What do we really know about brain death?

“Many members of the public do not understand the distinction between brain death and neurologic states such as coma and persistent vegetative state.” Dr. Joe Vukov, in his talk, explained not only the distinction amongst these three, but also why the public has such a hard time understanding the distinction amongst those three states. To begin his talk, Dr. Vukov, explained the incorrect statements that health professionals make when speaking about these states, especially when conversing with the families of a brain-dead patient. Dr. Vukov recommended that health professionals be a bit more cautious of not only the distinction between these states, but also better communicate it to the families in the terms of how it actually is: death. Dr. Vukov, then, explained the differences amongst the three states, he first explained the state of coma which he defines as a state of unconsciousness in which a person can’t be awakened and are usually unresponsive to painful or verbal stimuli. Coma is typically irreversible. Then, Dr. Vukov explained persistent vegetative state as a “state of unconsciousness that continues for a long period of time,” however in that state, the only difference is that the patient does not require a ventilator for support as they’re able to breathe on their own. A patient in Persistent vegetative state may have some degree of awareness and might have a possibility of recovering some function. Unlike the optimism that some families receive from having a loved one in a persistent vegetative state, families of a brain-dead patient do not receive that same optimism. Brain death is defined and determined through the following criteria: “irreversible coma, absence of function of the entire brain, including the brainstem, and lack of spontaneous respiration,” if a person fits into all these categories, the person is declared to be dead. However, to determine whether the coma is actually irreversible or not, appropriate tests are performed so as not to make a wrong diagnosis.

Dr. Vukov told us a clear black and white spectrum of death by presenting us with the criteria of brain death. However, a recent article posted by Gina Kolata on “’Partly alive ‘: Scientists Revive Cells in Brains from Dead Pigs,” raises new questions as it introduces a discovery in which researchers were able to restore cellular activity in brains that were removed from slaughtered pigs. Although no electrical signaling was present as the solution that was given to the brains contained chemicals to block nervous activity, they did however see blood vessels in the pigs’ brains starting to function, and certain brain cells even regained metabolic activity which even responded to drugs. This raises a lot of controversy on the topic of brain death, as we’re starting to learn that parts of the brain may be recoverable after death. This raises not only a lot of question about brain death itself, but also of what is actually considered dead, alive, or partly alive now. Where does partly alive stand in terms of death? Although this is a new topic for scientists, health professionals, and bioethics to discuss about to determine some kind of criteria of distinguishing these three spectrums of life and death, researchers are quite optimistic with this discovery for multiple reasons. Now, not only are we able to learn about the whole mammalian brain outside the body after death, we’re able to learn more about brain injuries, cellular repair, and how drugs affect the brain, which might even help us discover what drugs can help recover the brain from such traumatic brain injuries. This discovery paves the way into many new discoveries and cures for other injuries and diseases. Dr. Farahany who speaks about this research states that a solution like the one given to the brains of the dead pigs, can possibly even help resuscitate patients in the future, which she thinks can be a possible standard medical practice. This discovery can create the biggest advancement for human life, as it can reduce the number of brain-dead patients.

References

Kolata, G. (2019, April 17). 'Partly Alive': Scientists Revive Cells in Brains From Dead Pigs. Retrieved from https://www.nytimes.com/2019/04/17/science/brain-dead-pigs.html?searchResultPosition=42

Powell, T. (n.d.). Brain Death: What Health Professionals Should Know. Retrieved from https://www.dropbox.com/sh/yrruoccwcc8fc6i/AADV3iapxtsrrO019ar7ZD3oa/(04.02.19) - Joe Vukov?dl=0&preview=Powell_Brain_Death.pdf&subfolder_nav_tracking=1

Resurrecting the Dead

On April 2, 2019, Dr. Joseph Vukov spoke at Loyola University Chicago to discuss death. There are two legal definitions of death: the permanent arrest of circulatory and respiratory functions, or the irreversible halting of brain and brainstem functions. Either one of these is sufficient to declare someone dead. For brain death, it was previously required to have two brain scans done within hours of each other to constitute death. However, starting in 2010, the revised law requires only one scan to qualify for brain death. The difference between cardiac and brain death is that while a person that qualifies for the respiratory definition of death visibly looks dead, a brain-dead individual may not look obviously dead. Because of this, it is not a topic of debate to determine death by cardiac function termination. However, with brain dead patients, if they are on a ventilator, they can look as if they are simply asleep. They are visibly breathing, as can be seen through chest movements, are warm to the touch, and oftentimes look healthy. Therefore, to the families of the victim, and even sometimes the healthcare professionals, they do not immediately identify this as something that constitutes as death. However, brain death is not like a coma or persistent vegetative state; in a vegetative state, a patient does not require a ventilator to breathe. A brain-dead patient cannot breathe on their own, and this is completely irreversible — at least, for now.

New data and current research are underway that may completely change how the world views brain death. According to Medical News Today, a company based in Philadelphia named Bioquark has received approval to head experimental trials to attempt to revive brain-dead individuals. They will be recruiting twenty people who have died from traumatic brain injury and are kept on cardiopulmonary and trophic support. Interestingly, the participants must be unwilling for organ donation, meaning that the participants will not be affecting the organ donor population.

The Bioquark CEO, Ira Pastor, has stated that they will be using patient adult stem cells along with other materials to attempt a “combinatorial” approach in which they use four different techniques and drug approaches to grow connections between new neurons. They hope to bring a brain-dead individual back into a comatose state. Pastor hopes that “with the tools of 21st century regenerative medicine, that there are possibilities to push that transition [from a coma to an irreversible coma] in the opposite direction to save lives… we hope the trial will answer certain 'deeper' issues about the human mind.”

The crux of Dr. Vukov’s seminar is that there is a lack of education around the irreversibility of brain death. He spoke about how the conversation must change so that families and loved ones of victims of brain death understand that “pulling the plug” on a brain-dead individual does not terminate all efforts and hope for the individual to recover because there is no chance at recovery; in other words, the person is already dead. If this becomes a more widespread understanding, Dr. Vukov argues, the healthcare system will be able to benefit from the viable organ donor population within the brain-dead populace while still respecting the victim and their families. However, what Bioquark is attempting, if achieved, will break down Dr. Vukov’s argument, and the medical field will have to start anew in terms of treating the brain dead.

Bioquark has received ample backlash and criticism for both what they have attempted and their methods. Some have pointed out that their method has no biological basis and is unethical and immoral; critics believe that this will only stream false hope for recovery for the families of the participants. This argument plays back into what Dr. Vukov described as part of the ethical issue of brain-dead individuals; talking about “pulling the plug,” or letting these individuals stay on a ventilator, give a sense of false hope to their families and loved ones.

However, what Bioquark is proposing is slightly different. Pastor clearly acknowledges brain death as a permanent state that is irreversible, at least with today’s technology. Furthermore, others are not as quick to completely dismiss the project. Opinions on Bioquark’s experimental trials have gained slightly more optimism after thirty-two pig brains regained cellular functions after hours of being dead. These experiments, done by researchers at Yale University School of Medicine this year, have begun to change the field of neuroscience and may break down the current definitions of death.

Overall, even though Dr. Vukov’s seminar discussed a critical issue in healthcare, recent developments in science seem to break down all current concepts and knowledge surrounding brain death. While the revival of pig brain neural activity is a far cry from bringing someone dead back to life, this experiment, along with Bioquark’s mission, show that human knowledge surrounding death is nowhere near complete. Although death, on the surface, seems very black-and-white, we are slowly discovering the gray areas to it. Even so, Dr Vukov, along with critics of Bioquark’s experiment, are correct in that venturing into gray areas will only seek to provide hope that currently has no real end and may or may not be accomplished in the future. It is still crucial to properly educate people on the current circumstances of brain-dead patients, and until real evidence is shown to revive these patients, there must be a continued focus on empathizing with the living.

References:

Greshko, Michael. “Pig Brains Partially Revived Hours after Death-What It Means for People.” National Geographic, 17 Apr. 2019, www.nationalgeographic.com/science/2019/04/pig-brains-partially-revived-what-it-means-for-medicine-death-ethics/.

Powell, T. “Brain Death: What Health Professionals Should Know.” American Journal of Critical Care, vol. 23, no. 3, 2014, pp. 263–266., doi:10.4037/ajcc2014721.

Vukov, Joseph. Loyola University Chicago Neuroscience Seminar. 2 April. 2019, Chicago, Loyola University Chicago.

Whiteman, Honor. “Reversing Brain Death: Far-Fetched or Feasible?” Medical News Today, MediLexicon International, 18 Aug. 2017, www.medicalnewstoday.com/articles/319035.php.

Real Life Resurrection: Overcoming Brain Death?

Scientific American posted an article in June 2017 titled “Resurrected: A Controversial Trial to Bring the Dead Back to Life” discussing the current research to reverse brain death. A research company, Bioquark, located in Philadelphia, aims to use injected stem cells and a protein blend along with electrical nerve stimulation and brain laser therapy in order to grow new neurons with new synaptic connections, thereby reversing brain death. Researchers will analyze behavior and EEG for signs that the treatment is successful (Sheridan). In his presentation, Dr. Vukov explained that brain death is diagnosed using EEG and monitoring pupil dilations. Physicians have found that only a single test, in contrast from the two tests performed pre-2010, is sufficient for diagnosis (Powell). Trials of this four part treatment have not yet been conducted on animal models, only single treatments for other conditions such as stroke or coma (Sheridan).

This controversial study originally launched in Rudrapur, India, and in April 2016 was shut down due to lack of Drug Controller General approval. Bioquark is now planning conduct trials in Latin America. Neurologist, Dr. Ariane Lewis wrote an article in response to this initial study launch. Lewis calls this study out for having “no scientific foundation” and argues it gives families “a cruel false hope of recovery” (Lewis). Lewis brings up very valid ethical issues, which this study is rich with. Sheridan adds that if patients do regain brain activity, what would they be capable of? Additionally, trial paperwork becomes an issue since participants are legally dead (Sheridan). Another ethical issue related to this study involves the future of organ transplants. Dr. Vukov touched on the “Dead Donor Rule” regarding organ transplant. Legally in the US, brain death is synonymous with death and many of the organs transplanted in the US are harvested from brain dead patients. If long-term recovery becomes a possibility due to the technological advancements in this study, an important question arises: What is to come of organ transplant? Theoretically, if techniques in this study prove successful, traditional organ transplant must be abandoned.

Brain death is very distinct from other disorders of consciousness, despite common confusion of the terminology. A coma is defined as lacking both arousal, manifested by spontaneous eye opening, and awareness, assessed by looking for responses (Powell). Coma is just one of the many disorders of consciousness that Vukov described throughout his presentation. Brain death, on the other hand, is very unique and specific. To be diagnosed brain dead, patients must exhibit three specific criteria: the patient is in a demonstrably irreversible coma, there is a complete absence of brainstem function and, absence of spontaneous respiration. The Scientific American article goes on to state that the technique Bioquark is developing has a very slim chance of working. An orthopedic surgeon interviewed for this article explained that this technique “relies on there being a functional brain stem... If there’s no functional brain stem, then it can’t work” (Sheridan). In order to be diagnosed as brain dead, a physician must be certain that the brain stem is nonfunctional. Despite the obstacles Bioquark faces, this article sparks imagination in an often confused area of science.

References:

Lewis, Ariane, and Arthur Caplan. “Response to a Trial on Reversal of Death by Neurologic Criteria.”Critical Care (London, England), BioMed Central, 22 Nov. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5118884/.

Powell, Tia. “Brain Death: What Health Professionals Should Know” American Journal of Critical Care, 7 April 2018, https://www.dropbox.com/sh/yrruoccwcc8fc6i/AADV3iapxtsrrO019ar7ZD3oa/(04.02.19)%20-%20Joe%20Vukov?dl=0&preview=Powell_Brain_Death.pdf&subfolder_nav_tracking=1.

Sheridan, Kate. “Resurrected: A Controversial Trial to Bring the Dead Back to Life.” Scientific American, 1 June 2017, www.scientificamerican.com/article/resurrected-a-controversial-trial-  

to-bring-the-dead-back-to-life/.

Does Circadian Rhythm Research Support the Idea of Later Starting Times for School

On April 16, 2019, Dr. Cavanaugh was a guest speaker for Dr. Robert Morrison's NEUR 300 001 course at Loyola University Chicago. His talk was titled "Using Flies to Understand the Circadian Disruption." His research agrees with some of the points made by Professor Anne Skeldon and Professor Der-Jan Dajk at University of Surrey. Skeldon and Dajk discuss the ineffectiveness of implementing a permanent daylight savings time to allow students to begin school later.

Before discussing daylight saving and changing our clocks, it is important to understand the biological clock. Circadian disruption occurs when the biological clock of a species is altered. How this biological clock, known as the circadian rhythm, works has baffled scientists for decades. The circadian rhythm suggests that there are certain rhythms of the body that are regulated like clockwork throughout the day. These rhythms include body temperature, hormone release (specifically cortisol and melatonin), reaction times, alertness, metabolism, muscle strength, and sleep. Scientists believe this is the work of two proteins in the brain, TIM and PER. The production and degradation of these proteins roughly takes (unsurprisingly) 24 hours and likely is an evolutionary trait.

Dr. Cavanaugh's work with fruit flies revealed two interesting observations: 1. a reduction in life span in fruit flies when their circadian rhythm was disrupted and 2. circadian rhythms don't seem to be significantly affected by the environment such as light. Mutations of the TIM and PER proteins (as induced in Dr. Cavanaugh's experiment in fruit flies) and intentional disruption seem to be the largest causes of circadian disruption. Examples of intentional disruption for humans would be social jet lag, shift working, and traveling. Social jet lag occurs when (usually the younger population) has a regular sleep schedule during the week and ignores that schedule during weekends by going out with friends, studying late, drinking, etc. In other words, the Monday blues is a real biological process of circadian disruption. Dr. Cavanaugh's work revealed that a 4 hour difference in circadian rhythms can cause a disruption. In humans, the consequences of chronic disruption is an increase risk for certain diseases such as diabetes, heart disease, cancer, and shortened life spans.

Now, the article of Skeldon and Dajk claims two reasons that permanent daylight savings would not benefit students if schools had delayed starting times. One, later starting times will result in students staying awake later at night. As mentioned above, this is known as social jet lag. Social jet lag greatly impairs cognitive function  and alertness that is needed throughout the school day. Research has shown that students that suffer from social jet lag suffer from GPA lowering. Another permanent daylight saving issue is that our biological processes will not adapt to the changes. As we saw from Dr. Cavanaugh's research, starting school or other processes later in the day will not change the bodies natural tendencies to release various hormones at specific times. As Skeldon and Dajk write in their article, waking up later for school will have the same amount of difficulty for students as current timing. Biologically, this is because of the hormone release of cortisol.

As mentioned in Skeldon and Dajk's article, the idea behind circadian rhythms is very complicated and not well understood. But as we can see from Dr. Cavanaugh's data, until we understand the mechanism more, it is important not to mess with. With what we know about circadian disruption, changing school starting times would have very limiting benefits and more consequences. If any students are reading this, the most important piece of information to take away from this research is that it is crucial to our academic success to listen to our bodies signals and sleep schedules.

References

Anne C. Skeldon, Derk-Jan Dijk. School start times and daylight saving time confuse California lawmakers. Current Biology, 2019; 29 (8): R278 DOI: 10.1016/j.cub.2019.03.014 

Cavanaugh, D. (2019). NEUR 300: Using Flies to Understand the Circadian Disruption. [lecture notes]

University of Surrey. (2019, April 22). Debate on daylight saving time and school start time. ScienceDaily. Retrieved April 27, 2019 from www.sciencedaily.com/releases/2019/04/190422112809.htm

Blue-Light Exposure: The Detriment to Sleep and Circadian Rhythms

Most of the metabolic and behavioral processes in many organisms follow daily 24-hour oscillations known as circadian rhythms. The word “circadian” is derived from latin, with “circa” meaning around, and “diem” meaning day, translating to “circadian” in english. Out of the organisms that follow these circadian rhythms, some are diurnal, like humans, and others are nocturnal, like owls. In either case however, we see that circadian rhythms are entrained into these organisms by environmental cues that are crucial in also maintaining their circadian rhythms. Thus, for most organisms, maintaining their respective circadian rhythms is vital in keeping homeostasis in processes such as rest/activity, feeding behaviors, and metabolic processes.

In Dr. Cavanaugh’s talk, he described how maintaining circadian rhythms is crucial to the organism’s maintenance of crucial metabolic processes and overall organism homeostasis. Dr. Cavanaugh’s work shows how inconsistent circadian rhythms and things like night shift work and jetlag can have adverse effects on humans. Inconsistencies in circadian rhythms result from chronic circadian misalignment (CCM), which leads to “profound metabolic and cognitive consequences,” however the underlying mechanisms responsible for the effects of chronic circadian misalignment is unknown (Boomgarden et al., 2019). Through Dr. Cavanaugh’s findings, we see the adverse results of chronic circadian misalignment on the homeostatic processes of Drosophila melanogaster (fruit fly), and the underlying molecular mechanisms responsible for these results.

One of Dr. Cavanaugh’s major findings was that “exposing flies to CCM leads to a ~15% reduction in lifespan in both male and female flies” (Boomgarden et al., 2019). These are very profound results because they show a direct correlation between inconsistent circadian rhythms and the reduction of the organism’s lifespan. One aspect of this result that I found to be very reassuring was that he showed this to be the case with both male and female flies, showing a consistency between both sexes. Often times, researchers leave out female organisms because of their constant change in homeostasis due to their hormonal cycles which aren’t present in males, which can often make finding consistent results difficult because of this hormonal variance. However, Dr. Cavanaugh’s work shows thorough results that are consistent between both sexes, which is significant. In addition to this, Dr. Cavanaugh used “whole body RNA-sequencing to assess differences in gene transcription between control and misaligned flies”. Through this technique Dr. Cavanaugh is able to analyze the molecular mechanisms that are responsible for the physiological effects of CCM. Through this RNA-sequencing technique, Dr. Cavanaugh found that CCM on fruit flies led to “large-scale changes in gene expression” (Boomgarden et al., 2019). He found this change in gene expression to be comprised of an “upregulation of genes involved in response to toxic substances, aging and oxidative stress” along with a “downregulation of genes involved in regulation of development and differentiation, gene expression and biosynthesis” (Boomgarden et al., 2019). Thus, from his work, Dr. Cavanaugh concluded that the upregulation of those genes involved with aging, oxidative stress, and toxic substances was a result of CCM, which lead to “premature organismal decline”. He also concluded that “genes involved in lipid metabolism are overrepresented among those that are differentially regulated by CCM and aging”. This finding shows that out of all of the molecular mechanisms believed to be mediators in this process, Dr. Cavanaugh found altered lipid metabolism as a “potentially important mediator of the negative health consequences of CCM” (Boomgarden et al., 2019).

Thus, we see that maintaining regular circadian rhythms is crucial to maintaining homeostasis and having longevity. While shift work and jet lag are obvious detriments to circadian rhythms that result in CCM, the silent killer of circadian rhythms that most are unaware of is blue light exposure. In an article by Dr. Michael J. Breus in The Sleep Doctor, the effects of blue light exposure on sleep are made apparent. Dr. Breus discusses how scientific studies have shown that blue light is a type of light that is detrimental to sleep. This article talks about how this occurs as an effect of blue-light’s effect of melatonin suppression, and how it suppresses melatonin two-fold compared to the other wavelengths of light. As a result of this double suppression of melatonin it was shown that circadian rhythms were varied two-fold as well. This suppression of the circadian rhythms “can have a significant effect on health, creating problems with the cardiovascular, metabolic, and immune systems, disturbing mood, and compromising cognitive function” (Breus, 2019).  

Dr. Breus then discusses how new a growing problem of blue light exposure on young adults has been brought to attention from new research. In the study, it was found that otherwise healthy young adults who were exposed to blue light from the interval of 9-11pm were found to display shortened net sleep duration, “significantly suppressed melatonin production, and diminished sleep quality” characterized with more significantly increased awakenings. In addition to this, it was found that blue light prevented the drop in body temperature, which is a “key element of the body’s progression into sleep” (Breus, 2019).

This same study observed the effects of of red light, on the opposite side of the spectrum to blue light, and observed that “red light exposure during the same two-hour evening time period did not interfere with sleep and circadian biology”. Thus Dr. Breus shows that using warmer, redder lights are favorable for sleep and circadian maintenance, while blue light exposure preceding sleep is detrimental to sleep and circadian rhythms, and result in CCM (Breus, 2019). He suggests, however, that blue light has its time and place, and that blue/cool light is beneficial for increased productivity and reaction time, and thus is good to intake in the mornings and afternoon. On the other hand, red/warm lights are more beneficial in the late evening until bedtime, as they promote relaxation and melatonin production.

All in all, going into finals week, I encourage everyone to take the extra steps to avoid blue light exposure preceding and during sleep by activating the night-shift feature for Apple users, and turning your device face-down while sleeping to ensure quality of sleep and a healthy circadian rhythm and prevent chronic circadian misalignment.

Sources:

Boomgarden, A. C., Sagewalker, G. D., Shah, A. C., Haider, S. D., Patel, P., Wheeler, H. E.,...

Cavanaugh, D. J. (2019). Chronic circadian misalignment results in reduced longevity

and large-scale changes in gene expression in Drosophila. BMC Genomics, 20(1).

doi:10.1186/s12864-018-5401-7

Breus, Michael J. “The Latest on Blue Light and Sleep.” Your Guide to Better Sleep, TheSleepDoctor, 22 Jan. 2019, thesleepdoctor.com/2017/11/06/latest-blue-light-sleep/.

Distinguishing, Defining, and Defending the definition of brain death

This semester we heard a talk by Dr. Joe Vukov. During his talk he discussed brain death and much of the conversation surrounding the topic. Dr. Vukov took time to clarify the difference between brain death, coma, and being in a vegetative state. Brain death includes 3 essential findings: coma, loss of brain stem reflexes, and apnoea. In addition, it occurs when a person has irreversible, traumatic brain injury that results in the cessation of all brain function. Dr. Vukov emphasized the irreversibility of brain death. People who suffer brain death cannot breathe on their own and they will not recover from their injury. A person who suffers brain death is deceased. This can be often hard for family and friends of loved ones with brain death to process because the person (while on the ventilator) typically looks like themselves. In addition, Dr. Vukov mentioned that many of the accidents that result in brain death (car crashes, motorcycle and bike accidents, and other trauma) often occur in younger people. The age of the victim can make their death even more impossible for the family to process. 

Many confuse the terms coma and vegetative state with brain death. According to Dr. Vukov, a coma is a state of deep and prolonged unconsciousness as a result of injury or illness. In the article "Understanding brain death vs. states of consciousness" the author iterates the difference between a coma, vegetative state, and brain death. Patients in a coma are "alive, but in a state of eyes-closed, depressed consciousness from which they cannot be aroused." unlike brain death, coma patients have brain stem responses, spontaneous breathing and/or non purposeful motor responses. In addition, coma patients have the possible outcome of "progression to brain death, recovery of consciousness, or evolution to a state of chronically depressed consciousness." Patients in a vegetative state are alive, but have severely limited and/or impaired consciousness. 

Although, brain death has been distinguished from coma and vegetative state, it continues to be an area of confusion for many people. Dr. Vukov mentioned that some of the confusion arises from the legal definition and categorization of brain death. One of the most confusing of these cases is the story of Jahi McMath. Jahi McMath and her family have been at the center of a debate on brain death since 2013. McMath was declared brain dead in December 2013 when she was 13 years old. However, her mother refused to believe this. For this reason, her mother moved her to New Jersey, a state that accommodates religions that do not recognize brain death, so that she could remain on life support. This case sparked the debate on ethics of religious refusal surrounding brain death. Dr. Vukov discussed this during his talk. Regardless of New Jersey’s legislation or religious beliefs, brain death is still medically considered death. Dr. Vukov explored this by reiterating the medical implications of brain death. Brain death is death. Hopefully, brain death will continue to be more widely understood. 

“Mother: Girl at Center of Debate Over Brain Death Dies.” U.S. News & World Report, U.S. News & World Report, www.usnews.com/news/us/articles/2018-06-28/girl-at-center-of-debate-over-brain-death-dies-after-surgery. 

Szabo, Liz. “Understanding Brain Death vs. States of Consciousness.” USA Today, Gannett Satellite Information Network, 10 Jan. 2014, www.usatoday.com/story/news/nation/2014/01/09/brain-death-states-of-consciousness/4397515/.

Dr. Vukov talk 4/02/2019

To Know or To Think You Know

To know or to think you know: Examining insight and neurological processing in the brain

According to the American Mathematics Association (AMS) “The volume of a typical human brain is 1400 cm^3 and its weight is about 1000 times that of a typical rat's brain. Mundane facts about brain data do little to give us insight into this amazing organ.” From this vast organ, Kara D.Federmeier discusses “the activation of the right temporal lobe? is seen and analyzed through neural correlations.” The dilation of the pupil may be used as a reference, and as the pupil dilates, it is found that an insight is obtained, and the subject’s perception is changed. It is found in research conducted by Yale University that the “alpha sights affect over the visual cortex which usually occurs during a relaxing phase.” Before getting an insight, the brain blocks all visual distractions, or whatever the brain perceives to be distractions. All the best ideas may come to a person in the shower or in bed, this is because the brain excludes all visual distractions in order to obtain a coherent solution. According to the study, “in order to obtain a solution, we avert our gaze to find a solution which is the “offline mode;” an imaginative phrase which depends on more abstract problem solving.” Hence, the visual cortex is significantly more activated when an individual is looking for an analysis in contrast to placidly listening to the joke or statement. This is correlated to an insight because of the physical change in demeanor of the subject. The brain houses almost 100 times more visual neurons in the visual cortex than any other area in the brain; which is why the neural mechanisms involved in insight can be depicted in adolescents that may have difficulty in mathematics. 

Contrary to what people may believe, having insight is not an all-or-nothing process. Rather, it is a process which involves more trial and error as opposed to the “all or nothing” approach most people think it is. Insight occurs in human learning when people recognize relationships between objects or actions that can help them solve new problems. During her talk at Loyola University, Jelena Radulovic discussed how an individual is more likely to make a mistake in the last five minutes of an exam because they are unlikely to have a moment of insight. This is shown through electroencephalography (EEG) scans or positron emission tomography (PET) scans which depict the change in brain activities in students. The change in brain activity occurs because as the time for an exam concludes, the hypothalamic region of the brain is being used more in contrast to the informational processing area of the brain, the cerebral cortex. In regard to test mistakes, since the hypothalamic region is in control of releasing hormones, this may disrupt information processing as the corticotropin-releasing hormone (CRH) is involved in the body's response to both physical and emotional stress. It signals the pituitary gland to produce a hormone called adrenocorticotropic hormone (ACTH). ACTH triggers the production of cortisol, an important stress hormone. This stress hormone may result in careless mistakes on exams. 

The results from Dr. Rudovic’s experiment also found that an individual show more progress and better results qualitatively on their exam when shown a question or an object to their left side. Therefore, the right hemisphere was more active. Dr.Radulovic focused on the crossing between the hemispheres, i.e. the left being interpreted by the right and vice versa. Seeing the problem in the left visual hemisphere allows the information to get processed by the right hemisphere in the brain. However, the time calculated was faster when shown in the right side when completing the problem. In Dr. Radulovic’s article, “Differential contributions of glutamatergic hippocampal- retrosplenial cortical projections to the formation and persistence of content memories”, she states “the subjects examined the solution in 15 seconds and then pressed a button to indicate an insight.” The right internal lobe is the key region in processing sensory information which can facilitate problem-solving (i.e., insight) which is seen through analyzing the difference in resting potential in the Functional magnetic resonance imaging (FMRI).        

            Having this moment of insight is very difficult for individuals with a Specific Learning Difficulty (SLD) which according to the DSM-5, is common in children and may have numerous consequences in both an individual’s personal and professional life. Evidence and research from a study conducted from the American Mathematical Society (AMS)  shows that SLD is associated with impairments in the intraparietal sulcus (IPS) which is involved in insight development as well. Although, SLD develops due to genetic mutations, and the role of the mutations in SLD is still unclear; SLD may be related to a lack of obtaining valid insight. SLD might be related to a lack of obtaining insight because core numerical abilities are affected. It may be so that a lack of  numerical abilities may lead one to obtain an insight at a lower threshold which is why SLD may be related to a lack of obtaining insight. The IPS is also involved in several non-numerical processes which may contribute to math skills such as pointing, grasping, and object manipulation. Therefore, the processing state and understanding state are seen as two different stages. The processing state is the time when an individual attempt to logically reason through a scenario (in this case solving the problem) and the understanding state is when the problem has registered in the brain and is fully comprehended. In research experiments conducted by AMS and Jelena Radulovic, the processing state was studied through rewards. The students with SLD solved more problems when the monetary value was stopped. According to impaired neural processing of transitive relations in children with math learning difficulty, males are more confident on their solution. The study measured moments of insight with either confidence level through physical persona or questions answered correctly. Thus, confidence was not necessarily correlated with insight unless the answer selected was correct. However, females have a higher success rate. When asked a series of questions, one was provided with a reward for answering the question correctly. It was shown again, that the males had an insight earlier than the females and were more confident in their answers. However, as the females took longer and did not obtain a direct insight their responses were more accurate and precise. This was similar to Dr.Rudulovic’s findings as the consistency in answering questions was also gender based. However, contradict the above finding that people make more mistakes in the last five minutes of testing because they are less likely to use insight. In conclusion, having this moment of insight is very difficult for individuals with Specific Learning Difficulty due to the impairments in the IPS. With respect to confidence levels of an individual when asked to solve problems, one must factor their confidence and it was found that confidence is only correlated to insight if the answer is correct. 

            One can conclude that different parts of the brain are used during cognitive tasks and when achieving an insight. Both math and insights utilize the right hemispheres and due to academic research scientists now argue that they are two different mechanisms. From both Dr. Radulovic’s paper and the study published by the American Mathematical Association finding the balance between obtaining an insight and rational problem solving is difficult to achieve. Thus, further research is needed to fully explain the true meaning of insight and what brain activity looks like when obtaining an insight.

Sources: 

1. “Alpha Wave.” Alpha Wave - an Overview | ScienceDirect Topics, www.sciencedirect.com/topics/neuroscience/alpha-wave.

2. “American Mathematical Society.” AMS, www.ams.org/publicoutreach/feature-column/fcarc-brain.

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