NEURAL BASES OF DISORDERS OF CONSCIOUSNESS
We are interested in the functional and structural bases of consciousness and its disorders. Specifically, we use magnetic resonance imaging (MRI) to study patients who are in a vegetative state (VS), or related disorders of consciousness such as the minimally conscious state, or coma, after suffering severe brain injury. Patients in a VS are awake but do not show any behavioural sign of awareness. Nevertheless recent fMRI studies have demonstrated that some of these patients may retain higher cognitive functioning than that they are able to show behaviourally. We combine diffusion weighted imaging and functional MRI to study how damage to specific regions of the brain can generate the particular patterns of impaired or preserved cognitive function each patient exhibits. Finally, we use tDCS to establish causal links between specific brain networks and awareness.
This line has received funding from MRC and BBSRC.
The diagnosis of VS patients is currently made solely on the basis of subjectively observed behaviour, with a known error rate of over 40%. We work to develop objective structural MRI markers that can be used in the clinical settings, with the final goal of reducing misdianosis in this population. In parallel, we aim to identify early prognostic biomakers that can assist the clinician when making important decisions about allocation of resources, and continuation (or otherwise) of medical care.
Mild traumatic brain injury (mTBI), often referred to as concussion, can result in long-term disability due to persistent headaches, imbalance, memory disturbance, and poor mental health, and ~30% of patients are not able to return to work or sport after 12 months.
We are leading/co-leading the MRI and cognition workstreams of mTBI-PREDICT, a long-term study that aims to identify the most accurate, reproducible and clinically practical biomarkers to better identify those at risk of long-term health issues after mTBI.
At the moment, there are not effective therapeutic options available for patients in a VS, regardless of the level of cognitive function each patient may retain. We are assessing the potential for a noninvasive form of electrical brain stimulation (i.e. transcranial direct current stimulation –tDCS) to provide VS patients with a degree of control over their external behaviour, which would give them a physical means of interacting with the world for the first time since their injuries. This line has been funded by the MRC (New Investigator Research Grant), the University of Birmingham and is now funded by the Wellington Hospital as part of the RAINDROP trial.