“ Spindles happen normally during sleep and they’ re showing some level of organization in the brain, suggesting circuits between the thalamus and cortex needed for consciousness are intact.”
Issue 34.2 SPRING 2025 can hear and understand their physicians’ instructions( to open and close their hand, for example) even though the patients do not physically respond.
But the techniques can be difficult to implement and can yield false-negative results.
Claassen decided to focus on sleep, as brain circuits that are fundamental for consciousness, including cognitive motor dissociation, are also critical to control sleep.
“ I’ m always thinking about how my work can be best implemented and used in the real world, and looking at sleep made sense practically and scientifically. Sleep brain waves are easy to record and do not require intervention from the care team.”
Jan Claassen, associate professor of neurology, Columbia University Vagelos College of Physicians and Surgeons
Sleep spindles predict recovery In the new study, the researchers looked through EEG recordings of overnight brain activity in 226 comatose patients who also underwent the more complex testing for cognitive motor dissociation.
“ The electrical activity during sleep looks relatively chaotic, and then occasionally in some patients, these very organized, fast frequencies appear,” Claassen says.
These bursts-called sleep spindles-often preceded the detection of cognitive motor dissociation with the more complex method, the return of consciousness, and longterm recovery.
“ Spindles happen normally during sleep and they’ re showing some level of organization in the brain, suggesting circuits between the thalamus and cortex needed for consciousness are intact.”
About one-third of patients had well-defined sleep spindles, including about half of patients with cognitive motor dissociation.
Patients with sleep spindles and cognitive motor dissociation were more likely to recover consciousness and functional independence. Among those with sleep spindles and cognitive motor dissociation, 76 % of patients showed evidence of consciousness by the time they were discharged from the hospital. A year later, 41 % of these patients had recovered neurological function, with either minor deficits or a moderate disability, and were able to care for themselves during the day. Only 29 % of patients with neither sleep spindles nor cognitive motor dissociation showed signs of consciousness by the time they were discharged and just 7 % regained neurological function a year later.
Even though these findings don’ t prove that inducing sleep spindles would translate to better outcomes, they raise the possibility that improving a patient’ s sleep-possibly by changing their environment-may promote their recovery.“ If you think about the ICU environment, it is rather disruptive for a good night’ s sleep. There is noise everywhere, alarms going off, clinicians touching them, 24 / 7. This is all for a good reason, but it’ s hard to sleep in that environment,” Claassen says.
Moving toward clinical practice Claassen cautions that the findings only apply to patients with recent injuries, not those with long-term disorders of consciousness. For most patients in the current study, normal sleep spindles appeared within days of the initial injury.
And the predictors were not perfect: 19 of 139 patients who did not show sleep spindles or signs of cognitive motor dissociation did recover consciousness. Other data will likely be needed to make more accurate predictions.
“ I see these spindles as a way to direct more sophisticated testing to the patients most likely to benefit,” Claassen says.“ The techniques are not ready for use in clinical practice yet, but this is something that we’ re actively working on right now.” g
“ Spindles happen normally during sleep and they’ re showing some level of organization in the brain, suggesting circuits between the thalamus and cortex needed for consciousness are intact.”
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