of consciousness which for example move
a mirror in front of his eyes but he
will never follow and the physicians who
sent him to us initially thought he was
in a persistent vegetative state I don’t
like that term I don’t think we can
compare humans with vegetables plans so
it’s chairman of the European task force
well we’ve proposed to refer to them as
being in an unresponsive wakefulness
because that’s what we see there after
their coma awakening meaning they open
their eyes with their own responsive
they will never respond to a simple
question they will show no oriented
responses and even if with the team at
the University Hospital in yet we’ve
seen many hundreds of people like him
it’s still for some of them a real
challenge and I remember wondering is
there anybody in there and the story I
would like to share today with you is
the one of a man named loris and he
agreed that I would tell you historian
so that his parents who actually
encouraged me to tell what happens he
was at a party with his girlfriend and
two of his friends and they had quite a
lot of drinks and
wanted to drive back home but their car
hit the truck and they all died except
for Loras who survived the spirit and
intensive care were initially was
breathing through a machine and then he
started to breathe on his own and he
opened his eyes and he was one of these
patients who were sent to us and yet
from all over Europe actually basically
for two questions and that is is there
any consciousness and the second
question is there anything we can do to
help them so let me share here with you
the brain scans so what we see here is
an MRI looking into his brain and you
see a normal brain with all these
billions of neurons taking a lot of
space and in his case there is an
atrophy the brain really is much smaller
and it’s this black this is fluid taking
the place of what should be brain and
that is caused by that traumatic car
accident but now let’s look inside and
look at the connections in this brain
and again you see in a normal brain it
sits like a tree with all these branches
these connections we call axons and you
see basically the fragility and in his
brain it’s very clear that there is way
less of these branches this is what we
call by fuse external injury it’s it’s
all over the brain and this shock
basically broke these brain connections
and was the reason for him to become
Atos but we still wonder okay there’s a
lot of damage here but would there still
be a functioning brain somehow a
functioning mind and that’s why we do
another test which is called PET CT
where we basically inject radioactive
sugar and your brain is using a
of energy and we can see it here you see
the yellow it’s it’s these neurons using
the sugar and in his case well we see
that there are some parts some islands
in his gray matter also being active so
there seems to be a functioning brain a
functioning mind and we can also try to
access that by using what is called a
brain computer interface so here we look
at the electrical activity of his brain
let’s just look at the from there in red
and you see that when we’re presenting
him with different sounds his brain will
react differently that’s that green part
so yes we’ve answered the first question
he is somehow in there perceiving seeing
feeling even if it calmed communicated
this is what we call a minimally
conscious State and I think it’s very
important to try and answer that first
question whether or not these patients
are conscious because of course many
things change because now we no llores
can perceive emotions with also pain so
we should be very careful we should give
him painkillers make sure he’s
comfortable what I wanted to say is that
here we answered the first question and
that’s is he somehow conscious and yes
he is it’s a condition we now call
minimally conscious and I think it’s
very important because many things
change already we now know that loris
can perceive emotion was also pain so
we’ll make sure he’s comfortable receive
painkillers but we also want to make
sure he gets proper we have we want to
simulate his damaged brain and that can
be a challenge he came from France and
there some parts of the country it’s
very difficult actually to get access to
these rehab centers when I saw him he
was 27 and in the Netherlands that’s too
old to get access to rehab after
traumatic brain injury and I think that
is outrageous we should change that
now everything I’ve been telling you so
far is like clinical routine for us all
the brains
and now I would like to share with you
what might be a potentially new
treatment for these people with severe
traumatic brain injury and that is
called transcranial direct current
stimulation where basically we’re trying
transcranial means it goes through the
skull and the direct current will be
applied for 20 minutes every day you see
the electrodes and we’re trying to
increase the brain function of these
parts here in yellow you see the
electrical fields and of course this
this is a new therapy so so we take this
through the ethics committee and we need
the patient’s to give their informed
consent that they come because they
can’t communicate so is the family who
write down they agree to participate in
this scientific experiment where if you
want to find out that a specific drug or
in this case the electrical stimulation
really helps you need to perform what is
called a placebo controlled randomized
double-blind study whoa that means
placebo controlled you’re going to
compare your treatments often it would
be a drug with a placebo sugar pill in
our case it’s the electrical stimulation
with some fake stimulation just put the
electrodes and the machine pretends it’s
doing something
we’ll do it randomized it means you will
just flip a coin that coin decides where
the patient at this moment receives the
real or the fake stimulation and then
it’s double-blind that means the patient
the family but also the clinician they
done know whether it’s the real or the
fake because you really want to make
sure that if you see some change some
improvement that it’s really caused by
your treatment so Loras enrolled in this
clinical trial put on the machine
stimulate him and
using this coma recovery scale then we
see now he’s answering two simple
questions in this case it would move
your leg and then he starts to vocalize
do this for every day one week then we
stop take the other machine we don’t
know which is the real fake one but the
second time basically there was no
change and of course in medicine we
don’t like anecdotal evidence so we’re
going to do this in many patients we now
have over hundreds that benefited from
this technique and what I show you here
is the result from from that group and
this is being published and in black you
see the the scores going up the patient
is getting better and in gray you see
the fake stimulation basically it’s it’s
not changing so we here think we could
have something that could help patients
with severe brain injury to get better
and then one could bounce a question
well alright but why should we care and
Loras sure he’s still dependent on
others to eat get dressed and we need to
accept that everyone is different there
and we all have our values and some
people might prefer not to live in
certain conditions and I think also as a
medical doctor we should take care of
those very difficult end-of-life
decisions but here for Loras what to me
was maybe the most important is when his
father asked him are you happy and he
gives a huge smile and his science yes
so I think we should care and in Europe
everyday there’s 200 people dying
traumatic brain injury mostly young
adults and there’s even more who
survived their coma and remain severely
disabled for the rest of their lives
like Loras and I think as a society but
also my medical community we’ve been
ignoring this silent epidemic and so
when some including my own colleagues
would say I think you know it’s just a
waste of time and money what you’re
trying to do there I would strongly
disagree and traumatic brain injury can
strike anyone anytime I think we should
care about persons like Loras and
there’s hundreds of him and we should
improve their care pathway and not
ignore these patients with severe
traumatic brain injury and is it worth
it
well I think his story and his smile
definitely for me tells me this so I
want to thank him his parents our team in the ash and all those who do care