Link found between your brain and your consciousness

Human consciousness is a topic philosophers have long struggled to define.
 
Now, a team of researchers led by neurologists at Beth Israel Deaconess Medical Center (BIDMC) has pinpointed the regions of the brain that may play a role maintaining it.

"For the first time, we have found a connection between the brainstem region involved in arousal and regions involved in awareness, two prerequisites for consciousness," said researcher Michael D. Fox. "A lot of pieces of evidence all came together to point to this network playing a role in human consciousness."

Classical neurology holds that arousal and awareness are two critical components of consciousness. Arousal is likely regulated by the brain stem - the portion of the brain, contiguous with the spinal cord, that is responsible for the sleep/wake cycle and cardiac and respiratory rates. Awareness, another critical component of consciousness, has long been thought to reside somewhere in the cortex, the outer layer of the brain responsible for many of its higher functions.

The researchers analyzed 36 patients with brain stem lesions, of which 12 led to coma and 24 did not. Mapping the injuries revealed that a small "coma-specific" area of the brain stem - the rostral dorsolateral pontine tegmentum - was significantly associated with coma. Ten out of the 12 coma-inducing brain stem lesions involved this area, while just one of the 24 control lesions did.

Armed with that information, Fox and colleagues, including lead author David Fischer, MD, then a medical student at Harvard Medical School, used a wiring diagram of the healthy human brain - based on a large, shared data set called the Human Connectome - to identify which other parts of the brain were connected to these coma-causing lesions. Their analysis revealed two areas in the cortex of the brain that were significantly connected to the coma-specific region of the brainstem. One sat in the left, ventral, anterior insula (AI), the other in the pregenual anterior cingulate cortex (pACC). Both regions have been implicated previously in arousal and awareness.

"We now have a great map of how the brain is wired up in the Human Connectome," said Fox. "We can look at not just the location of lesions, but also their connectivity. Over the past year, researchers in my lab have used this approach to understand visual and auditory hallucinations, impaired speech, and movement disorders. A collaborative team of neuroscientists and physicians had the insight and unique expertise needed to apply this approach to consciousness."

The team included co-lead author, Aaron Boes and co-senior author, Joel Geerling.

Finally, the team investigated whether this brainstem-cortex network was functioning in another subset of patients with disorders of consciousness, including coma. Using a special type of MRI scan, the scientists found that their newly identified "consciousness network" was disrupted in patients with impaired consciousness. 

The findings - bolstered by data from rodent studies - suggest the network between the brain stem and these two cortical regions plays a role maintaining human consciousness.

"The added value of thinking about coma as a network disorder is it presents possible targets for therapy, such as using brain stimulation to augment recovery," Boes said.

A next step, Fox notes, may be to investigate other data sets in which patients lost consciousness to find out if the same, different or overlapping neural networks are involved.

"This is most relevant if we can use these networks as a target for brain stimulation for people with disorders of consciousness," said Fox. "If we zero in on the regions and network involved, can we someday wake someone up who is in a persistent vegetative state? That's the ultimate question."

The study, which already garnered multiple awards from the American Academy of Neurology, has been published in Neurology.

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MULTIPLE SCLEROSIS

Multiple Sclerosis may be incurable but early diagnosis helps manage the disease’s progress and assure the patient good quality of life.

Multiple Sclerosis (MS) is a disease of the brain and spinal 

cord marked by loss of balance, vision loss, weakness of limbs, 

and bladder dysfunction among other symptoms. However, it 

often goes undiagnosed, leading to delay in treatment. It 

affects women more than men. The disorder is commonly 

diagnosed between 20 and 40 years but can be seen at any 

age.

MS is caused by damage to the myelin sheath, the protective 

covering that surrounds nerve cells. Due to damage in the 

nerve layer, transmission of signals from the brain and spinal 

cord is affected.

Misconceptions

Due to certain myths and misconceptions, many people do 

not come out in the open to get themselves diagnosed and 

treated. Multiple Sclerosis is stereotypically believed to be a 

disease that is fatal, contagious, genetic, that can’t be treated, 

and that every patient ends up in a wheelchair.

According to research, most people with MS have a normal 

life expectancy and it is not contagious or infectious. As for 

the fear of ending up in a wheelchair, most MS patients do not 

require a wheelchair if diagnosed early. At the same time, the 

use of mobility devices is just a way of providing 

independence and relief from fatigue and other symptoms. 

The fear of MS being a genetic disease can easily be explained 

by the fact that, even though people with relatives who have 

MS have a slightly higher chance of getting it, there is no 

genetic certainty.

The last decade has seen the development of disease-

modifying therapies (DMTs) to treat MS. These therapies 

directly affect the underlying process in relapsing-remitting 

MS. The physician will determine the best DMT course 

depending upon various factors. An accurate diagnosis of 

multiple sclerosis is based on the combination of clinical 

features, cerebrospinal MR imaging, neuro-physiological and 

laboratory tests.

Therapy matters

MS may be a chronic debilitating disease but it can be 

managed with proper care. Alternative therapies such as 

physical therapy, speech therapy and occupational therapy 

help manage the symptoms.

While researchers are working to develop new treatments for 

different stages of MS, several other forms of treatments are 

being undertaken. The problem, though, is that these are 

untested and cannot be recommended safely. Take stem cell 

treatment, for example. It may be a reality in the future but 

is now used only for research. Even though technologically 

advanced, stem cell treatments pose the threat of 

uncontrollable growth in the stem cells leading to tumours.

Need for awareness

As a result these treatments may be said to take undue 

advantage of the patient’s desperation. Also what is needed is 

much higher awareness among patients about these 

treatments.

MS is largely incurable; but there are several ways of 

improving the patients’ life. In case of MS, the patients must 

avoid stress at any cost. Other factors that can worsen 

symptoms include over exposure to sun and steam baths. 

Increased body temperature can temporarily make the 

symptoms worse by causing the nerves affected by MS to 

function even more poorly.

Many patients with MS understand these arguments but still 

insist on going ahead with banned or non-viable procedures 

like “liberation therapy” and “stem cell therapy”. They can 

hardly be blamed as they fear ongoing loss of function and 

premature death.

Leading a healthy lifestyle and paying heed to the suggestions 

of experts is recommended. Health decisions should not be 

based on hope and desperation but should be rational and 

practical.

Symptoms

Muscular: Unable to balance, numbness or tingling or pain 

in any part of the body, unable to move arms/legs properly 

or coordinate movement,  muscular spasms, tremor or 

weakness in limbs.

Bowel and bladder: Constipation, inability to control 

bowels, difficulty urinating or frequent need/strong urge to 

urinate.

Eye: Uncontrollable rapid eye movement, double vision, 

discomfort, and vision loss.

Sexual: Decreased sexual drive, problem with erections, 

ejaculation or vaginal lubrication.