X-Message-Number: 13078
Date: Mon, 10 Jan 2000 20:41:43 -0500
From: Jan Coetzee <>
Subject: Movements common in brain-dead patients

Movements common in brain-dead patients

By Merritt McKinney

NEW YORK, Jan 10 (Reuters Health) -- Even after being declared brain
dead, nearly 40% of
patients make spontaneous movements such as jerking their fingers and
toes, report Argentinean

While these movements may seem like signs of recovery, they are reflexes
triggered by the spinal
cord, not the brain, and should not give false hope to families and
doctors, one of the study team
told Reuters Health. Despite these movements, the patients are brain
dead and will not recover,
according to Dr. Jose A. Bueri of the J.M. Ramos Mejia Hospital in
Buenos Aires, Argentina.

The phenomenon of movements in brain-dead patients should not be
misinterpreted as a sign of
life, nor used to delay removal of organs for transplant, the study
authors advise.

``Time should not be wasted if there is a possibility of organ
donation,'' Bueri told Reuters

Brain death ``is the irreversible loss of function of the brain,'' the
researchers note. The brain
loses the ability to control vital functions such as breathing, even
though the heart may continue to
beat for a while. Sometimes a person who is brain dead may be connected
to a ventilator to
maintain breathing. During this time, family members may decide to
donate the organs of the
brain-dead person to patients awaiting transplants.

It has been known that jerky movements sometimes occur after the brain
dies, but exactly how
often this phenomenon occurs was unknown, Bueri and his colleagues note
in the January issue of
the journal Neurology. During the 18-month study, the researchers
studied 38 people who had
been declared brain dead.

Fifteen of the patients made movements, with jerky finger movements
being the most common
type. Some of the movements were spontaneous, while others appeared to
be responses to touch.
All of the movements began within the first 24 hours after brain death,
but none continued past 72
hours, according to the report. Testing did not detect brain activity in
any of the patients who
made such movements after a diagnosis of brain death.

Another report in the same issue of the journal documents unusual
movements in two brain-dead
patients. Dr. Joan Marti-Fabregas and colleagues at the Hospital de la
Santa Creu i Sant Pau in
Barcelona, Spain, report on a 30-year-old woman and an 11-month-old boy
who were connected
to a ventilator after being declared brain dead. Each time the
ventilator inflated their lungs, the
patients would straighten their arms, bend their wrists and curl up
their fingers. In both cases,
tests proved that there was no brain activity.

``The living cells that were ordering these muscles to move were not
brain cells or brain stem
cells, but cells located in the spinal cord,'' Marti-Fabregas said in a
press release. ''It's important
for family members and healthcare professionals to be aware of this
possibility.'' SOURCE:
Neurology 2000;54:221-223, 224-227.

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