Consciousness, or rather, the lack of it, is a highly debated topic in the field of neuroscience. Not much is known about the lack of consciousness or what it is caused by, thus, allowing for the different types of consciousness to be misdiagnosed in patients. Such misdiagnoses of disorders of consciousness oftentimes leads to more issues when it comes to declaring whether a patient’s recovery is attainable, or rather, a patient may be declared as brain dead.
As a bioethicist, Dr. Joe Vukov investigates different disorders of consciousness, as well as their associations to brain death. In his presentation, Dr. Vukov mentioned two different disorders of consciousness: Locked-in syndrome and minimally conscious state. Locked-in syndrome is characterized moreso as a motor disorder, rather than as a disorder of consciousness, as the individual is perfectly aware of themselves and their surroundings, but is incapable of moving. The latter disorder can be described as the individual being able to do some of the same things that a conscious person can do, but to a minimal degree. In contradistinction to these two disorders, Dr. Vukov explains brain death as a demonstrable, irreversible coma. An individual that is declared as brain dead must have an absence of brainstem function (e.g. no neural activity), as well as an absence of spontaneous respiration (e.g. a respirator is required). In clarifying disorders of consciousness from brain death, Dr. Vukov claims that brain death is not an issue of consciousness, but is rather a category of death.
As a bioethicist, Dr. Joe Vukov investigates different disorders of consciousness, as well as their associations to brain death. In his presentation, Dr. Vukov mentioned two different disorders of consciousness: Locked-in syndrome and minimally conscious state. Locked-in syndrome is characterized moreso as a motor disorder, rather than as a disorder of consciousness, as the individual is perfectly aware of themselves and their surroundings, but is incapable of moving. The latter disorder can be described as the individual being able to do some of the same things that a conscious person can do, but to a minimal degree. In contradistinction to these two disorders, Dr. Vukov explains brain death as a demonstrable, irreversible coma. An individual that is declared as brain dead must have an absence of brainstem function (e.g. no neural activity), as well as an absence of spontaneous respiration (e.g. a respirator is required). In clarifying disorders of consciousness from brain death, Dr. Vukov claims that brain death is not an issue of consciousness, but is rather a category of death.
The article, “Computers Determine States of Consciousness,” discusses the gray area that is present in terms of brain death and its association to disorders of consciousness. In establishing such gray area, the article defines a minimally conscious state as having some possibility of recovery. This is in contrast to unresponsive wakefulness syndrome wherein an individual's’ actions are random and purposeless, with there being little possibility of recovery, eventually leading to brain death. In emphasizing the commonality of misdiagnoses between disorders of consciousness and brain death, the article claims that in as many as 40% of cases, the diagnoses of a minimally conscious state and unresponsive wakefulness syndrome are mixed up.
In proposing a possible solution to such misdiagnoses, the article references a study in the journal, Brain. In this study, EEG (electroencephalography) brainwave recordings are fed into machine learning algorithms that are used to distinguish unresponsive wakefulness syndrome from a minimally conscious state. The hope of these algorithms would be to extinguish the guessing game that might accompany diagnoses of brain death or disorders of consciousness. Alongside this, the article mentions a study done by researchers at a Parisian hospital in which machine learning algorithms were incorporated into the differentiation between disorders of consciousness and brain death. In this study, EEG brainwave recordings from 268 patients with either unresponsive wakefulness syndrome, or in a minimally conscious state were fed into a machine learning algorithm called DOC-forest. DOC-forest performed relatively accurately as roughly three out of four cases were properly diagnosed. When implemented into real life scenarios, DOC-forest continued to perform relatively accurately in comparison to the error observed by a physician’s diagnosis.
In having mechanisms like DOC-forest alongside EEG recordings, disorders of consciousness can be differentiated in patients more easily. This improved identification of consciousness disorders can thus allow for a better distinction between issues of consciousness and brain death. Identifying misdiagnoses of consciousness disorders would get to the root of the problem, in regards to brain death, as physicians commonly have issues declaring a patient as brain dead.
In proposing a possible solution to such misdiagnoses, the article references a study in the journal, Brain. In this study, EEG (electroencephalography) brainwave recordings are fed into machine learning algorithms that are used to distinguish unresponsive wakefulness syndrome from a minimally conscious state. The hope of these algorithms would be to extinguish the guessing game that might accompany diagnoses of brain death or disorders of consciousness. Alongside this, the article mentions a study done by researchers at a Parisian hospital in which machine learning algorithms were incorporated into the differentiation between disorders of consciousness and brain death. In this study, EEG brainwave recordings from 268 patients with either unresponsive wakefulness syndrome, or in a minimally conscious state were fed into a machine learning algorithm called DOC-forest. DOC-forest performed relatively accurately as roughly three out of four cases were properly diagnosed. When implemented into real life scenarios, DOC-forest continued to perform relatively accurately in comparison to the error observed by a physician’s diagnosis.
In having mechanisms like DOC-forest alongside EEG recordings, disorders of consciousness can be differentiated in patients more easily. This improved identification of consciousness disorders can thus allow for a better distinction between issues of consciousness and brain death. Identifying misdiagnoses of consciousness disorders would get to the root of the problem, in regards to brain death, as physicians commonly have issues declaring a patient as brain dead.
References:
Powell, T. (2014). Brain Death: What Health Professionals Should Know. American Journal of Critical Care,23(3), 263-266. doi:10.4037/ajcc2014721
Rose, S. (2018, December 18). Computers Determine States of Consciousness. Retrieved April 18, 2019, from https://www.scientificamerican.com/article/computers-determine-states-of- consciousness/
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