The case of a woman from the United Arab Emirates who regained consciousness after a 27-year coma-like state provoked by a brain injury has startled the world.
But it’s not quite right to say that she simply “woke up”, experts told AFP.
Munira Omar was 32 when, in 1991, she was injured in a traffic accident after picking up her son Omar from school in the city of Al-Ain.
She lost consciousness and didn’t regain it until May 2018.
Her son Omar — who is today 32 — was in the car but did not suffer serious injuries. “I always believed that my mother would get better,” he told AFP by phone.
Can we say she ‘woke up’?
Not if by that one means “the patient suddenly wakes up, as after a long sleep, as everyone does in the morning,” the German doctor who treated her, Friedemann Muller, told the magazine Der Spiegel.
Strictly speaking, the woman was not in a coma, but rather a state of “minimal consciousness.”
Even before she became more fully alert, she “was able to look at something for a short amount of time,” said Muller, chief physician at the Schon Clinic in Bad Aibling, Germany.
“She reacted especially strongly to her son’s face.”
Omar suffered from “disorder of consciousness”, an umbrella term for three distinct conditions: a full-on coma, in which the patient is neither awake nor responsive; a vegetative state characterised by “non-responsive wakefulness”; and finally a state of “minimal consciousness”.
The last applies to people who have “pulled out of a vegetative state and potentially regained some measure of conscious perception,” Benjamin Rohaut, a neurologist at Pitie Salpetriere Hospital’s Brain and Spinal Cord Institute in Paris, told AFP.
Concretely, people with minimal consciousness can follow someone’s movement with their eye, or show signs of trying to withdraw an arm when pinched in a pain-response test.
“Technically the patient was — as per the doctor’s description — already awake,” explained Martin Monti, an associate professor in the Department of Neurosurgery at the University of California, Los Angeles.
“However, she certainly seems to have emerged from a disorder of consciousness.”
She did so very gradually, noted Mueller. Eventually “she was able to pronounce her son’s name, greet us, and quote some verses from the Koran.”
Does this happen often?
“These cases are very rare, which is why they make headlines,” said Jenny Kitzinger, co-director of the Coma and Disorders of Consciousness Research Centre at Cardiff University.
“Media reports also sometimes promote a rather romanticised vision of what ‘recovery’ looks like,” she told AFP by email.
“It’s important to reflect on what ‘waking up’ after years in a disorder of consciousness actually means — it is not like in the movies.”
How to explain the improvement?
Muller’s approach was a multi-pronged treatment: muscle exercise to help reduce spasticity, a common consequence of brain lesions; general physiotherapy; and exposure to all kinds of stimuli, including contact with family and friends.
“We call this a holistic approach — the aim is to maximise the potential for recovery,” said Rohaut from Paris.
It is possible, he added, that lowering the dose of the epilepsy medication Omar had been taking helped her emerge from the coma-like state.
In the case of brain lesions, “we sometimes mistakenly diagnose epilepsy, which is often treated with drugs that have a sedative effect,” Rohaut said.
What next for Munira Omar?
Muller insists that Omar “can now consciously interact with her environment and return to family life.”
That said, expectations for her should not rise too high.
“She still has suffered a very severe brain injury, so nobody should imagine that she will miraculously go back to being exactly and fully the person she was before,” he said.
The length of her coma-like state makes a complete come-back even less likely, added Kitzinger.
“It is possible to recover from a short period of unconsciousness relatively well, but the longer one is in a disorder of consciousness the less likely, and more limited, any recovery is likely to be,” she said.