Steven Laureys is a Belgian neurologist recognized worldwide in the field of neurology of consciousness. His research is dedicated to neurological disability and neuronal plasticity in patients who suffer from brain damage. Steven is a testing partner within the ComaWare project, and uses the mindBEAGLE system for assessment and communication of patients with disorders of consciousness (DOC). Brendan Allison, our Senior Researcher, had a little chat with Steven and asked him about his work.
Brendan Allison: Steven, you lead the Coma Science Group at the Cyclotron Research Center and the Department of Neurology at Liège University Hospital. You’re also a Clinical Professor (University of Liège) and Research Director (tenure) at the Belgian National Fund of Scientific Research (FNRS). How did you first become interested in helping patients with disorders of consciousness (DOC)?
Steven Laureys: “It is a difficult question because we tell ourselves stories to justify our work…. It is out of frustration. When I was in medical school, then in intensive care, with patients who we considered comatose – how good was that evidence? How sure could we be that they truly were fully unaware of anything? It was out of frustration that I turned to neuroimaging. We had the cyclotron, with PET scanning, to try to see what was going on in the brain. We needed to move beyond more expensive and complicated technologies, where the patient has to come to us, to more cheap and transportable technology, where we could go to patients.”
Brendan Allison: You are now a very well-known figure in this field, with an h-index higher than 80. Do you have any advice for young researchers to produce high-impact research?
Steven Laureys: “I think it is the most beautiful job there is. It is wonderful to be paid to think, and push the frontiers of our knowledge. It’s wonderful, I think, as a scientist, to question the truth of today. To be able to see the effects of your research directly translated to diagnostic and prognostic problems and challenges – that is very nice. The most important thing that is needed to become a good scientist is just to be curious, not to accept anything you read in the books as absolute truth. There should be more places for just creative thinking and research. The most wonderful papers, that I am most proud of, involved thinking outside of the box, not clearly hypothesis-driven, where we knew what we would find. The most exciting are the most creative and unexpected, and we can keep the curiosity we all had when we were kids.”
Steven Laureys: “It is important to be in a good laboratory, to learn from how things are. It’s very hard to learn from scratch. It is important to be competitive, like the Olympic Games. Like the Olympics, there is no medal for those who come in second. It is an exciting, but competitive field. We need more motivated scientists in Europe because that is the future, and the interaction with technology and industry. Even if we shouldn’t expect a direct commercial return, as is the case with most funding. Even if you don’t know what you will find.”
Brendan Allison: What’s your favorite story about the positive impact of your work?
Steven Laureys: “Of course, now, we have so many students. A lot of projects and a lot of failures – everything you plan does not work out. We have a number of stories where the whole team was very moved. Of course, there were patients where BCIs challenged our clinical diagnoses. I remember a young woman in her 20s who had a very extensive brainstem stroke. I examined her more than a month after she entered our intensive care department. No sign of consciousness whatsoever. Then we tried this EEG – ERP paradigm and that was the only thing we had. She apparently heard and understood what we asked her to do, which was counting the target. That was a very important moment for all of us. She subsequently survived intensive care, recovered some movement with a finger, and can control a wheelchair now. That was a very real illustration of how these technologies changed our care. That was very intense and powerful.”
(c) Johannes Gellner
Steven Laureys: “There are many stories. The first patient who could communicate with fMRI – we could watch the screen and see him saying yes or no. Those are important moments. We see the direct consequences. You mention the h-index and the papers we write, which is also an important part. You do not see the direct consequences, but later you speak with colleagues and you can see how you can influence the whole field, how books are being rewritten, and our understanding and care for a patient population is changing over the years. That is very, very gratifying. So one goal is to save one life, and to see directly the result, and the other is to do large studies, try to publish good papers, and change the field with people very far away. When I speak with colleagues in Malaysia and North America, that is also very important. Even if you do not see it, you are influencing quality of life and improving care or decision-making.“
Brendan Allison: You’ve been using mindBEAGLE for several months now. Has it been helpful with assessment of any patients?
Steven Laureys: “Yes, it is helpful. It is, as always, a big help for us to use the paradigms as they are implemented in mindBEAGLE for very challenging patients. We need to complement what we think we know at the bedside, with all the other neuroimaging results from the PET, and the high-density EEG, coupled with TMS, and try to combine all of those results. Because, with the patients we see, it is very hard to quantify the unquantifiable, what we call consciousness. We should not think it is just one test we should think of as the gold standard, or the absolute truth. It’s a very challenging thing to try and reduce the uncertainty about the presence of consciousness and then try for some to make it a communication tool. There are many confounding factors and biases. It is hard to ask for their collaboration. They have a lot of muscle artifacts and uncontrolled movement and eye movement that make it terribly difficult.”
(c) Florian Voggeneder
Steven Laureys: “The big advantage of mindBEAGLE is that it is integrated. You can take it to any patients and plug them in and get the results directly. That is helpful and that is what you are trying to do. It is still a challenge and it doesn’t work with all the patients. It is good to have it as a research team. We have many, many tools. In addition to hardware and software, we also need skills and expertise from teams of engineers and mathematicians to analyze the data. We added mindBEAGLE to our routine assessments of people from all over Europe. I am very happy that it exists and I hope we can continue to try and improve it. These patients are extremely challenging for all the reasons we just said. Some of them have visual or auditory impairments, or a very limited attention span…. Sometimes, we can miss things if we totally rely on a muscle response. It is great that we now have other tools, even if it is still a very challenging field. I would think that we will see more and more patients, not only where we can reduce the uncertainty about the absence or presence of consciousness, but also help in communicating, giving voices to this voiceless, silent epidemic in post-traumatic and post-intensive care.”
Brendan Allison: Thanks for your time, Steven.