2024-03-06 07:33:28
Will he, or will she, wake up one day? In which state ? All families faced with a loved one’s coma ask themselves the same questions. And for the moment they all get the same non-answers. “Unfortunately, today, it is very difficult to imagine and know, in the acute phase of resuscitation, which patients have a significant chance of waking up and which ones will have irreversible after-effects,” explains Benjamine Sarton, resuscitation doctor at Toulouse University Hospital.
This inability to predict the outcome fuels real “family tragedies”, sometimes false hopes. For caregivers, it also blurs the limits of therapeutic relentlessness.
“Therapeutic nihilism”
Added to this uncertainty in the prognosis is what Professor Stein Silva, also an intensivist at the Pink City University Hospital, calls “a certain therapeutic nihilism”. “We do a lot of things to protect the brain from possible secondary cerebral attacks, to prevent it from becoming further damaged. But we have no medication or any action that strictly speaking allows us to help our patients progress,” recognizes Benjamine Sarton.
The procedure is often limited to maintaining their vital functions so that they can leave the intensive care unit for a recovery center. Not to really treat them because, underlines the specialist, “coma conceals many underlying mechanisms that are still misunderstood”.
But there is one less since ToNIC*, the research laboratory of the two resuscitators, published its latest discovery in the prestigious neurological journal Brain. The team led by Stein Silva revealed, “for the first time”, that the brains of comatose patients present “significantly” inflamed areas.
The study, which lasted four years, involved 17 patients treated in a deep coma by the various departments of the University Hospital: 11 of them were head trauma patients, whose brains were damaged in an accident or fall. ; the other six were victims of anoxia, their brains were deprived of oxygen most often following a cardiac arrest.
Using innovative imaging methods, “a very recent biotracer”, the researchers targeted certain cells of inflammation in the brains of these patients. “When we compare the brains of coma patients to the brains of healthy patients, we see that the former have very high levels of inflammation,” explains Benjamine Sarton. And quite interestingly, we see that these inflamed regions concern specific regions that we know to be fundamental in the emergence and maintenance of a conscious state.
Furthermore, the same areas are not inflamed in traumatic patients and anoxic patients.
Those who have chances, those who don’t
Finally, if the researchers do not know at this stage whether these inflammations reflect injuries or a brain defense process, the length of the study allows them to say “that the patients who have the highest level of inflammation, are unfortunately those who have the worst prognosis, who do not wake up or wake up with the most after-effects.”
Comparison of inflamed areas in a patient in an anoxic coma (left), in a patient in traumatic coma and in a healthy patient (right). -ToNIC
The first open perspective is therefore that with these “simple” scanners, we can scientifically say, “whether the patient is part of the category of those who are likely to wake up or not, and thus better guide families through this ordeal.” », assures the resuscitator. By answering, really, the crucial questions. And with the focus on the idea of no longer passively taking care of comatose patients but of carrying out “brain repair”. “Because identifying and localizing these levels of inflammation for the first time allows us to possibly consider therapeutic targets,” assures Benjamine Sarton.
* Toulouse NeuroImaging Center (Toulouse University Hospital, Toulouse 3 University, Inserm)
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