Will he, or she, wake up one day? In which state? All families facing the coma of a loved one ask themselves the same questions. And for the moment they all get the same non-answer. “Unfortunately, today, in the acute phase of resuscitation, it is very difficult to visualize and know which patients have a significant chance of waking up and which have irreversible effects,” explains resuscitation doctor Benjamin Sarton of the University of Toulouse. Hospital.
The inability to predict the outcome fueled real “family tragedies”, sometimes false hopes. For caregivers, it also blurs the limits of therapeutic continuity.
“Therapeutic Nihilism”
Adding to this uncertainty in prognosis is “certain therapeutic nihilism,” says Professor Stein Silva, also an intensivist at Pink City University Hospital. “We do a lot of things to protect the brain from potential secondary cerebral attacks, to prevent further damage. But we don’t have a drug or an action that, strictly speaking, allows us to make our patients progress,” Benjamin Sarton recognizes.
The procedure is often limited to preserving their vital functions so that they can leave the intensive care unit for a recovery center. Not really treating them because, the expert underlines, “coma hides many underlying mechanisms that are still misunderstood”.
But there is one less since ToNIC*, the research laboratory of two resuscitators, published its latest findings in a prestigious neurological journal. the brain. A team led by Steen Silva revealed “for the first time” that comatose patients showed “significantly” inflamed areas in their brains.
The study, which lasted four years, involved 17 patients treated in deep coma by different departments of a university hospital: 11 of them were head trauma patients, whose brains were damaged by an accident or fall. ; Another six suffered anoxia, their brains deprived of oxygen following mostly cardiac arrest.
Using innovative imaging methods, a “very recent biotracer”, the researchers targeted specific inflammatory cells in the brains of these patients. “When we compare the brains of coma patients with the brains of healthy patients, we see that the former have much higher levels of inflammation,” explains Benjamin Sarton. And quite interestingly, we see that these swollen regions concern specific regions that we know are fundamental in the emergence and maintenance of the conscious state.
Furthermore, shock patients and anoxic patients do not have swelling in the same areas.
Those who have a chance, those who don’t
Finally, if the researchers don’t know at this stage whether this inflammation reflects injury or a protective process of the brain, the length of the study allows them to say that “patients who have high levels of inflammation, unfortunately, are the ones who have the worst prognosis. Those who don’t wake up or wake up with the most after-effects.”
So the first open perspective is that with these “simple” scanners, we can scientifically tell, “whether the patient is part of the category of people who are likely to wake up, and thus better guide families through this ordeal.” » , assures the resuscitator. Indeed, by answering critical questions. and by focusing on the idea of not passively caring for comatose patients but rather carrying out “brain repair”. “Because by identifying and localizing these levels of inflammation for the first time we can potentially consider therapeutic targets,” assures Benjamin Sarton.
* Toulouse Neuroimaging Center (Toulouse University Hospital, Toulouse 3 University, Inserm)
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